Sylvia Ptashnik, 32, is a thoughtful-looking woman who often wears an “I love life” button on her nurse’s uniform as she carries out her duties at Winnipeg’s Seven Oaks General Hospital. As a unit nurse on a ward devoted mainly to cardiac patients, Ptashnik is responsible for almost everything that happens to the ward’s 10 patients during her shift. On a typical day last month, which began at 7:30 a.m., Ptashnik was rarely able to work on any task for more than five minutes without being interrupted. As she tried to read patient records, another nurse asked her to help weigh a patient. Just as she finished that, an electronic beeper went off in another patient’s room. While she attended to him, a doctor asked to speak to her about another problem. Finally, late in the morning, she managed to find the time to spend a few minutes talking to an elderly and lonely woman who had no relatives to visit her. But unlike her and many other dedicated members of the profession, thousands of other nurses across Canada have quit their jobs in recent years, angered by poor pay and working conditions and a lack of respect for their profession.
Working hectic seven-day working weeks for a $28,000-a-year salary that Ptashnik says barely recognizes her two years of training and 12 years of experience has not yet driven her from nursing, although she says that there have been times when she considered changing careers to something that would offer more recognition and less arduous work. Some nurses have left the profession, while others have been enticed away by foreign employers. American hospitals regularly stage so-called hiring fairs across Canada to lure nurses with annual salaries that go as high as $78,000, subsidized child care, free university tuition, and less arduous schedules.
Now the flow of nurses to other countries, to part-time work and to nursing jobs outside hospitals has led to a serious shortage, especially in the key areas of critical, long-term and psychiatric care. In several Canadian cities, hospitals have been forced to close beds, temporarily shut down emergency departments and cancel elective surgery because there are not enough nurses to keep those vital facilities going.
The consequences can be fatal. All the fatalities were linked to a shortage of trained nurses. “In the surgical intensive care unit,” he added, “we are short six to 10 nurses. We have a 10-bed unit, but the 10 beds are seldom open because we do not always have a nurse to take care of the patient for that bed. And we are short six to 10 nurses in the operating room.”
While many of their colleagues leave the profession, nurses who have remained are becoming increasingly militant in their demands for better pay and working conditions and a greater voice in the health care system. There, they angrily demanded the resignation of Health Minister Elinor Caplan, who they say should influence the Ontario Hospital Association to renegotiate their contract. One nurse carried a placard that read “Someday your life will be in my hands when I’m tired, overworked and underpaid.” Last February, about 11,000 members of the United Nurses of Alberta ended an illegal 19-day strike to back their demands for an improved package of wages and benefits.
In Saskatchewan, 5,750 members of the Saskatchewan Union of Nurses walked the picket lines over similar issues. Patricia Van Horne, speaking for 17,000 members of the British Columbia Nurses’ Union, said that the strikes show that urgent reforms are needed. Nurses have an independent and key role to play, and it is not as handmaidens. That has to be recognized if you want to keep nurses in the business.
Nurses everywhere in the country are becoming increasingly restless. More than half the nurses surveyed at 10 English-language hospitals said that they were seriously considering leaving their jobs within a year, while one-quarter said that they were determined to quit.
Despite the growing shortage, Canada’s 242,000 nurses make up the largest professional occupational group in the country. Still, at many hospitals demand has far outstripped supply. During the period that the Ontario survey covered, nearly half of Canada’s nurses chose to work part time–up from 27.6 percent. Said Arminee Kazanjian, acting director of the division of health services research and development at the University of British Columbia: “People choose casual work because that gives them the option of dropping out any minute they wish when they are disgusted or upset and cannot hack it anymore.”
As shortages develop, the nurses who are left in hospitals inevitably have to work harder. That means that many nurses now have to do chores they consider themselves overqualified to do. Jean Candy, a 14-year nursing veteran who works at Halifax’s Camp Hill Medical Centre, said that she objects to such tasks as sterilizing the beds of patients who have left the hospital. As well, in the past five years, one-third of all new nurses have chosen to work outside hospitals–as visiting nurses, in nursing homes and in schools.
As pressures mount, nurses are increasingly demanding a change in their role within the system. One of the key issues is their relationship to doctors. Prof. Colleen Stainton of the University of Calgary faculty of nursing said that nurses find it frustrating when patients give all the credit to the doctors who saved their lives. “The patient gets better because of a nurse’s observations,” said Stainton. “Who in the hell gets the doctor back to the bedside when there is a heavy hemorrhage?” Added Stainton: “Nurses desperately want the opportunity to refer patients to other health workers. Today they cannot refer to a social or psychological worker without the doctor’s approval.”
Despite the critical need for more nurses, Helen Glass, former president of the Canadian Nurses Association and a professor of nursing at the University of Manitoba, expressed concern that necessary and fundamental changes may be slow in coming. “There is such a long-standing tradition of having health care centered on the physician,” she said. “It is not something which is easily broken down. We are so entrenched in the type of illness-driven, cure-oriented health care system where there is only payment for tasks, tests, and treatments which are carried out–that there is no incentive for making better use of nurses and other health care professionals.”
Many nurses said that low levels of pay are the source of many of their frustrations. In most parts of Canada, nurses’ salaries start at around $24,000 a year and “top out” after six or seven years in the $34,900 to $38,000 range. After that, salaries do not grow appreciably, despite the nurses’ added experience and knowledge. David Schreck, a Vancouver health economist, says that low pay for nurses reflects a traditional sexual stereotype about women’s role in society. Said Schreck: “The fact that there is a chronic nursing shortage indicates that society is simply not offering enough to attract nurses. Most folks, if they were asked to work the kind of shift work and long hours that nurses are asked to work, would not last long in the job.”
Attention: There are indications that some politicians and hospital administrators are paying more attention to nurses’ demands. In Alberta, Health Minister Nancy Betkowski unveiled in December a four-year, $30-million program aimed at giving nurses a bigger say in the health care system, including the establishment of a nursing committee to advise the government on nursing issues. As well, nurses are in line for appointment to each of Alberta’s eight provincial hospital boards. For many nurses, such moves are a step in the right direction. But they also insist that much more will have to be done if Canadian hospitals are going to be able to maintain a supply of the dedicated professionals who play such a key role in Canada’s health care system.