Conditions in Ontario

[Cdn_Psych]

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Overworked nurses are paying `hidden cost'

by Michele Landsberg COLUMNIST

HAVE YOU, or someone you love, been an acute care hospital patient lately? If so, you'll know two things for sure: That medical services are under tremendous pressure, and that most doctors and nurses strive heroically, despite everything, to offer compassionate and competent care.

The Hospital Report 2001, published last week, confirmed that 89 per cent of patients rated their nursing care as excellent or good.

Think of all you've heard about nursing shortages and hospital over-crowding. How can it be that the overwhelming majority of patients still rate their bedside care so highly?

The Registered Nurses Association of Ontario knows the answer. The nurses are working harder, faster, more frantically, and they are paying what association executive director Doris Grinspun calls ``a hidden cost.''

Just a week ago, after I wrote about the crisis in home care, a nurse called me from York Region to express her despair over working conditions. She insisted on remaining anonymous. (Since '95, it's astonishing how many people are terrified of authority and give interviews only on condition of secrecy.)

``I go to bed in tears and wake up dreading the next day,'' said the nurse I'll call Anna. ``The cutbacks are so drastic, we're told that if our home care charges don't die promptly, we must discharge them.

``There's to be no more pain management, and no more time spent on emotional support. I've got a patient with metastatic breast cancer and two little kids. Who's going to come out at 3 a.m. and give her a Stematil shot when she's vomiting from the chemo?

``We're being severely compromised. In hospital, we don't even let registered practical nurses do IVs (intravenous drips) and here I'm being told to teach patients' families to do it themselves.''

In Anna's opinion, her professionalism is being ``given away, inch by inch,'' and unless she wants to be unemployed, she's helpless to stop the erosion of long-cherished standards. ``I go home worried sick and my husband tells me: Just do what you can do, and document, document, document.''

Shockingly enough, I heard a similar story from Beth, a long-time intensive care specialist in a famous downtown Toronto teaching hospital - one that emerged from the ``report card'' with stellar marks.

``It's a pressure cooker,'' she said. ``Historically, you're assigned to just one of the most critically ill patients at a time. Now, we run back and forth between two.

``I can only describe it as the exquisite pain of physical, mental and spiritual fatigue. Basically, downtown hospitals are all towers of intensive care units. All the patients are desperately sick.

``If someone is sobbing at the bedside, I pretend I'm giving them privacy because I have no time to offer comfort. I should tell people `That's too bad, you're scared half to death but your crisis doesn't fit into my schedule . . . .'

``We're missing breaks, working overtime . . . I do a 12-hour shift, but I never get out of there before 13 hours, and I'm often asked to work an extra four hours when someone calls in sick.''

Sick time is a particular irony for nurses. Ontario hospitals have casualized the profession of nursing to such an extreme that about half of all nurses work part-time - ``about 70 per cent of them involuntarily,'' said Grinspun.

The result is that nurses are working at multiple jobs and collapsing under the stress. In '98-'99, Ontario paid $171 million in overtime for hospital nurses. That's the equivalent of 2,250 full-time nursing positions. An article in Hospital Quarterly, Spring 2001, points out that overtime costs relate ``almost exactly'' to the level of sick time. In other words, this stupid system is making nurses sick with burn-out, and then having to pay others overtime to fill their shoes.

Grinspun thinks that, as the public becomes more knowledgeable about nurses' unfair working conditions, the profession is gaining in clout. (Recent public support of striking nurses in Nova Scotia bears her out.)

But if the vast majority of nurses were men, instead of women, would the profession be asked to bear the brunt of these dangerous and brutal cutbacks? I doubt it. Women's work is disregarded in Canada, and until the prevailing sexist winds shift around to a more wholesome air of respect, nothing will change.

The Centre for Social Justice and the National Action Committee on the Status of Women recently commissioned a fresh analysis of Statistics Canada numbers. The upshot: Women are doing far worse economically than we've been led to believe. In Ontario, 45.5 per cent of all women (compared to 27.5 per cent of men) had after-tax incomes under $13,786. The median after-tax income of all women in Canada is 61 per cent of the median income of men.

That's a measurement of persistent, destructive, deep-rooted attitudinal bias that works its way, like toxins in the water, into education, training, provision of child care, hiring, promotion, wages and pensions. And, of course, terrible working conditions.

``When ICU nurses, who are tough and seasoned, start breaking down and crying on the job, you know there's a crisis,'' Beth said. ``You have to learn to walk out at the end of the day and leave it behind, or you'll die.''

Anna's last remark was equally grim. ``Unless you've seen it, trust me, you've no idea how bad it is out here.''

Nurses are paying the hidden cost now. Sooner or later, each one of us will pay it with interest.

Michele Landsberg's column usually appears in The Star Saturday and Sunday. Her e-mail address is [email protected]

[fiestynurse]

It sickens me to hear these types of stories on the working conditions that nurses are enduring. It truly breaks my heart, because I use to be one of those nurses crying in the parking lot after an unbearable day at the hospital, where I too felt that I was giving substandard care and being pushed beyond my limits. I feel that some major changes need to take place in nursing, on a global level.

I look to the writings and speeches of the late Jo Ann Ashley, educator, author, and nurse. We need more inspirational leaders in nursing like her.

"Our generation of nurses must question the use of a framework of limitations and boundaries when applied to our physical and professional identity. Our laws must be re-written with another framework in mind, a framework that defines us as professionals and not just licensed workers who must be employed by agencies repressing our actions and our freedom in giving society the nursing care it needs. ...if nurses are to have any major impact on changing the law and on changing the economic structures in the world of work, our class struggles within nursing must be eliminated. The lack of unity we hear so much about in nursing is really an outgrowth of the phenomenon of classes constantly struggling and fighting. We must understand these struggles and these fights more fully. Knowing about the detrimental purposes they serve can help all of us overcome the conflicts we have about them. Knowledge alone can help us nurses overcome the brainwashing we have been subjected to by the legal and economic systems paying up poorly and treating us like dogs in exchange for our labor."

-presented at the Festival of Life and Learning Program, sponsored by the School of Nursing, University of Manitoba, Manitoba, Canada, February 4, 1977.

Regulations on appropriate nurse-patient ratios and whistleblower laws for nurses are a good start, but so much more is needed. Lets keep-up the fight for nurses everywhere.

Okay everyone... Open your windows... Climb out on your rooftops... And scream... WE NURSES ARE NOT GOING TO TAKE IT ANYMORE!!