Big Idea: Protect Nurses in the Workplace

I became a registered nurse in 2007. I’ve held many jobs since then—in prenatal education, women’s health and in various leadership roles—but I got my start in the postpartum unit. In those early years, I spent much of my time at my patients’ bedsides administering medications, checking wounds, drawing blood and otherwise attending to the needs of moms and babies. By 2016, I was a clinical nurse specialist working on staff education within the Greater Toronto Area, which is where I met Amie Archibald-Varley, another nurse. Our friendship really grew after we started exchanging horror stories.

Amie and I had both been bullied during our careers. In my case, a co-worker ridiculed me in front of our colleagues when I couldn’t handle a heavy workload and made hurtful comments about my appearance—including a rash I’d developed from anxiety. For a while, I struggled with insomnia. It was actually Amie who suggested I go on stress leave, which I didn’t even realize was an option; I’d never met another nurse who’d taken one. My doctor provided me with a note that said I needed time off, but because it didn’t include an official diagnosis, my employer didn’t approve it. I took my concerns to human resources, but nothing happened. No one was listening.

In 2019, Amie and I decided to create an outlet where we could talk openly about what it’s really like to be a nurse—the unsustainable caseloads, the unsafe working conditions, the harassment from patients and employers. All of it. That’s how The Gritty Nurse podcast was born. At first, we were producing it for our fellow nurses, but our audience has since grown well beyond health care professionals. Every day, people tell me they had no idea what nurses faced on the job. Amie and I advocate for ways that the profession can better protect them.

Even before COVID, roughly 32,000 nursing positions in Ontario were vacant; nationally, that number is expected to grow to nearly 120,000 by 2030. This staff shortage has contributed to the record-breaking hospital wait times we’ve all heard about. Typically, the conversation about nurse retention focuses on money, or specific wage-suppressing legislation, like Ontario’s long-overturned Bill 124. Low pay for long hours is one tangible example of why my colleagues feel underappreciated, but the issues go much deeper than that. Nurses regularly contend with physical and emotional abuse during work hours. In fact, according to the International Council of Nurses, health care workers are more likely to be attacked at work than prison guards and police officers. 

These stories may seem like outliers, but they occur in all kinds of health care settings: at hospitals, in long-term care centres and during home visits. Eavesdrop on any nursing break room and you’ll hear some terrifying tales. One nurse told me about a time when she was attacked by a patient with dementia—anger can sometimes come along with the disease process—and a door locked behind her. When she escaped, the first thing management said to her was, “What could you have done differently?” Another nurse recently told me she kept an aggressive patient calm by placating him with cheeseburgers, bought with her own money. Eventually, the patient’s doctors started wondering why he was gaining so much weight. Another nurse was accosted by a patient and slapped him in self-defense. At the time, her management said, Don’t worry, we’ll protect you. The next day, she got a call saying she’d been let go, without a chance to tell her side of the story. She’s been out of work for months.

During violence-prevention training, when we do receive it, nurses are typically instructed not to fight back. At the start of home visits, we’re told, look for an exit path. In hospitals, call a “code white,” curl up in a ball and wait for security—or for the abuse to end. Refusing care to a patient is against our professional obligations—nursing colleges call this “patient abandonment”—which means that, in many cases, nurses are forced to continue attending to someone who has assaulted them. Nurses also bear the legal responsibility for their patient’s safety, and we can lose our licence if anything goes wrong. Our employers are not accountable to us in the same way, particularly in situations where our mental health is at risk.

Instead of funnelling money and resources into recruiting international nurses, provincial governments can take concrete steps to protect (and, therefore, retain) nurses here at home. One solution is to cover all Canadian nurses under presumptive care legislation, which mandates employers to accept disease or disorder claims from workers without requiring them to prove their condition directly resulted from their job. In many provinces, presumptive care already applies to emergency workers like paramedics, firefighters and police officers. In plenty of jurisdictions, however, nurses are not considered “public safety officers” under law, which means they aren’t afforded the same overall protection, despite enduring the same kinds of abuse as other PSOs—and, sometimes, at higher rates.

Say a nurse was suffering from post-traumatic stress disorder. With presumptive care in effect, at the first sign of symptoms, they would be able to seek help from their employer. In an ideal world, that would include paid time off, a detailed, employer-provided care plan, or perhaps a visit to an on-site clinic dedicated to treating and preventing workplace injuries. The affected nurse would also be given access to outside psychological supports (i.e. from a therapist or a peer-support group). Right now, nurses have to jump through so many hoops to prove their plights, often losing pay due to time spent at diagnostic appointments. Presumptive care would alleviate this extra burden.

The push to make presumptive care more widespread is slow, but it is happening. This past January, a bill came into effect in Washington State that increased nurses’ access to workers compensation benefits and recognized repeated exposure to traumatic events as an “occupational disease.” Out west, the United Nurses of Alberta is pushing to expand presumptive coverage for psychological injuries. A petition created by Local 68 union president (and ER nurse) Heather Murray garnered almost 1,000 signatures before it was tabled for consideration in the Legislative Assembly of Alberta last November.

I’ve heard from some employers in Canadian health care who are worried that nurses will take advantage of presumptive care if it’s enacted. In my experience, nurses are the kinds of employees who show up no matter what they’re dealing with, illness or otherwise. Every day, we put our lives on the line to care for others, but we are notoriously bad at asking for help for ourselves. It’s a struggle to get us to speak publicly about the bad parts of the job, but it’s crucial that we do. In June of 2020, a study by the Canadian Federation of Nurses Unions found that one in three Canadian nurses reported having suicidal thoughts, a rate higher than the general population and comparable to those of correctional workers and paramedics. (Notably, the data was collected in 2019, before the start of the pandemic.) Just recently, I spoke to a nurse who said she worked on a unit with five colleagues who died by suicide. She had to perform a post-mortem examination on one of them.

We cannot continue to perpetuate a situation where nurses are abused, offered no support and simply forced to cope because they need their pension or want to keep their seniority or have 10 sick patients on their roster who need them. I know this from my own painful experience of having to navigate the system by myself. Providing better care to patients also requires taking care of workers first. Presumptive care would provide support without nurses having to ask for it; simply knowing it’s there in an emergency will provide some relief. As with any other issue in health care, prevention is key.

Sara Fung is the co-author of The Wisdom of Nurses: Stories of Grit From the Front Lines and the co-host of The Gritty Nurse podcast.