March 9, 2005

On the frontlines

By Armando D'Andrea
adandrea@uwo.ca

Nurses like the 27-year veteran assess patients from head to toe when they arrive to prepare them for the procedures they need that day.

And on a day when nurses like McKenna could be called on to see as many as 15 patients and not only assess their conditions accurately but also hold their hands, the battle sometimes claims its own nurses as casualties.

"You're going full tilt. The emotional pressure is very high. Patient needs are high. But, I mean, that's the job. Sometimes that just wears pretty heavy. Sometimes you can do a full shift, and it's full out all shift and it's still not enough," she said. "That's where nurses get burned out."

And now, after the provincial government approved cutting the equivalent of 757 full-time nurses in January, as part of the balanced budget process that requires hospitals to tighten up financially, nurses like McKenna may find themselves in another kind of battle.

She said these cuts make job security a prime worry for many of her colleagues even though the government agrees there is a nursing shortage and promises to add 8,000 nursing jobs by the end of its mandate.

But for now the concern lies with her patients and how they will be affected by the fact that fewer nurses are in the hospitals.

"Our patients aren't like cars in an assembly line," she said. "They require all the care and time that we can give them. Our nurses are telling us now that they can't give them the level of care they want to. If there's fewer of us at the bedside it will reduce the level of care we can give."

"Most of our patients are the ones at risk, and that's our greatest fear."

A critical part of the job is giving patients individual attention. A nurse like McKenna has to assess patients she's never met before and determine how to prepare them for the procedures they need.

This could involve checking vital signs, taking blood samples or doing X-rays and it falls on the nurse's shoulders to notify physicians of any discrepancies that might, in McKenna's words, "alter the plan of the day."

The pace can be difficult.

"It's a very busy unit. The face of health care is quite different. The push is on to have as many patients in and out as quickly as possible," she said.

Adding to the pressure of this pace—which McKenna says can have her on her feet for a whole eight-hour shift as she moves from "patient to patient to patient"—are those who need more than an X-ray or a vital sign check.

She said surgery is an extremely stressful experience for many patients, and the handholding part of the job can take its toll on nurses. It involves being clear with patients about what they can expect but sometimes they also need comforting.

"Sometimes they just need someone. Sometimes they're alone. Not everyone has family. We're close friends with them," she said.

In addition, nurses deal with patients' families that are feeling stress. Children especially may feel vulnerable.

"And day after day after day it wears people down. I've seen it with my peers," she said.

The pressures nurses are under are such that many schedule themselves to allow for recuperation time. McKenna said many nurses work two 12-hour day shifts followed by two 12-hour night shifts back to back so they can get the following five days off.

"They need the break. They're working full tilt. It's tough out there. They're really slugging it out physically," she said. "Mentally it's difficult.."

The Ministry of Health and Long Term Care directed requests for an interview to press releases posted on its website.

Ministry of Health and Long-Term Care website

Health Minister George Smitherman says nursing cuts can be absorbed by reduced overtime and retirements.

In a Jan. 25 press release George Smitherman, minister of health and long term care, said,

"A strong public health care system depends upon a strong nursing profession."

He said slashing the equivalent of 757 nurses from hospitals would be absorbed through reduced overtime and voluntary retirement.

But he also said that the Liberal government is committed to creating 8,000 nursing jobs by the end of its mandate and that many of these jobs will be outside the hospital setting as part of a new model for health care.

"As a government we have a responsibility to ensure that the right care is provided in the right setting at the right time for patients," Smitherman said. "Often that's as close to home as possible. As services move from hospitals into the community, nursing and other health professionals will naturally move too."

Despite the promise of new jobs for nurses, the acting executive director of the Registered Nurses Association of Ontario said she was puzzled over Smitherman's justification for the cuts, particularly in light of the current nurse shortage.

"Slashing of these jobs will be a problem," said Irmajean Bajnok. "There is no way right now in the hospital sector that you could take 757 full-time equivalents and not have a reduction in services."

There were two things she wanted the Ministry to consider. The first was, "If we want to retain nurses, why are we encouraging them to retire?"

Second, she said that the reason nurses work overtime is because there's not enough staff. In order to get rid of overtime, it's necessary to have more staff and to give nurses reasonable workloads. She said that Smitherman's explanation made no sense.

Bajnok, who has been a registered nurse for 30 years, also expressed concern over the whereabouts of some of the 8,000 nursing jobs that Smitherman promised, and wondered if cutting the equivalent of 757 nurses would leave health care in Ontario playing "catch-up."

She said the notion that many new jobs could be available in community health centres, making up for lost jobs in the hospitals, is also problematic.

"One of the things about nursing is that it's a specialized practice. You have a knowledge base that enables you to practise in ICU (intensive care unit) or with the elderly or with the patients with kidney problems. It doesn't mean you can go and work in a community health centre tomorrow and be effective."

Although Bajnok said she's for health care reform, she stressed that it should be a gradual process. She said there is support for that view also.

"Laying off one nurse at this time is just one too many. People on the street are getting this - taxi drivers," she said. "'This government is crazy,' they say. 'What are they doing? I thought there was a nursing shortage.' So the public has got it."