burnout among ont. nurses is threatening the health system

by: elizabeth paynenineteen months into the pandemic, there is a new threat to ontario’s health system: burnout.among nurses, especially, rates of burnout have reached alarming levels — double what they were early in the pandemic, according to ontario’s science advisory table. without attention to some of its causes, health experts warn that burnout rates will continue to grow, driving nurses away from the profession and worsening already crippling staff shortages. the problem is that those staff shortages are a key factor in burnout rates.“it is at crisis proportions,” said deb lefebvre, who is on the board of the registered nurses’ association of ontario, the professional association representing registered nurses in ontario. the organization has been outspoken about rates of burnout in nursing and what the province should do to address the situation.it is something many nurses see on the job every day.at the ottawa hospital, registered nurse cheshta sharma says she sees changes in some colleagues who have ridden waves of the pandemic, including being transferred to unfamiliar parts of the hospital to help with surges of covid-19. after dealing with increased workloads and sometimes abusive patients and families while working long hours, they are showing signs of burnout.“it’s a mental and physical burnout,” she said. “people constantly say, ‘i slept fine, but i still feel tired.’ they can’t bounce back to their baseline. people are considering different professions.”sharma, who has been a nurse for more than 11 years, says the phenomenon is apparent in every hospital, nursing home and retirement home. “you hear a lot of comments that people are done with nursing.”burnout can show up as feelings of fatigue that can’t be shaken, disengagement, irritability and inability to concentrate. nurses who are severely affected have to take time off work, exacerbating staffing shortages and creating more burnout.sharma took advantage of the hospital’s employee assistance program early on during the pandemic when there was a lot of anxiety among health professionals about what was coming. the counselling helped, she said, and she has used some techniques to help protect her mental health throughout the pandemic, but it is tough to maintain balance.burnout can be an occupational hazard in nursing, related to the nature of the work, but rates during the pandemic are beyond what has been seen before.as the pandemic was beginning across canada in the spring of 2020, the prevalence of severe burnout among hospital-based health-care workers was already high — between 30 and 40 per cent, ontario’s science advisory table reported in a recent paper. a year later, in the spring of 2021, as the deadly third wave was underway, burnout rates higher than 60 per cent were being reported and as high as 80 per cent in some centres. nurses, especially those working in icus and emergency departments, were at the greatest risk.a survey by the registered nurses’ association of ontario earlier this year found that one in 20 nurses said they planned to leave the profession now or just after the pandemic end. among younger nurses, aged 26 to 35, one in 10 said they were very likely to leave the profession.“things have not gone smoothly for nurses in the pandemic,” rnao ceo doris grinspan told the canadian medical association journal.

registered nurse kate magladry has worked at the bedsides of some of the sickest covid-19 patients in ottawa. she has held ipads up to unconscious patients’ ears while their families tell them they love them and plead for them to get better.“i don’t think i have ever held one of those without crying.”like other nurses working in the intensive care unit of the university of ottawa heart institute during the pandemic, magladry carried a heavy truth: the odds were against those patients.the heart institute is one of two sites in ottawa (the other is cheo) with extracorporeal membrane oxygenation, or ecmo, equipment. the system pumps the blood out of patients who are failing on ventilation alone, takes out the carbon dioxide, adds oxygen and pumps it back in. the highly invasive treatment of last resort has been used for some of the most critically ill covid-19 patients during the pandemic. a large percentage of them do not make it.“all efforts are being exhausted to save this person’s life but, despite that, there is a high chance they will die. at best, the rest of their life will be dramatically altered.”icu nurses are used to seeing poor outcomes in their work — it comes with the territory. but the pandemic has amplified that in ways that have reverberated with already stressed and overworked nurses.“covid in icu was a sad outcome, followed by a sad outcome, followed by a sad outcome,” magladry said.those sad outcomes — cumulative occupational stress — are one factor contributing to rates of burnout among nurses at a time of severe shortages.magladry, who has been a registered nurse for 13 years, has so far avoided burnout. working part-time, she said, has helped her maintain some balance despite the challenges.but she is increasingly dissatisfied with the disconnect between being called a hero and the way nurses are treated compared to other — especially male-dominated — health professions.“i don’t feel physically exhausted all of the time, but i do feel disrespected,” she said.“the word ‘hero’ has forever been tarnished. when i hear that word now, it sets off alarm bells and i think, ‘oh, they’re calling us heroes. that’s their licence to under-protect and undervalue our work,’” she said.nurses don’t want to be heroes, magladry said.“we are highly educated, highly skilled professionals. we deserve safe work environments and appropriate compensation for the work that we do.”the ontario government’s bill 124 has been a focus of exhausted and frustrated nurses. the bill, which applies to all public-sector workers, limits annual wage and benefit increases to one per cent. nurses are already underpaid compared to similar male-dominated professions, she said, and the bill will mean they fall further behind. it will also mean nurses can’t negotiate better mental health supports at a time when many need them and there are long waits for existing employee mental health benefits.“there is this profound feeling of disrespect from the government” magladry said.“it just feels like if an event like this where you saw how important we were didn’t compel you to appreciate us, what would?”the issue is potentially catastrophic for the health system, which is dealing with unprecedented staffing shortages and increased demand while it tries to rebuild a system rocked by covid-19. it is also dangerous for patients and bad for all health workers.“burnout is associated with worse patient outcome and reduced workplace satisfaction and productivity for healthcare professionals and trainees of all disciplines,” wrote members of ontario’s science advisory table.the province is training more nurses and trying to hire more to fill gaps, but nurses say some of the issues contributing to burnout can and must be addressed before that.increasing the numbers of new graduates will benefit the entire workforce, but retaining current staff is also crucial, wrote members of the science advisory table. that can be done through financial compensation, fostering supportive workplaces, effective communications, autonomy and collegial relationships among workers and managers.doing away with bill 124, increasing staffing levels and improving support for early and mid-career nurses are among recommendations the rnao has made to the government. the province, meanwhile, says it has invested more than $50 million in recruitment and retention of more nurses.will that be enough? magladry said the public should be aware of the risks of not turning the situation around.“we have grown used to hearing about exponential growth with covid. that’s what we are dealing with in nursing burnout now,” she said. “measures to retain nurses need to be the focus of this administration and those that will follow.”