Nurses’ mental health, leave of absence and return to work experiences: Introducing a new partnership initiative

The mental health and wellbeing of nurses and other health providers is of paramount importance to RNAO. We are delighted to present an article from Abby Ayoub (University of Ottawa), Sheri Price (Dalhousie University), Melanie Lavoie-Tremblay (McGill University), Kelly Lackie (Dalhousie University) and Ivy Bourgeault (University of Ottawa) introducing the nursing case study of the Healthy Professional Worker Partnership. The partnership originated in this research study.

Nurses face significant mental health issues from high rates of work-related stress, anxiety, depression, burnout and PTSD. A recent report from investigators at the University of Regina in collaboration with the Canadian Federation of Nurses Unions found that 81.7% of nurses surveyed reported experiencing critical incident stress at least once during their career.  This translated into symptoms of burnout and compassion fatigue from overwork and exposure to prolonged stress. Several work-related factors all contribute to making nursing a demanding, stressful and difficult profession, including heavy workload, lack of resources, poor relationships with supervisors, long work hours, high rates of physical and psychological violence, negative and unpleasant working environments.

These challenges predate COVID-19.

The global pandemic has made concerns for both the health and mental health for nurses even more critical. In addition to the usual challenges at work, nurses find themselves dealing with added stressors, such as lack of access to personal protective equipment (PPE), fear of infecting family members, isolation from family members, increased emotional and physical exhaustion coupled with the inability to take time off just to name a few.

Nurses are hailed as heroes; their work considered essential, but at the same time, the time and energy they put into their work remains devalued.

Case in point is the Ontario Conservative government’s Bill-124 which capped provincial workers’ wage increase, including benefits, to 1% for the next three years. Nurses, a frontline female-dominated profession, were subjected to this Bill while other frontline (male-dominated) professions, including police and firefighters, were exempt.

Why are nurses expected to do more with less? It should come as no surprise that turnover rates, absenteeism, and early career attrition are very high in the nursing profession. The lack of recognition takes a toll on nurses’ mental health.

The Healthy Professional Worker Partnership, a multidisciplinary and collaborative research initiative on mental health, leave of absence, and return to work issues for professional workers began to look at these issues before COVID-19 broke out. Our team is looking specifically at the case of nurses, and how their circumstances compare with other professional workers within health care and outside of health care.

Mental health, leave of absence, and return to work are longstanding issues within the profession of nursing. In a pilot study, we found that mental health is affected by several factors including personal, familial, work and organizational challenges. They can also influence nurses’ decisions to contemplate or take a leave of absence from work. These factors can also support or create barriers to return to work after a leave. Furthermore, a nurse’s gender (being predominantly women) and other characteristics such as race, Indigeneity or age likely influence how these factors affect mental health, the decision to take a leave of absence, and how one can return to work.

Taking a leave of absence is a challenging and frustrating process, but even more so for mental health. Required forms ask nurses to indicate a specific event, date and time that led to their personal injury, but how does one pinpoint exactly when they became so burned out they could no longer continue? That is, the policies and processes of taking a leave of absence are not well-adapted to mental health issues. This makes it harder for nurses to take a leave when needed.

Further, if nothing changes at work while on leave, it is remains difficult upon return. The choice nurses often face is to return (or not) to the same toxic environment as issues around organizational work context, such as work overload, understaffing, lack of resources, violence, etc., remain constant.

Through support from the Registered Nurses Association of Ontario (RNAO), one of our partners, our research team will be hosting a webinar in August to discuss our preliminary findings and approach to our next phase. We welcome nurses to share their experiences – both pre-COVID and during this ever evolving COVID context.  We will be pleased to sign up volunteers to participate in an interview or fill in our short online survey.

Our partnership ultimately aims to identify interventions to better support nurses’ mental health and facilitate healthy return to work.

Nurses spend their days caring for others. It is up to us to find better and more sustainable ways to support their care and mental health.

RNAO update: RNAO is proud to contribute to this partnership and research study. On Monday, August 10 RNAO will deliver a webinar for nurses to meet with the researchers and hear more about the study. You can already register for this webinar here.