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'That constant witnessing of human suffering, it takes a toll': Behind B.C.'s nursing shortage

Statistics Canada says B.C. is short 4,265 nurses. The results are closed ERs, and stressed patients and staff.

Aashna Thapar grew up wanting to be a nurse, inspired by her father, a nurse in Surrey. But her recent student placements delivered a dose of reality medicine: While they reinforced her love for the profession, they also revealed the extent of the nurse shortage across B.C.

“Being able to work with patients was such a rewarding experience. But at the same time, you can see how busy it is in the hospital, and just how much the shortage of nurses is really affecting everyone, as well as patient care,” said Thapar, who did her student placements at the University Hospital of Northern B.C. in Prince George.

“It really opened my eyes to the reality of nursing.”

There’s a serious shortage of nurses, and it goes well beyond Prince George. It extends through all of B.C., across Canada, and into many other countries. And it comes at a time when demand for health care is surging in this province, mainly due to an aging population, more people moving here, and the COVID-19 pandemic.

The scarcity of health-care workers, as well as the ­growing number calling in sick ­during this seventh ­COVID-19 wave, has wounded B.C.’s primary-care system. Over the past several months, several ­emergency departments in rural ­communities have closed temporarily, including in Port Hardy and Port McNeill.

On Friday, Island Health advised that the Cormorant Island Community Health Centre would be closed overnight for two weeks starting Aug. 2 due to a nursing shortage.

At Lions Gate in North Vancouver, a patient died on July 11 after waiting on a stretcher for about two days in the ER’s overcrowded and understaffed waiting room. That death, which distraught staff described as avoidable if there had been more nurses and beds, is under review by Vancouver Coastal Health.

Thapar, who is halfway through a four-year nursing degree at the College of New Caledonia and the University of Northern B.C., said during her training she witnessed nurses working full-out to care for as many patients as they can. She hopes governments will do more to help.

“We need more support with mental health, with funding, we need more nursing staff. We need to find a way to have better working conditions for nurses and students,” said Thapar, who is on the executive of the B.C. Federation of Students.

“For me, why I went into nursing is because of how rewarding the career is. When you go into the hospital and put a smile on a patient’s face for just the smallest things, you definitely want to continue.”

Provincial and federal governments have responded to this crisis, but much more needs to be done to address the “really urgent” nursing shortage, said Elizabeth Saewyc, director of the University of B.C.’s school of nursing.

“It sometimes feels like the system is willing to just keep squeezing and squeezing and squeezing until there are not enough health-care professionals — nurses, physicians, health-care aides, respiratory techs — to meet the need. And when that happens, the quality of health-care suffers, and tragedies happen,” she said.

“When the system is so strained that we cannot actually meet the health-care needs of British Columbians, that’s a real concern.

B.C. hiring as fast as it can, Dix says

Health Minister Adrian Dix said his government is hiring as quickly as it can. This is crucial, he said, “not just because we need more staff in places, but because the existing staff is worn down” after 2½ years of the pandemic.

“The overall impact of COVID has been challenging for people and people’s health. And so we’re dealing with this, and we’re responding with a massive addition to health-care staffing that, in some cases, was proven insufficient to [meet] demand. And we’ve got to keep working on it,” Dix said.

As of March 31, according to the most recent figures available from Statistics Canada, B.C. had 4,265 nursing vacancies — three quarters of them for registered nurses, 20 per cent for licensed practical nurses, and a small number for nursing supervisors. Nearly two-thirds of these vacancies are in Metro Vancouver, Fraser Valley, the Squamish to Lillooet corridor, and the Sunshine Coast. The rest are scattered in other parts of the province.

This tally of vacancies is lower than the 5,875 recorded on the same date in 2021, when we were one year into the pandemic. But it is still much higher than the 3,230 unfilled nursing spots at the end of March 2020, when the pandemic had just begun, and it’s 2½ times the 1,715 open positions on March 31, 2019, before the pandemic arrived.

Health vacancies hit ‘all time high’

Nationally, a StatCan report released in June said health-care vacancies had reached an “all-time high.” It found Canada was short more than 34,000 registered nurses and licensed practical nurses, accounting for two-thirds of the vacancies in health occupations.

The crisis expands across the globe. A report released in January by the International Council of Nurses found about 13 million new nurses are needed worldwide “due to existing nursing shortages, the aging of the nursing workforce, and the growing COVID-19 effect.”

Dix said the provincial government is trying to address this problem by adding 602 more nursing spots in public post-secondary institutions: 362 for registered nurses, 40 for registered psychiatric nurses, 20 for nurse practitioners and 180 for licensed practical nurses. That will bring the total number of nurse training spots in B.C. to about 2,600.

When the NDP was elected in 2017, ending 16 years of Liberal reign, Dix said B.C. had the lowest number of nurses per capita of the 10 provinces. His government has since “led the country in adding registered nurses” — there were 43,985 in 2018 and 51,575 by 2022 — but has more work to do.

“When you started last, there is more room to go,” he said. “We’ve got to lead the country for a number of years to come.”

The most recent figures from the Canadian Institute of Health Information showed B.C. had climbed to just ninth place by 2020 for its per-capita number of registered nurses.

‘Incredible stressors’ on health system

The nursing shortage is exacerbated by health-care workers contracting the newest strain of COVID. For example, more than 8,300 health-authority employees were ill between July 11 and 13, the time frame that included the death of the North Vancouver patient, representing five per cent of B.C.’s health-care workforce, the Health Ministry said.

And that number of people off sick is higher than for that same three-day period in both 2020 and 2021, Dix said.

Not having enough nurses to treat patients has “created incredible stressors on the health system,” UBC’s Saewyc said.

“So we’ve seen what was already a shortage to start with has gotten worse. And there’s been early retirements, there are people leaving the profession because of the work environment, the intensity, the serious concerns,” she said. “It’s stressful when you’re worried that your patients are going to not get the care they need.”

The solution is not just recruiting new nurses, but retaining existing ones, said Saewyc and Adriane Gear, vice-president of the 48,000-member B.C. Nurses’ Union.

Salaries could be raised, their work environments could be improved to address the documented increase in verbal and physical abuse from stressed-out patients, and the 12-hour shifts could be adjusted to make it more attractive for older nurses to continue to work.

While nursing has never been “glamorous,” it is typically fulfilling, Gear said. Except when nurses are short staffed — and they are left worrying about what they missed, if they helped someone quickly enough, and whether they paid enough attention to patients and families.

“That constant witnessing of human suffering, it takes a toll,” Gear said. “If nurses can’t be supported to do a good job, then people are not interested in staying.”

In response to questions about retention, the ministry’s statement said the nurses’ contract expired March 31, and collective bargaining had not yet begun, and it said several online tools have been created to support nurses’ mental health.

The ministry also said it is trying to speed up the process for foreign-trained nurses to get accredited in B.C., which could help 1,500 applicants in the next year.

While it is laudable that the province has created 602 new nurse training spots, Saewyc said those will be difficult to accommodate in the short-term. That’s because most of the province’s 17 post-secondary institutions that offer nursing degrees are short of instructors, either due to retirements or an inability to hire new staff, said Saewyc, incoming chair of the Nursing Education Council of B.C.

In addition, she said, there aren’t enough clinical placements for even the current batch of nursing students, because if veteran nurses are already overworked, they don’t have time to train students as well.

The Health Ministry did not answer a question about nursing instructors and student clinical placements, but said it expected all 602 new seats to be filled.

Danna Domasig was caught by the under-resourced nursing-education system. After completing a recommended nursing foundations course at Douglas College, she had to apply and reapply for two years before finally being admitted for this September.

“I thought about it for a long time, and this is the career that I want to pursue. I stuck with it because I think I would be really good at it, but the two-year wait list is crazy,” said Domasig, 26, whose mother is a nurse.

She wonders, though, if other young people facing these delays will choose different career paths. And she worries about the expectations for new nurses when they graduate into a short-staffed workforce — but also hopes that by the time she graduates, B.C. will have filled some of its nursing void.

“I really hope more students have a chance to be in the nursing program. The goal of getting more nurses needs to be aligned with letting more students in,” Domasig said.

“Until that happens, the crisis will continue and the communities will suffer unnecessarily.”

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