Front Burner - ‘Deflated, defeated’: a nurse’s view from the front lines

Episode Date: January 11, 2022

After working as a nurse — in a job she loved — for more than 20 years, Nancy Halupa says she now thinks about quitting every day. The COVID-19 pandemic has highlighted and exacerbated nursing shortages, and at the Toronto hospital emergency department where Halupa works, she says experienced nurses like herself are being stretched too thin. And there's more. Patients swear at her. She's been called a Nazi. Sometimes, tears come when she doesn't expect them, and other times, she finds her emotions walled off. Today, Jayme Poisson hears Halupa's perspective on the difficulties of being a nurse in a Toronto emergency department now. "I just don't know how much longer I can work like a robot," Halupa says. "And I feel like that's what we're doing, we're just robots and we're doing an assembly line of patients."

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. I'm so deflated and defeated. I can't even describe to you the feeling. It's just, I don't want to do anything. I don't, you know, I'm, I go to work and I come home. I don't want to go out anymore because I just, I'm so tired of wearing the masks.

I'm just so tired of fighting for a normal life that I would just rather stay home. This is Nancy Halupa. She's a nurse in the emergency department of a busy Toronto hospital where she's worked for more than 20 years. I think this wave has been probably the hardest one for me. I wasn't, I, to be honest,

wasn't really expecting to have another Christmas and New Year's like this. I think we were all kind of hopeful that it was over and minimal, but obviously it's not. And I don't see an end in sight. Today, with Omicron raging, staff shortages and hospitalizations nearing or hitting pandemic record highs in Ontario, Quebec and New Brunswick, the view from a nurse just barely hanging on. Nancy, can you tell me what it's like in your emergency department right now? I almost wish I could walk around with a camera just so people could see it because I don't think describing it does it justice. You walk in or you drive in and there's already 10 ambulances waiting outside. So you know your shift's going to be bad. And then you walk in and those paramedics are just lining the walls with people that need stretchers. And then there's

patients lining the hallways. I don't even recognize most of the nurses that come in anymore because they're either from agency or they're from the float pool. There's so few of us seniors left that can do, you know, the critical areas. You spend 12 hours just running around nonstop, sweating into these masks and this PPE and trying to make sure your patients are all taken care of and trying to make sure that the new nurses patients are taken care of because you see them struggling. I mean, if I'm struggling and I've been doing this for 23 years, these new people are not going to, they're not going to have an easy shift. When you say there were, there are like 10 ambulances waiting, what's wrong with the people coming in a lot of

people have covid symptoms i'm not saying this this wave is is mild in any means because the people that do come to the hospital are not mild cases but there's there's everyone you know there it's winter there was falls there's been accidents heart attacks strokes bleeds like we don't just get covid patients people are coming in sicker and the nursing homes are overrun again. So they're sending their patients out to us. You can't just put these nursing home patients in wheelchairs in a waiting room. Most of them are bedridden. They need stretchers. You know, I wouldn't want my 98 year old grandmother sitting in a wheelchair in her nightgown. I wouldn't want someone else's either.

So it's just, I'm not even blaming this whole healthcare collapse on COVID anymore. COVID just brought it all to light, but this has been like impending doom for us for years. We've been saying this for years, that something's going to happen and these, you're not going to have enough nurses to help. And it's happened. That it was a system already on the brink and COVID has just exacerbated it. Just finally brought it to everyone's attention. What's the staffing situation like at your hospital right now? It's the same as it is everywhere. I can't even tell you how many vacancies we have. It is everywhere. I can't even tell you how many vacancies we have.

In my department, from October 2020 to October 2021, we lost 56 nurses. So you don't have that closeness that you had with your group of people that you work with all the time, where you just, you work well together without needing to speak. Every day, it's like meeting someone new. You kind of have to get into the groove of how they work and how you work. The nurses that left, why are they leaving their jobs? What do they say? A couple retired early because they just said it's not worth the extra money that they're going to make in their pension to continue working like this. Others went to public health where it was better wages and a better job conducive to having a family. It was Monday to Friday.

It was nine to five. Others went to vaccine clinics or assessment centers, just anywhere but the bedside, the busyness and craziness of the bedside. Right. If a Monday to Friday job comes up that pays even a dollar less, then people will take it. You know, it's different because hospital nurses take eight years to get to top pay. So when you start off as a nurse, I think they start at like 33. An hour. So a nurse making an hour.

Yeah. So a nurse making $33 an hour could easily go work at public health and start making $40. I understand too, there are nurses that work for private agencies. And I wonder if you could tell me how that is working as well. Well, they make $85 an hour. So I know people say that agency nurses don't have benefits. They don't have pensions. They don't have a lot of the perks that hospital nurses have, but I'm just going to explain my situation.

I'm casual. So I'm a step below part-time, but I've always worked full-time hours. The only reason I did casual was because it worked out better for my family. I could pick my own schedule. So I don't have any perks or benefits either. I still make $47 an hour, even though I've been at that hospital for 23 years. You know, people say, why don't you just go work agency? Well, cause I have a family at work that I don't want to leave. You know, there's a lot to be said for loyalty. And I think if, you know, the hospital can afford to pay that much for external private agencies, then they can afford to pay their own stuff. When there aren't enough nurses working in your emergency department, what effect does that have on your job day to day?

There's just no time to give patients proper care. So if you're five nurses short, that means that the department is either increasing your patient ratio, which in an emergency department to go up from a normal ratio of one to four, let's say in our urgent area where people are sick, but not, you know, dying sick. To increase their load to one to five is a significant difference, because you have a mixture of acute emergency patients that just arrived that need treatment. And then you have the mix of admitted patients just waiting for beds. And it's two different types of nursing. So, you know, your admitted patients probably not going to get as much attention because they've

already kind of been stabilized and dealt with. And you need to deal with the ones that the new ones that are coming in and get them sorted and dealt with. So nobody's getting 100% of that nurse's attention. Every patient's getting like 10% of that attention. So do you worry that the care that patients are receiving is being compromised? I do. And we can't work any harder. I mean, these nurses, no one's taking breaks, no one's leaving on time. People are staying afterwards to do charting because they weren't even able to chart anything during 12 hours. And then if, God forbid, your replacement doesn't show up because there was an error on the schedule, you just, after 12 hours, you just want to leave. Like nothing is more enticing than running out of that door.

And having to stay five minutes extra to do charting is painful. How has COVID changed your job? Well, the respiratory arrests that come in, whether they're COVID positive or suspected COVID, they are a little bit harder to deal with because you have to get your PP on first and you have to maintain that area without breaching infection control. And they do take up a lot more of your time when you do have to do anything on them. And most of the time, those patients are so sick that it's not just a one-to-one nurse patient ratio. You need like two or three nurses sometimes to get everything down on this one patient. And if you don't have

those extra knowledgeable hands, it's impossible to get these patients stabilized in less than two to three hours. And so then what happens if you, you just deal with it and you just, you have to decide who's sicker of your patients. It sounds like triage. It is. And we've been doing this for months. I've had cases where I'm doing a cardiac arrest in one room and a respiratory arrest comes in, in the next room, and I can only be in one room. So, you know, we've been lucky where we've had extramurphs that have just dropped everything and ran from their assignments to come and help. But then you're leaving those patients unattended. So it's a snowball effect. You can't take care of one patient and not neglect your others.

These are life or death decisions that you're making. And it weighs on us so much that I don't think I've gone to sleep a night in the last two years without having nightmares about work. And then I wake up thinking, Oh my God, did that actually happen? Or is that just a dream that I had? And then you, you know, sometimes it did happen and you think, well, what could I have done differently? And we have to stop beating ourselves up for what we could have done differently because we're not given any tools to do done differently. And we have to stop beating ourselves up for what we could have done differently, because we're not given any tools to do anything differently.

I wonder, is there an example of that, that that is at the forefront for you? There's so many of them. I mean, I work in charge a lot of the times and there's been nights where I've had nobody in recess and I'm in charge of the department and I'm the recess nurse. So I have to choose, okay, do I do anything that the charge nurse is supposed to do? Or do I run and deal with this really sick patient? I don't care about the charge nurse duties at this point. The phone can ring off the hook. You know, it's someone's family member in there. And especially now with kids getting sicker, those kids take up so much time because kids are never an easy patient to have. You always have to have two nurses at minimum because, you know, starting an IV on a kid who's And sick is a forehand job. Sometimes six, if you can get it.

And people are getting left and forgotten. You know, it's or you triage someone and you know, they shouldn't be going into the ambulatory area because you just know something's wrong. But there's nowhere else to put them. You mentioned that kids are getting sicker now. They're coming in, they're getting sicker now. That must be very difficult. Can you tell me a bit more about that? It is. I mean, I love our pediatric population. I've always loved

the fact that we see kids in my department, so I don't mind the sick kids, but a lot of our new grads don't have pediatrics experience. And I know people think kids are just small humans, but they're not. Physically they are, but emotionally they take a little bit more time yeah so the kids end up coming to the veteran nurses to get IVs done and catheters and all that stuff right it's snowballing into everything falling on the veteran nurses that there's not enough of just another thing for you and your colleagues who are the ones who are still there. Yeah. You know, you talked about all the protocols around COVID.

I had to go to the emergency room earlier this year. And I mean, it's very clear, right? Like you can't bring anybody in with you. Does it change the way that you have been treated having to sort of police this situation it's awful the names we get called on a daily basis either in person from family members that are trying to get in or by phone from people that are calling is horrendous I don't make the rules but but I have to follow them. So yelling at me because you're not allowed to see your family member isn't going to do anything

other than completely deflate me for that day. And I understand their anger. I've had my dad who had a heart attack in May and I couldn't stay with him. So I understand their fear and I understand their anger, but you're taking it out on the wrong people. I imagine you don't even really have the time to maybe communicate with family members about their loved one who's in the hospital. No. And we try, you know, we try to make it clear. Please just have one family member call. Cause we can't keep answering the phone for, you know, we try to make it clear, please just have one family member call. Because we can't keep answering the phone for, you know, brother, cousin, sister, mother.

And the nurses try to answer those calls. But you know, when they happen every hour, sometimes, if you have five patients, there's only so much you can spend on the phone. You need to get back to your patients. And then the patients themselves, you know, I suppose this might feel minor compared to everything else you've talked about. But I would also imagine that you don't have time to comfort the people in the emergency department to talk to patients to explain what's going on to them. You don't. I'm sure is a part of your job that you're proud of right it is and I mean we try I try specifically with the older patients that are confused and have no idea why they're here and

you know I give them my cell phone to call their families if they can't speak English or I we've all tried to go above and beyond to make patients feel safe, but we're not their family. And yeah, we sat there with them and held a lot of hands watching them so that they wouldn't be alone when they passed, but we're still not their families. And we would sit in rooms for them with them for the first couple of weeks and our full PPE for hours, just waiting for them to die because they were alone. That, I imagine that that takes an incredible toll on you, having to do that. It does. And I think the worst part of that, I think I noticed was when I wasn't even crying anymore. That's not like me. I would cry when anybody died a couple of years ago. As soon as you even hear the family crying, you start crying. But towards, I guess, a year ago,

I stopped crying over stuff like that. And that's not normal to me. I should be crying over this. And yet I'll cry when I can't find an ID bag that I need. Like I cry at the completely most ridiculous times, or I'll cry if someone calls me something, which I've been called a million times, but you just kind of have to step away from the whole death aspect of it. Cause it's's it's too much for one person I wonder if I could ask you the death is it something that you've seen or had to deal with more in these last two years oh definitely you know I I used to love getting to know my patients but then I would find out oh he died yesterday or she died yesterday. And it was

heartbreaking because you'd kind of send them to the floor thinking, okay, they'll do better. And then you find out they haven't. So it's, it's kind of a toss up for me now, whether I want to know what happens to my patients or whether I don't want to know. pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo.

50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Cups. You mentioned your dad had a heart attack. I'm really sorry to hear that. I hope he's doing okay now. Oh, he's doing better now. Yeah. Good. I wonder if having this inside view of how stretched hospitals are makes you worry about your own family. I'm terrified. And I keep saying to my mom,

because she keeps saying, just quit, stop nursing, just stop completely. And I keep saying, well, who's going to take care of you and dad when you're sick? Like I need to be in the hospital. I need to still be a nurse to help them when they're sick. Otherwise, who's going to do it? I can't rely on the nurses that are overworked and burnt out to take care of them properly. It'll have to be me. You know, I've always been the caregiver in my family since I was little. And I took care of my grandparents when they were getting older and dying. I've taken care of my in-laws. And to not be able to do that for my own parents feels like such a waste of my whole profession to me. I know it's, maybe it's the Italian in me, but it feels

like I've done everything for other people. And now I'm going to quit right before my parents might need me. I just, I don't want to do that. Plus I still love my job. I have to say like, as hard as it is, I love this profession. And it's the only reason that I decided to go public with all of this is because I love it. And I want other people to become nurses. And I want these new nurses to feel like the gratification that I used to feel and the pride I used to feel in being a nurse and I just don't have that pride anymore do you think about quitting though uh because of all the strain and every every day every day every day I just don't know how much longer I can work like a robot. And I feel like that's what we're doing is we're just robots and we're doing

an assembly line of patients. That's all we're doing. What does it feel like on a day when you, when you have to go to work and you wake up, what does it feel like? I have crippling anxiety before my shifts. I don't sleep well before I have to go in. I don't eat the day before because I'm so nauseous. It's, I mean, I only do nights because I would not sleep the night before a day shift. nights because I would not sleep the night before a day shift. So, you know, I'm 46. I'm still doing nights. I didn't think I'd still be in this position. What does your family say?

Um, my husband's always telling me to just quit. He's very supportive, but I think those last two years has been, he doesn't, he never really used to tell me much about how much he hated very supportive, but I think those last two years has been, he doesn't, he never really used to tell me much about how much he hated my job, but now he's been very much more vocal on how much he hates my job. You know, when I come in home and I'm telling him the things people have said to me or the things people have called me or the fact that I got spit on or kicked or scratched, he's infuriated now. so i don't even tell him how stuff that happens anymore what do people call you oh you have no idea the things people call me i've been called a cunt you fucking bitch you're a whore like the things people say

are just horrendous the latest ones are that I'm not, I'm a Nazi. And, you know, the truth will come out and I'll be punished for all my lies. I didn't invent this pandemic. You mentioned that you still love the job. I just wonder if you could tell me a bit more about what keeps you from quitting, what keeps you there? It's usually like that one patient you get on that one shift who makes you smile or says, thank you. A couple of weeks ago, I had, I think he was eight or 12, but like the most high strung eight or 12 year old child I've ever seen in my life. And I love kids. They're my, they're my strength, I think can emerge. And we just chatted and I kind of talked to him off the ledge because he was going to get some stitches done. And

the doctor said, I can't believe, what did you do with that kid? I said, I just talked to him. You know, it just, if you spend some time with the kids, sometimes you don't need to hold them down or, or struggle to get get things done you can just reason with them and you know it was like that one kid where I even said to him after we were done with him I was like you know buddy I was gonna quit my job after tonight but you made me happy today so I think I'll stay for a couple more shifts you said that to the kid yeah And he was just the most grateful dad and the most grateful kid. And the doctor was grateful that I helped. And that's what keeps me there. You sound like such an excellent nurse. Thank you.

You obviously, you know how desperately you're needed and nurses are needed more generally. I imagine that must be a tough thing for you to think about, guilt-provoking even. Yeah. And like I was saying, when I got into nursing, I don't think I was ever more proud of myself in my entire life. It was just something I had said I was going to do from when I was six years old. And I used to be so proud of saying, I'm an eMERGE nurse. and I used to be so proud of saying I'm an emerge nurse and that you know people would always be like tell me your worst story what's the worst thing you've seen and now it's just like if I told you the worst thing I'd seen you wouldn't be able to deal with it so I don't tell people where I'm an emerge nurse a lot of the times if we don't know if they don't know me because I don't

want to get asked those questions anymore I don't want to get asked how cool is it because it's not cool anymore it's 90% of our shifts are terrifying and it takes a lot for an emergent nurse to be scared I don't often get scared. What do you think needs to be done to keep you and healthcare workers like you in the job? Bill 124 needs to be repealed. And our union needs to be able to bargain a livable wage for us. You know, I know everyone says nurses are crying for more money, but we deserve it. Your majority of your health care is nurses. It's a complete disrespect to our profession.

No one's going to join this profession if that's how we're treated, especially new kids just finishing high school. Why would you be a nurse and work weekends, nights, holidays, you know, when you can do Monday to Friday, 9 to 5 for the same salary? Right. And Bill 124, this is the Ontario legislation that essentially caps wage increases to a maximum of 1% total compensation for over three years. Yeah. So that's like, I don't know what would that be? It was 47 cents on my paycheck. We had just finished the first wave and that's when we got our first increase. And I was like, wow, I didn't even notice I even had a raise. Someone had to tell me because that's how little it affected my paycheck. Because that's how little it affected my paycheck. Antina, you've been so open and so forthcoming.

I really, I want to thank you so much for this. Oh, thank you. I just, I wonder what message you want people in a position to change things, to take away from all that you've said today. That nurses aren't just fighting for more money. We're fighting to be able to take care of you properly. You know, money is one thing, but we want safe staffing ratios. We want safe patient ratios. We want to be able to go into work and actually take care of our patients the way they deserve.

Nurses want to be able to go into work and actually take care of our patients the way they deserve. Nurses want to be able to take care of you properly. And when you yell at us because we're not, it's breaking us down even more because we are trying, but we're not being given any help. You need to start yelling at other people who can actually change things. Nancy, thank you so much for this and i really i really want to thank you for for all everything that you do thank you for getting the word out thank you All right, so that is all for today. We've got another episode in the works, one that takes a wider look at the cuts to healthcare over the last several decades. So please keep your ears out for that.

Thanks so much for listening to FrontBurner. I'm Jamie Poisson, and we'll talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.