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Overworked nurses cracking under the strain of pandemic

Intensive care nursing staff at UHNBC are struggling to keep up with the workload at the hospital and are cracking under the pressure, according to a letter an ICU nurse sent to the head of the province’s nursing union.
18 critical care No. 1 with patient
Intensive care unit nursing staff at UHNBC have been feeling the strain of staff shortages in the hospital and increased workload during the pandemic's second wave.

Intensive care nursing staff at UHNBC are struggling to keep up with the workload at the hospital and are cracking under the pressure, according to a letter an ICU nurse sent to the head of the province’s nursing union.

Staff shortages exacerbated by the pandemic are putting the lives of critically-ill patients at risk and nurses, some now working overtime shifts to cover otherwise unfilled shifts, are feeling the strain.

“They’re stretched too thin and many of these nurses have been working enormous amounts of overtime,” said Christine Sorensen, president of the BC Nurses Union.

“We do know if nurses do not get the rest they need to recover from the physical impact of their work in the highly-stressful environment that they’re in, this can impact their physical health as well as (cause) moral injury.

“Certainly if we have outbreaks in facilities we have to look at whether we’re placing people at risk. We are doing everything possible to keep people healthy and safe but things happen when people are exhausted.”

The intensive care unit at UHNBC was doubled from 10 beds to 20 to prepare for the pandemic and a 10-bed high-acuity care infectious disease unit was added to the hospital, but Sorensen says no additional critical care staff were hired to handle the increased workload. Nurses typically work four 12-hour shifts in a work week but Sorensen some are coming in to fill shifts on their usual four days off and they aren’t getting any days off.

“The usual ICU baseline staff of eight registered nurses who work to cover that 10-bed ICU are now asked to stretch and cover potentially up to 30 beds, depending on how many infectious disease high-acuity patents are admitted into this extra space,” said Sorensen, who works in Kamloops as a public health nurse.

“Instead of 10 ICU beds, they’re really running 20 ICU beds with the same number of nursing staff. That group that makes up that rotation are now being asked to manage 20 beds, so you’ve doubled their capacity and if nurses are off-shift to rest and recover but what’s happening is they’re being called in because all these beds are full.”

The shortage of nurses in the Northern Health region is nothing new. BC Auditor-General Carol Bellringer, in her February 2018 audit, reported that in the previous year Northern Health was short 121 full-time registered nurses – close to 15 per cent of its 790 registered nurse positions -  and needed 5.9 full-time nurse practitioners to meet its quota.

The worst of the pandemic locally was the Jubilee Lodge outbreak at UHNBC, which was finally declared over on Thursday, nearly two months after it began. Seventeen residents of the long-term care facility died of COVID-19 infections and the outbreak caused 48 patients and 14 staff to become infected.

“This is a site where nurses are understaffed, not having access to person protective equipment, struggling with the numbers of people who are exposed and infected with COVID – that has been an emotional roller-coaster at Jubilee as so many people became infected,” said Sorensen.

“The numbers of deaths has been so incredibly high and the nurses who work there develop very close relationships with these residents and they see them as extensions of their own families and they’ve cared for them often for a long time. So when one of them passes away to takes an emotional toll on the nurse, partly because these residents have been isolated from their family for so long. The distress the nurses are facing is considerable.”

As of Thursday, there were 37 new cases of COVID in northern BC and 337 active cases. Ten people were hospitalized with the virus, seven of whom were being treated in ICU.

More than 1,200 nurses have been infected since the start of the pandemic last March. And nurses remain fearful of facility outbreaks, like the one at Royal Inland Hospital in Kamloops which infected 60 healthcare workers. Compounding that fear, Sorensen says there have been issues with nurses accessing N-95 masks and she says the province won’t reveal how many of those masks have been distributed to hospitals.

The province has continued to push its Surgical Renewal Commitment, a plan announced in May to get hospitals to resume near-normal surgery schedules after the onset of the pandemic postponed non-essential surgeries for nearly two months. Shortages of operating room nurses is causing overworked nurses in that stream to burn out and Sorensen suggested a solution would be to postpone non-essential surgeries until later in the spring, when the pandemic is more likely to ease.

“These nurses have been struggling in the north for a very long time and over the last 10 months they’ve been supporting the surgical renewal plan and are really not seeing a break from either the plan or the pressure to move as many surgeries through as the government is asking for,” said Sorensen.

“Now there’s an increasing need to prepare for some very sick patients who have COVID, as well as all of those who are coming in from all over the Northern Health area. Your outbreak numbers are increasing quite quickly and that only adds pressure to an acute healthcare system that’s already struggling under incredible workloads.”

Sorensen said there’s no immediate help on the way. Most private agency nurses are already working in the publicly-funded healthcare system. She said the BCNU will continue to pressure Health Minister Adrian Dix to improve working conditions in hospitals to help retain nursing staff through the duration of the pandemic. The union will try to convince the province to do what it takes to increase the number of seats in nursing schools and step up its international recruitment efforts while making it easier for internationally-educated nurses to come to the province to work.

“In the short-term, we need to look at putting in mental health supports for nurses and alleviate the non-nursing work that they’re doing, such as clerical work, housekeeping work,” said Sorensen.