Patients and nurses are feeling the squeeze of staffing shortages—but they don't feel free to talk about it

A photo submitted to Island Health by Linda McVicar in response to a call for submissions on National Nursing Week. Image: Island Health / Flickr

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For the past three weeks, Rachel has been recovering in a crowded unit at Royal Jubilee Hospital (RJH). Like most units at that hospital these days, hers has too many patients and not enough staff to look after them, creating an unsafe situation for everyone involved.

“I’ve never seen the system so bad,” said Rachel, a 37-year-old woman who has had chronic health issues and complex care needs for decades, resulting in a deep familiarity with RJH, and other hospitals across the country. Her name has been changed to protect her identity as she fears that Island Health could remove funding for the types of healthcare she needs, in retaliation for criticism.

“They're supposed to have a certain ratio of health care aides; they're short on those too,” she said. “We will go days without housekeeping and garbages are overflowing.” Despite being a patient, she said she is constantly having to wipe down surfaces because of a shortage of housekeeping services. There have also been days when the unit has had no clean towels, when Rachel herself tied up garbage bags and placed them outside the unit, or when, due to there not being a unit clerk for a few days, even medical supplies ran short.

“I needed a specific kind of needle for a medication and they didn’t have any for over a day because there was no unit clerk,” Rachel said. “The staff were so exhausted, not even getting their breaks [while] caring for patients, that they couldn't run to another unit and get one.”

The shortage is having real and immediate consequences for patients, staff, and the public: as recently as last weekend, a nurse shortage forced the Port McNeill and District Hospital to shut down its emergency room for three days. Patients were told to go to Port Hardy, a half-hour drive away, instead—just the latest in a series of diversions and closures.

Rachel was fortunate to have had her mother by her side round the clock to help nurses fill the gaps in care when she was first admitted. But, she said, those who are too sick to advocate for themselves and don’t have someone who can be with them spend hours unable to get to the bathroom, and waiting too long for their medications and meals.

Nurses would ordinarily attend to four patients at a time but now regularly care for seven to 10 people, all with varying degrees of acute care needs. According to Rachel, several beds in her unit are also occupied by patients who have nowhere to go because there are no supportive housing or long-term care beds available—some have been there for months, and one for almost a year.

“I see how exhausted [nurses] are; I see how so many of them will come in on their days off because they feel for their colleagues, because they know what it's like to work short,” Rachel said. “So they'll come in and compromise their own health.”

Non-nursing duties

Nurses spent National Nursing Week in mid-May drawing attention to the growing crisis of burnout in the industry and a lack of immediate action from the province and Island Health.

At a BC Nurses’ Union-led rally at the legislature on May 10, union Vice President Adriane Gear told Capital Daily she was “appalled” that there was no prominent Island Health leadership present to help nurses deal with the number of patients that needed attention.

In a statement to Capital Daily, Island Health said they schedule leadership to be on-site 24/7 at large acute care sites like RJH. “We have confirmed that for the past weekend at VGH, there was a Coordinator Site Operations (CSO) on-site all weekend,” said the statement.

Gear says she made her rounds towards the end of the day, before the night shift, and didn’t notice any leadership from the health authority. “There should be a manager or director or somebody at that level, providing support in situations like that,” she said in a phone interview.

In their absence, it falls to nurses to take on administrative tasks—like scheduling staff to take on more shifts—and non-nursing duties like changing people’s beds, Gear said. Like Rachel, Gear also noted how the shortage of housekeeping staff adds to nurses’ workloads.

“How are you supposed to admit another patient to the Emergency Bay if the stretcher hasn't been cleaned?” Gear said. “Sure, there might be housekeeping in the building but if you're gonna have to wait two hours to get it cleaned, you're forced to have to do it yourself.”

The stories Gear has been hearing from some nurses about the shortage of housekeeping services echo Rachel’s experience at the Royal Jubilee Hospital, but Island Health insists it doesn’t affect patient care.

A spokesperson for Island Health said housekeeping staff are also a part of the healthcare worker shortages being experienced across the province, in a statement to Capital Daily. The health authority is actively recruiting “environmental support services” staff through job fairs and advertisements, according to the statement.

On their own hiring website, the majority of the health authority’s active listings (584) are for positions in Victoria, of which 34 are for housekeeping staff, three at Royal Jubilee Hospital. All three of these posts have been up since April 11.

“Although there are challenges with staffing, this has not affected patient care and safety,” reads the health authority’s statement. “Infection prevention and control remains the top priority, and enhanced cleaning of high-priority areas continues.”

Housekeeping services at Royal Jubilee Hospital are currently contracted out, though the health authority says these workers will become Island Health employees on June 24, which they say will, “support stable, consistent and supportive patient care.”

For nurses, the lack of support staff and the sheer quantity of patients filling hospitals at the moment is one part of the problem. The other is a growing disillusionment that many have with their employer, Island Health.

Bait and switch

Senior leaders at Island Health are not always aware of how dangerous some staffing situations are, Gear said, adding that there is a disconnect between frontline nurses and health authority leadership.

She said there have been incidents involving patient care and safety that nurses have reported to their managers, only to have the issue ignored. The nurses have then brought the matter to Gear, their union representative.

“There were certainly staffing situations that were just going to be left as they were, which were extremely unsafe,” Gear said. “It took the union highlighting the situation before steps were taken.”

At hospitals, Gear said there are some managers who do their best to work with nurses, while others “come at it from a different place” with comments about sick leave that Gear thinks  are intended to make them feel guilty for the crisis.

The phone doesn’t stop ringing for nurses who have a day off, all calls from managers and colleagues begging them to help out. Those who do answer the call, Gear said, are often treated to a misleading tactic.

“Your colleagues are calling you because they're desperate, and then you agree to go in to help out your unit, only to be sent someplace else,” Gear said. “That would be a tactic that Island Health has done; we call it ‘bait and switch.’”

Redeploying nurses to different shifts and units without their knowledge or consent is used as a strategy to mitigate the staffing crisis, Island Health confirmed. Gear says she has heard from nurses who find it extremely disrespectful, and are more inclined to stop taking extra shifts as a result.

“Nurses can certainly understand that that needs to happen in an emergency situation,” she said. “We've been languishing in this state for a couple of years now, so it feels very manipulative; it feels abusive.”

In March, multiple nurses also highlighted consistent errors in the amount they’re paid by Island Health, usually because overtime hours or missed meal breaks go unpaid. “It’s become an extra job just to ensure we’re being paid properly, in a time when we are all already at the end of our rope,” said one nurse. In a statement at the time, Island Health denied any overarching payment issues.

The practice of redeploying nurses without their knowledge is not likely to end, based on a statement from Island Health that says this strategy is used by all health authorities when necessary.

“We consider the needs of the patients (acuity/complexity etc.) and the experience/knowledge/skills and abilities of the staff as well as their schedule when determining who is most appropriate to redeploy,” they said. “This is done in a fair and equitable manner.”

Gag order

Over the past two years, Capital Daily regularly heard from nurses in Victoria and across the Island that they wanted to talk publicly about their deteriorating workplace conditions, but couldn’t because of a deep fear of being reprimanded for it at work. Earlier this month, the Vancouver Sun reported that a nurse in Interior BC was reprimanded for posting about her workplace conditions in a private social media group with other nurses from the ward.

During question period at the Legislative Assembly on May 9, BC Green Party leader Sonia Furstenau asked health minister Adrian Dix what he plans to do to address this “culture of fear within health care.”

“All health authorities have whistleblower protection rules, as they should,” Dix said. “There's simply nothing in place that stops people from speaking out. That's as it should be in a democratic society.”

The statement doesn’t reflect the reality of nurses Capital Daily has spoken with.

“I absolutely disagree with Minister Dix and his assessment of the situation,” Gear said, adding that in some cases, nurses have been instructed by their managers to withhold even from patients and their families that they’re working short-staffed.

“When nurses speak directly to their managers, they get answers like, ‘Just lower your standards,’” Gear said. “If a nurse was to go public with it, you better believe she’d be fired.”

In BC, healthcare workers are not covered under the province’s whistleblower act, which was recently expanded to include public sector workers at agencies, boards, and commissions other than in the health and education sectors.

At a press conference on May 4, Dix said healthcare workers would be brought under the legislation by March 2023, but added that they’re covered “in practice” already.

In reality, according to Gear and nurses who have shared their stories with Capital Daily, nurses are left to bear witness to unsafe situations that are ignored when reported internally and cannot be shared publicly without jeopardizing their own careers.

“The situation with nurses and speaking about their realities at work and what they're facing throughout COVID has been a challenge, like, across the board,” Marilou Gagnon, a professor in UVic’s school of nursing, told Capital Daily earlier this year, while she was working on a study about nurses who blow the whistle.

Employers across the country create internal barriers for nurses (like needing approval from a communications department) to speak out about their experiences in the workplace. If they do so without approval, Gagnon said nurses are often met with professional sanctions or are targeted by their superiors in the workplace.

“I was told by a lot of coworkers that if you go to the media, and Island Health finds out, they can fire you, you'll lose your pension, you'll lose your benefits, you'll lose everything,” said Christina, a nurse who has worked in Island hospitals for five years, in an article sharing testimonies from nurses who all chose to stay anonymous. “It was a big fear I had because so many coworkers said this to me.”

According to Gear, the BC Nurses’ Union has been encouraged by some steps the province has recently taken to address the crisis—adding new spots to nursing schools and funding for internationally educated nurses to get licensed to work in BC—but these do little to help with the current crushing workload.

In the short term, Gear said the health authority needs to hire more non-nursing staff—like care aides, unit clerks, or housekeeping staff—to cover duties that nurses currently have to take on, like cleaning, delivering meal trays, stocking, and running to the pharmacies. The practice of redeploying nurses without their knowledge also must end, she says.

Island Health said in their statement that staff scheduling processes follow the requirements of the current collective bargaining agreement. This agreement expired in March 2022 and is up for renegotiation, which is set to start sometime this fall.