12-hour days, burnout and lower wages: Ontario nurse says staff shortage getting worse

Sharon Hunter says many nurses are considering or planning to leave the stressful profession. (Sharon Hunter)

Sharon Hunter loves her job as a nurse, but she says she feels uneasy every day before she goes to work.

During her more than 15 years in health-care settings, Hunter says, the staffing shortages in her profession have never been worse in Ontario.

"I feel the dread every day when I get up in the morning, not knowing if we're going to have more patients to see than the day is going to allow us to see and thinking about how I'm going to triage and how I have to decide between people who are going to get the care today and who might get the care tomorrow or the day after that," Hunter said in a video interview with CTVNews.ca last week.

She says she feels guilt when she has to take a day off work, knowing her colleagues will have to find a way to take over her workload.

Hunter, 45, is a registered practical nurse (RPN) in the Belleville area, who has mainly worked in community and home care.

RPNs, also known as licensed practical nurses, are trained to support patients who have non-severe, stable and predictable conditions, while registered nurses (RNs) have more comprehensive education and handle more serious cases.

Both types of nurses work collaboratively in the community, homes and hospitals, including emergency rooms.

Hunter said the small team of RPNs and RNs she works with has a hard time recruiting nurses of all types. Her home and community care team visits patients in private homes, retirement homes and other community facilities.

The low compensation and considerable amount of travel required to visit patients have made nursing jobs in the community sector unappealing, she said.

Nurses feel 'moral distress'

Hunter describes the situation as causing "moral distress" for nurses like her.

In some cases, patients have been sent home from the hospital without the necessary medications or equipment or care they needed, she said.

"The patient just copes with the treatment plan that they have, and as nurse, that's what moral distress is," she said. "I know in my heart of hearts we're not doing everything to support patients."

Hunter says there's a lack of support in those cases that makes her feel helpless.

"I come home and at the end of the day. I'm devastated that I left the patient and there's nothing else I can do, and the only option is (for them) to go back to the hospital if they feel worse and if they can't tolerate the condition anymore."

Burnout is also deterring people from wanting to stay in nursing, she said.

When she first started working as a nurse more than 15 years ago, she recalled seeing eight to 10 patients a day. Now, it's typical for her to see about 12 patients a day, and even up to 16 isn't uncommon, she said.

"Over the last few years, specifically, the number of patients that you need to see per day is rising," Hunter said. "I have experienced many colleagues who have burned out, who have changed careers or change jobs because they just couldn't take the day-to-day stress of having such a high volume of patients to see."

Because of what Hunter describes as a staffing shortage, she plans her day the night before work to include both the patients assigned to her already and a contingency plan in case a colleague is sick or otherwise unable to work.

Sometimes an absence leads to triaging patients, meaning Hunter has to figure out which patients are highest priority based on their medical needs.

"Some patients may not get seen that day. Some visits may be moved, some visits may be shorter," she said.

Gruelling workdays

The workdays are long for Hunter and other nurses who travel long distances, sometimes a total of up to 700 kilometres a day, to see patients. Those in community and home care provide medications and connect patients to specialists, doctors and other health-care professionals, among other duties, she said.

Many patients she sees in private homes don't have family doctors or a medical support team, so it's a challenge connecting them to the supports and resources they need, Hunter said.

Since many don't have regular access to health care, their condition is often serious by the time they are seen at the hospital. They're referred to teams like Hunter's when their condition stabilizes, she said.

Nurses in her field travel to see patients such as seniors, people who are immunocompromised, people who have disabilities or aren't well enough to leave home, because they face financial and health barriers to visiting health-care providers.

"Some of these nurses are on the road at eight o'clock in the morning and don't get home till nine or 10 o'clock at night," she said.

On top of days that could easily exceed 12 hours, nurses working in community and home settings have to do unpaid paperwork once they get home, Hunter said. In her case, it's about two to three hours of doing reports, ordering medical supplies, updating physicians about patients and more tasks that could make her workday a gruelling 15 hours.

For those reasons, many of these types of nurses are leaving to work in long-term care facilities or hospitals, where they can have regular eight- to 12-hour shifts, Hunter said.

How shortage hurts patient care

Nearly half of RPNs (48 per cent) say they are considering quitting because of pressures stemming from the provincial nursing crisis, according to a new survey by the Registered Practical Nurses Association of Ontario (WeRPN), a union that represents RPNs.

In addition, the survey suggested 59 per cent of RPNs said they are working more hours than scheduled, and 75 per cent said they are being asked to assume more responsibilities.

The staffing shortage has hurt patient care, according to 91 per cent of RPNs surveyed for the union report, resulting in problems such as overall longer wait times and more difficulty for patients to access necessary care. Self-care and overall mental health have worsened for 72 per cent of RPNs surveyed. Seventy-five per cent of RPNs polled said they have financial stress.

"We've experienced a lot of stressors in the health-care system and on nurses in general that have just compounded over months and years," Hunter said. "Because those things have kind of gone untended, there have been so many nurses that have just left the profession that now we are facing a shortage like I've not felt during my 15 years of nursing."

The pay problem

Compensation is another issue for RPNs, Hunter said.

The WeRPN report suggested that among the 48 per cent of RPNs who are planning or considering leaving the profession, wages are the main reason for 84 per cent of them.

"You are compensated per nursing visit that you accomplish in a day, and in order to make a living wage, you then have to see more people," she said. "So essentially, they normalize the need to see so many patients in order to be able to earn the paycheque that you need to earn to be able to support yourself and your family."

Despite the higher wages offered in other sectors, Hunter said she loves working in home and community care. But the challenges she faces in her field have made new opportunities more appealing. She says she is looking at doing further studies to branch into business and leadership, potentially leaving nursing.

"The climate of nursing is just getting more strenuous," she said. "It's harder to keep your head up every day. You feel every day that you just cannot provide the care these patients need in the home. The resources aren't there, and as nurses, we're doing our best to piece together enough resources for these patients."

She has a few colleagues who want to train as RNs, because these jobs can lead to higher wages, and says others are thinking about returning to school and changing careers entirely.

When asked about the WeRPN report, a spokesperson for Ontario's Health Ministry said in an email to CTVNews.ca that the government has made efforts to "achieve significant progress to build a more connected and convenient health care system."

Hannah Jensen, spokesperson for Ontario Health Minister Sylvia Jones, said Ontario has the lowest wait times in the country and registered a record number of new nurses two years in a row. Moreover, it added 32,000 new nurses and 30,000 are studying nursing at one of the province's colleges or universities, she said.

"Through our government’s Your Health plan, we have broken down barriers for internationally educated health care workers, while allowing health care workers registered in other provinces and territories to immediately start working in Ontario, removing financial barriers for nurses wanting to upskill and expanded the Learn and Stay grant to provide eligible students in nursing with funding for tuition, books and other costs," she said.

The government's latest budget includes an extra investment of $743 million to grow the workforce through increased enrolment and retention programs like upskilling and the extern program, she added.