Nursing has always been a demanding career, and this has never been more true than over the past two and a half years during the COVID-19 pandemic and fallout.
“I’ve been in nursing for about 20 years, but I’ve been in the health care profession since the 80s,” said Alberta nurse Renee. “I always wanted to be a nurse.
“I didn’t realize it for many months because you got so caught up with the day-to-day work and just doing the chores, but eventually the stress affected my health to the point where I had to seek medical help, ” she said.
Global News agreed to use a pseudonym for Renee to protect her from possible job repercussions.
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In the past, Renee has worked in medicine, day medicine, palliative and family medicine. Just before the pandemic, she took a leadership position in infection control at a long-term care facility.
“It was when I began to notice the deterioration of my own physical health that I knew I could not keep it up.
“When I look back to try to sum up what it was like to work, the two words that come to mind are: perpetual anxiety.
“Going into that job every day — going, ‘I don’t know how I’m going to get through today, I don’t know what we’re going to face today, individually and as a team,’ — it was just like ‘ dragging a big, heavy ball on my leg to get to work.
“But you did it. You had to. You had patients whose lives were affected … staff needed us there as well.”
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In the spring of 2020, the challenges of nursing—the stress, difficult schedule, staffing challenges, long hours, the high stakes, the difficult decisions, the personal health risks, mental health exhaustion—were exacerbated.
The stresses of front-line hospital nursing – serious illness and death, emotional family and loved ones, managing differing opinions, administrative red tape and taking it all home – have increased exponentially.
Protests — some even outside hospitals — and political rhetoric and polarization have only made things worse, several Alberta nurses told Global News.
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Renee left her job in long-term care and took a community nursing position in a Primary Care Network (PCN).
“I wanted to be back with patients and feel like I was making a difference,” she explained. “I really enjoy what I do again. Once you get out into the community and find other positions related to your profession, there can be a lot of autonomy. Once you get a taste of it, it can be very empowering, very rewarding.”
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For registered nurse Ali Ryan, the pandemic conditions were the last push she needed to make a change.
“I just wanted to come home and not be so mentally exhausted.
“I love nursing. I love the fact that we can empower our patients with knowledge and alleviate their suffering and help them, but by the same token, I wanted to do something a little more creative and do something less intense all the time. Spiritually, it was the right time.”
After working in neurosurgery and then recovering, Ryan decided to finally enroll in a medical aesthetics course.
“It was something I thought about for a long time. I’ve always been quite a creative person and then with the pandemic – and seeing everyone just at their wits end and the burnout of it – I think it gave me that extra incentive to say, ‘OK, this is time for a change.’
She now works in esthetics, providing cosmetic injections, while still picking up casual shifts at the hospital.
“I love the hospital. I love my colleagues. I like the nature of the work.
“I just think mentally, I have to look after my own health and I have to not only be ‘Nurse Ali’ but a mother and a good friend and a good family member. And if I want to do all those things, then I have to have boundaries and I think that’s right.”
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Ryan says her job now has better hours, allows her to spend more time with her two young children and gives her more work-life balance.
“You can’t take good care if you hate what you do. We are lucky as nurses to be able to move around and I think we have to keep our eyes open for those opportunities.”
The work is also just more positive, she says.
“You help people feel beautiful and give them a little lift.
“There’s nothing better than having that interaction with people where they walk away and say, ‘Oh, I love that,’ and move on. That’s the joy of nursing: you can work in so many different capacities.”
Schools and companies offering courses in cosmetic injectables have seen a huge increase in registration over the past two years. Frida Academy in Calgary had its highest enrollment ever in 2021, doubling from the year before. It has had to add courses to meet demand, a spokesperson told Global News.
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Renee and Ryan aren’t the only two to have left the front lines; the union representing Alberta nurses is noticing a definite trend.
“It’s a common refrain we’ve heard from nurses in all kinds of practice settings,” said Cameron Westhead, second vice-president of United Nurses of Alberta.
“Whether it’s moving from ICU to a less acute type of care or moving from full-time to part-time or part-time to casual, nurses experience an incredible amount of stress and they’re looking for ways to reduce it and have more of a semblance of a work-life balance and life.”
The union says issues that existed before COVID-19 — nursing shortages, the relationship between the government and health care workers — have been fueled by the pandemic.
“When you’re dealing with these stressful situations — workplace violence, mandatory overtime, working with short staff — to recognize your job as important and critical in providing health care to Albertans,” Westhead said.
“Vacations are denied, understaffed, mandatory overtime, sometimes a lack of training.
“With Connect Care, which is an electronic documentation method, nurses are asked to undertake this training in their spare time and are not paid for it or asked to do it without pay.
“It’s one demand placed on top of another and it just eventually leads to a collapse.”
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The union said it is noticing more nurses moving away from certain units (particularly ICU and other critical care units) and into other units, such as recovery, where the ratio of shift work is lower.
“We’ve had so many nurses from cardiovascular ICU, ICUs come to the recovery room,” Ryan said, “because you have better hours, your patients flow throughout the day, so you’re not spending endless time where you’re just seeing chronic suffering all day long.”
The UNA is also noticing more Alberta nurses moving from full-time or part-time to casual.
“Casual nurses can have much more control over their schedule,” Westhead explained. “They can’t get a mandate to come in to work, and they can also refuse shifts, which is not the case with part-time or full-time nurses.”
Currently, just over 25 percent of nurses working for AHS and Covenant Health are casual.
Westhead understands why other nursing jobs can be attractive.
“Institutions such as aesthetics and community care, primary care, involve much less shift work and are therefore much more predictable in terms of how you can juggle your family life and your professional life.”
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Alberta Health Services says it is increasing the nursing workforce and says there are 1,900 more nurses working now than before the pandemic.
AHS hired 1,188 RN/RPN graduates – nearly 90 per cent of the 2021/22 Alberta RN grads.
However, AHS says there is still staffing pressure, especially in general medicine and emergencies in the large hospitals in Edmonton and Calgary, where demand is highest.
“Vacancies have increased because we are aggressively recruiting to further expand the workforce,” AHS spokesman James Wood told Global News.
Data shows that both AHS and Covenant Health have seen an increase in the percentage of nurses leaving during the pandemic. In the 2018/19 year, 459 full-time or part-time registered nurses resigned or retired from AHS (two per cent). In 2021/22 that number was 686 (2.8 per cent). (At Covenant Health, it went from 2.7 to 2.9 percent).
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Could AHS or Covenant Health have made any changes that would have made Ryan or Renee consider staying?
Additional resources would help, Renee said, as would more autonomy and a less “top-heavy” organizational structure.
Ryan says the system is broken in many ways. She’s not sure if any changes could convince her to stay full-time, but believes listening to front-line staff about what they’re experiencing will go a long way.
“Flexibility with hours, flexibility with shifts and allowing people to take the time off they need” will also help promote a better work-life balance, she said.
“Creating more part-time lines that people can then share full-time jobs would be really helpful because people get stuck in these full-time rotations that just aren’t healthy. They’re working seven days in a row. That’s not good for anybody. “
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Westhead says the union believes making current nurses feel valued and supported would be a good first step.
“Senior nurse retention is one of the most important factors in mentoring new grads and nurses new to that specialty area of practice,” he added.
“I think what nurses are looking for is hope.
“We know that from time to time there are extraordinary circumstances such as pandemics or natural disasters that require us to go above and beyond the contributions we normally make. But we also want to know that there will be a light at the end of the tunnel.”
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Ryan wants to encourage all nurses to consider their own health and well-being.
“The options are out there.
“You just have to open your eyes, be a little brave and be willing to take that leap of faith and just go for it.”