Rather than praise, let’s protect our nurses 

The following article was prepared in May on the occasion of Nursing Week but still remains relevant today. It was coauthored by Alex Harris (Manager, Professional Practice at Trillium Health Partners), Doris Grinspun (CEO, Registered Nurses’ Association of Ontario), Mike Villeneuve (CEO, Canadian Nurses Association) and Judith Shamian (President Emerita, International Council of Nurses).

This month marked the 200th anniversary of the birth of Florence Nightingale, and is being celebrated by the World Health Organization as the Year of the Nurse and the Midwife. A pioneering nurse, statistician and social reformer, Nightingale has served as an exemplar for the impact that nurses make across the globe. It seems apt, then, that the spread of a global pandemic should coincide with efforts to recognize the valuable contributions of nursing to health worldwide.  

Nurses have routinely answered the call during global health crises, acting as the first – and often only – point of care to the sick and vulnerable. They are the backbone of health systems everywhere, and nursing consistently ranks as the most trusted profession.

During the COVID-19 pandemic, much has been done to recognize nurses for their work. There has been an outpouring of support for them and for other healthcare professionals, with collective celebrations, donations and creative displays of appreciation abounding. Most recently, nurses’ status as healthcare ‘heroes’ was commemorated by the artist, Banksy, in which a child opts to play with his nurse action figure instead of the usual cast of characters.     

But while these efforts have been a welcomed source of support, nurses need protection more than praise.

Widespread shortages of personal protective equipment (PPE) have disproportionately affected those at points of care. Nurses and other healthcare providers are at the greatest risk of exposure to COVID-19, due to the frequency with which they’re exposed to the disease, as well as the proximity and duration of interactions. Yet, despite this risk, they are repeatedly asked to ration or reuse their primary source of protection. Horror stories of nurses wearing makeshift gowns and using one mask per 12-hour shift have contributed to anxiety and fear around contracting the illness and spreading infection to patients, coworkers and family members.

Protecting nurses, however, is not simply about ensuring an adequate supply of gowns and masks; it is also about providing them with the resources to practice safely. The pandemic is shining a light on long-standing susceptibilities in the system related to inadequate nurse staffing and heavy workloads. This is especially true in chronically under-funded areas of the healthcare system, such as community and long-term care. 

When we don’t invest in the nursing workforce, patients suffer. Studies have found that an increase in nurses’ workload, as well as lower proportions of professional nurses amongst hospital staff, are associated with higher odds of inpatient deaths. Most recently, the long-term care sector has served as a case study in this regard, wherein staffing levels and skill sets have not kept pace with the complexity of care. Prior to the 1980s, the bulk of patient care was provided by regulated nurses, including registered nurses, registered practical nurses, registered psychiatric nurses and nurse practitioners. Yet, despite a dramatic increase in complexity of patient care, up to 80-90% of care is now delivered by poorly-paid care aides and personal support workers who are left to do the best they can in challenging environments.

If we do not properly support and protect nurses now, the downstream implications on the broader healthcare environment will undoubtedly be dire, particularly as we prepare for the next wave(s) of the pandemic. Prior to COVID-19, nurses were already suffering from high rates of fatigue. A survey conducted by the CBC’s Fifth Estate in 2018 found that almost 40 per cent of registered nurses who responded reported feeling a high degree of burnout. And with preliminary reports of increased stress and post traumatic stress disorder (PTSD) among healthcare providers, inaction now will only further exacerbate these disturbing trends.

Managing the spread of COVID-19 is a marathon, not a sprint. Nurses are run off their feet; cheering and free coffee is appreciated, but can only take them so far. If we truly want to honour their knowledge, compassion and courage, we must invest in them, and in their protection.

Let history remember 2020 not just as a year that nurses came to our aid, but also a time when we came to theirs. 

RNAO update: RNAO is asking the government of Ontario to urgently address these and other concerns – most urgently in the Ontario long-term care sector. Please check RNAO’s Nursing Home Basic Care Guarantee here. We also urge you to sign our Action Alert and add your voice to 3,500 others here.