The Current - Nursing still in ‘post-traumatic state’ after pandemic, says front-line worker

Episode Date: March 7, 2025

It’s been five years since people banged pots and pans to support health-care workers battling the pandemic — but today many nurses say they’re still struggling in an overwhelmed system. Matt Galloway talks to two front-line nurses about the burnout, violence and staff shortages that are driving some out of the profession entirely.

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Financing. Advising. know-how. This is a CBC podcast. Hello, I'm Matt Galloway, and this is The Current Podcast. Remember that noise? It goes back to 2020. Remember that noise? Goes back to 2020. Those are people banging pots and pans in Vancouver to honour healthcare workers during

the pandemic. It's hard to believe, but next week is the fifth year anniversary of the World Health Organization declaring COVID-19 a global pandemic. Those healthcare workers were treated as heroes back then. Now, many nurses say they are struggling in an overwhelmed system. Canada had a nursing shortage before 2020. The pandemic made it worse.

It is estimated that Canada will be short some 117,600 nurses by 2030. Today, nurses say they are dealing with burnout, staffing shortages and high patient loads. And many of them are leaving the profession. Peggy Holton has been a nurse for over 40 years, currently working in the emergency department at Surrey Memorial Hospital near Vancouver. Also with me is Kamika Sylvester.

She is a registered nurse based in Toronto, previously worked in emergency rooms as a travel nurse across Canada. They both join us now. Good morning to you both. Good morning. Good morning. Kamika, you started working as a nurse during across Canada. They both join us now. Good morning to you both. Good morning.

Good morning. Kamika, you started working as a nurse during the pandemic in 2021? Yeah, I actually graduated from nursing school and did my education during the pandemic, which was extremely stressful and started my career in the ER right at the peak of the pandemic. That is like right into the frying pan.

What was it like? Unimaginable for a lot of people. You are seeing this new disease ravage our population and trying to answer questions that you don't have the answer to, dealing with patients who have lost loved ones, who've lost their livelihoods from businesses closing and there's like a divide between you know controversial opinions about the vaccine so on top of an already stressful job so it was definitely challenging. Did you feel like you were prepared for that going into that situation? I don't know that any of us were prepared for what happened five years ago but. I don't think I was

prepared I don't think in nursing school they really prepared but. I don't think I was prepared. I don't think in nursing school, they really prepared us, but I don't think they could have prepared themselves either. It was something out of a movie. You were also, I just said in the introduction, you were working as a travel nurse. Can you explain what that, what that involves? Yeah.

So travel nursing or agency nursing essentially is when you either work for an agency or independently and you take contracts at hospitals outside of your home hospital that are experiencing critical staffing shortages, that they're willing to have fly-in nurses from other places to provide the patient care that's necessary. Who are you working for? Well, I am an independent contractor, so I do, I'll work with a few agencies that have connected me to different hospitals.

That you were working across the country? Yeah. So I just came back from BC actually, a few weeks ago. So definitely excited to chat with Peggy and they have an amazing nursing union out there. I was in Nova Scotia and Alberta as well. And, and just the last point on this, you've worked in a few ERs. You're now in a surgical unit in Toronto.

Yes. What is it like, we were talking about 2021, what is it like being a nurse today? It is still challenging. I feel like we're in a post-traumatic state. We have tried to acclimate or get used to the staffing shortages, but it still makes your job incredibly stressful.

Mental health, morale, all these things are at an all-time low. There's more patients than we have beds for, and even if we do have the beds, they can't be open because we don't have the staff to provide the care. I want to come back to that, that post-traumatic state. That's a really powerful way of describing it. Peggy, you've been listening in. You work, as I mentioned, in this busy emergency department in Surrey.

Can you describe what an average day looks like for you? Well, in Surrey, we are one of the largest and busiest hospitals almost in North America. I think we maybe have, we are now one of the busiest hospitals in North America. We see over 500 plus patients a day. And we, we often have over 100 to sometimes 130 admits in our emergency department at any given time.

And so we do not have the capacity to manage this volume or the admissions that we have. So we have gone to like what they call boarding or over capacity beds, which is putting patients in hallways. Every nook and cranny is filled with someone so that we can provide them a bed space versus sitting in a chair. So it can be very daunting. You come on, you know your waiting room is full.

You know a lot of people there want care, you see the looks in their eyes, you try not to make eye contact because inadvertently somebody's going to want you to do something, take care of their pain crisis, get their loved one seen, or just out of sheer frustration want to vent with you. So, just to be clear, I mean, it can be really daunting. You try not to make eye contact with the people who are there being treated in the hallways, in the emergency departments, wherever, because you're worried that if you do, they will ask something of you in a situation

where you're already being pulled in all these different directions. Right, and if you already have, like, you know, maybe anywhere from eight to 12 patients under your care, you're already maxed out as to how much you can provide and how fast you can provide that. So we do try to provide our, like when we do

assessments at triage, we do try to provide pain control at that point in time, but there is a limit and it often isn't enough to manage the pain crisis that some patients may be in. So for nurses, it's often quite daunting. And then when you do start work, it's the fact that you're working short.

You don't have enough of the skilled ER nurses that you need. We're supplementing with med-surg nurses, with LPNs to try and at least get some of the patient care done and meet some of the patient's needs. And so it is daunting and it's almost like a bit demoralizing. You feel that you have a feeling of that you're not, you don't have any personal accomplishment, like you're not meeting patient's needs. And then we're also seeing high levels of like emotional exhaustion.

So it is a real challenging time right now. And also dangerous, right? Your union has said that something like 26 nurses a month in BC suffer a violent injury at work. What's happening there? Yeah. So violence is sort of on the uprise and we're seeing an increase, not decrease.

And it's again, a lot of things are due to their economic status. People are struggling in their own personal lives and then to have an illness put on top of that, just further exhaust and exaggerates their, their behaviors. And a lot of times people are really just trying to advocate for their founding members and then frustrated when we can't provide the care that

they feel that their founding member needs. The BC government says that, that, that they've provided something like 750 security staff working in healthcare settings. Does that help? Well, it does help, but there isn't enough security staff. At Surrey, we have like a huge amount of, we have

the security staff, but certainly not enough. Yeah. And we do have a lot of violence that happens. We have security staff, but certainly not enough. And we do have a lot of violence that happens. It can be in the form of verbal aggression, like sort of the yelling, the emotional abuse that comes with that. But it can also be the physical as well. And we have people that, because of their anger, they then lash out. But we also have a lot of, we have about, like, over 61%,

I guess they say, of our nurses are out facing, like, you know, contact with innocent substances as well. And we get a lot of people coming in with psychosis, and inherent in that is often a lot of violence and behavior that comes with that psychosis. And so that also, if you don't have enough security staff, nurses then get involved and do hands-on and then that creates injuries for our nurses and further exhausts our, or depletes our nursing, our nursing compliment for the day. Kamika, let me pick up on something that Peggy mentioned,

and that's just in terms of the number of patients that you're handling. She said eight to 12 patients can be under your care. There was an investigation for the Trump Star. It found that some nurses in the province of Ontario last summer had to look after as many as nine patients at the same time. Does that sound familiar? Well, I can't specifically speak to that because last summer I wasn't nursing in Ontario, but I do know before I left, our ER had a zone that I was working in where if your partner

goes on break, you have sometimes up to 12, 13 patients by yourself. What does that mean for patient care if I'm one of those 12 or 13 patients and there's you? It means that you could potentially get added to my caseload and be waiting, seen by a doctor and discharged if there didn't require any medical, any nursing interventions and I would have never seen you. Are you trying to avoid my line of sight when I'm looking at you, if I'm lying on the gurney and I'm trying to catch your eye?

Are you kind of looking somewhere else so that you don't... No. and I'm trying to catch your eye, are you kind of looking somewhere else so that you don't... No, I've been a patient in this system before. I've had family members and treated family members over COVID, so I do try to make eye contact because sometimes they just need to feel validated, they need to feel seen. When they're in a hallway, they don't have a call bell to actually call a nurse.

But you understand why somebody would do that though too, right? Peggy's talking about that could just, suddenly you feel like you can't help everybody. Exactly. So it's easier just to kind of have that gaze go straight through. And sometimes you do have to walk with your blinders on, especially if you're trying to respond to a critical event. But it's a balancing act.

And I think Peggy's speaking to really how daunting it is because you're making snap decisions, especially in the ER, that is impacting patients' lives. And sometimes stopping if you're on your way to a code or something and you have to stop and get somebody water in the hallway, like time, like we don't have the time sometimes. Peggy, just briefly, there was legislation that was passed in BC to standardize the nurse to

patient ratios in pediatric and surgical departments. You have one nurse for every four patients. Have you seen any changes since that law was passed? Well, we've just started now to implement our nurse patient ratios throughout BC. And so in our region, we've implemented in five areas at this current time. We're starting to see some light at the end of the tunnel, but it's just a glimpse at this point in time.

But I am seeing maybe a bit more hope in our staff in the fact that there might be some changes on the horizon. Our first site that we did implement, I think now they have basically filled all their vacancies, which is is a huge success. It was a smaller site, but it shows that it can be done. And if we look at what's happened in California and Australia, they saw like a lot of about 7,000 of their nurses that you know that were inactive that left during the pandemic and stuff like that come back. And so we're hopeful that this will give some hope and some willingness for some of our

nurses to come back and work in the system and that we can be able, we'll be able to provide the nursing care that we want to provide, keep up with our standards. We're almost out of time. Let me ask you both just briefly, and I'll start with you, Peggy. You've been a nurse for over 40 years. Given what you described, there are people, you could be one of those people,

who leave the profession. Why do I have to put up with this? Why do I, this is exhausting, the violence that I face. What keeps you going? What do you love about it and what keeps you there? It is, I want to make a difference. I want to be able to provide the care that my mother, my father, my family member would benefit from. I want to have care there when I get old and when

I need it as well. And I think that I have learned through the years, the 40 years of nursing, I've learned more from my patients and my families than I've probably taught them. and my family's, then I've probably, you know, that I've probably taught them. It is such a rewarding profession. I've been able to, I'm family birthing trained, like I'm able to see the birth of a child, but I'm also able to hold the hand of someone and provide support for family members as people take their last breaths. It's an incredible journey and it's such a great profession. We just need to be able to sort of deal with the shortages, deal with the violence and provide some safer

workplace conditions. And it'll go back to being as great as it was before. Kameka, you're relatively new to this. Yes. Given everything that you have described, would you consider leaving nursing? Do you regret being in this profession? I don't regret being in this profession. Do you ever think about leaving? I have thought about leaving, but not necessarily leaving healthcare, but leaving

bedside to pursue impacting the system because I've seen that I can make an impact with my patients immediately, but I want to make an impact for generations to come. So like what BC is doing is moving in the right direction, but there's still so much left to do. Like even if we have patient ratios, that doesn't fix the fact that the ER has patients that are there because they have nowhere to live, or they don't have a livable wage, or they can't access prescriptions that were prescribing for infection, so they're coming back frequently. So I I really want to make a difference. And so, I have pondered leaving to pursue full-time, like, you know, my nonprofit that I founded in the healthcare space,

and another venture that's looking at mental health support for black healthcare providers. But you haven't left yet. But I haven't left. Just finally, what is keeping you at the bedside? It's, I think like Peggy said, those moments where you get to hold someone's hand through a really tough time, where you get to see the look in their eyes when you provided care to them and they feel the compassion. It's those moments that I feel like that's why God put me here to actually make a difference in someone's worst moment, especially in the ER. So I wouldn't... It's those moments that I feel like that's why God put me here to like actually make a difference in someone's worst moment, especially in the ER.

So, I wouldn't, it's hard because I wouldn't trade that for the world. I just wish the system would give us all the tools that we need to do our job and actually, you know, support a healthier population so that it's not as stressful. Your patients are lucky to have you both. Thank you both for being here and being honest and talking about what you're up against, but also what you love about the job. Peggy, thank you. You're welcome. And Kamika, thank you very much. Thank you for having us. Peggy Holton has been a nurse, as you heard, for

over 40 years, currently working in the emergency department at Surrey Memorial Hospital near Vancouver. Kamika Silvester is a registered nurse working in Toronto. You're an entrepreneur. Growth is essential for your business. At BDC, we get that.

And we're here to help you. And we're here to help you. in Toronto. You're an entrepreneur. Growth is essential for your business. At BDC, we get that. And we're here to help you stay two steps ahead. With our flexible financing and advisory services, we help you adapt, growing your business in the face of today's challenges and tomorrow's opportunities. Stepping up for entrepreneurs, we're on it.

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Lee Chapman is Canada's chief nursing officer. She advises the federal government on nursing issues. Lee, good morning to you. Good morning, Matt. That portrait of nursing from these two nurses is pretty bleak, I think it's fair to say. When you hear that, what goes through your mind? Well, I would agree it's bleak. It's certainly not surprising. I've met with nurses in every province and territory across the country and I've heard very, very similar stories. I think the 130 no bed admits in an emergency department is a record. The most I'd ever heard was 100. So that's a bit shocking because we don't have the capacity, we don't have the infrastructure to look after admitted patients typically in an emergency department.

And you can just hear how Peggy describes, you know, folks are in the hall, they don't have access to a call bell. It's very difficult for nurses to actually meet the standards of practice under those conditions. Why are we in this position where Kamika describes it as a post-traumatic state, where you have nurses who are afraid to make eye contact with their patients because they're worried about what they'll be asked to do that they can't do? Yeah, I think we've just had this, you know, massive erosion, you know, of the working conditions in health care in general. We've had the duress of the pandemic, we've had massive workforce challenges, and I think we're just climbing our way out of that.

I think Peggy's words were telling that there is some hope and inspiration that change is coming. The change takes time. These are structural changes that are needed in terms of how we're valuing nursing work and how we're actually changing the work environment, but it does take time and patients keep coming in. And so it's very difficult to change as you're still providing care. When you took on this role, you said that you wanted to make nursing a profession of choice in Canada.

Given what we've heard, why would anybody want to be a nurse? I mean, the, the making a difference part, the, the ability to reach people at their, the best days of their life and the worst days of their life and everything in between. There's no profession like this where we get to actually be so involved in learning from patients, learning about their lives, developing a relationship with them as we're providing care. But the system is such that, I mean, again, that phrase of being in a post-traumatic state suggests that the benefits, it's hard to see those

benefits for some people, given, I mean, even Kamika, who's been in the job for four or five years, is thinking, is thinking of leaving. It is, and sometimes we derive the benefits from our colleagues, you know, from the staff that we're working with. It's very difficult. The working conditions are very difficult right now. There's no question. I mentioned earlier that Canada is expected to face a shortage of 117,000 nurses

by 2030. That's in five years' time. What would that mean for the healthcare system, do you think? That's in five years time. What would that mean for the healthcare system, do you think? I mean, it's unfathomable. We still have massive shortages and vacancies, and I think, you know, we have a global nursing shortage, so we really need to rethink the way in which we're optimizing nursing work.

And I've been really focusing on retaining nurses and encouraging the return of nurses who may have left, because I think that's exactly where the strategic focus needs to be. Do you understand why some nurses would leave government jobs, if I can put it that way, for private agencies that would offer perhaps better conditions, more choice, better pay? Do you understand why people would do that? Oh, absolutely. There are structural changes that are needed

and I think they can find flexibility and balance their life in different ways when they're working for private staffing agencies. But there's also things that the public system can do to entice them to come back. The province of Ontario has the largest number of nurses in the country. And we contacted the Ontario government. It sent us a statement that says, in part, for the third year in a row, we have registered a record number of nurses, adding a total of 50,000 new nurses, another 30,000 are studying nursing at one of Ontario's colleges or

universities says it's trying to make it easier as well for international nurses to get certified. Is that enough? Do you think when you hear those numbers in light of the need, but also the conditions that nurses are working in. What does all of that mean? Is the government doing enough to address the crisis? I mean, every single jurisdiction is working on recruitment efforts, whether it's increasing

seats in nursing education programs or enticing internationally educated nurses or accelerating their integration into the system. And that's all around recruitment. We still have more nursing students apply to nursing education programs than we have seats across the country. There's still high, high demand for nursing education programs, but we also need an investment in retention. And so what do you do about that? You've hinted at this a couple of times. What can bring those nurses back from private agencies but also keep nurses in the system so

that they don't leave for other jobs? I mean, we heard in BC the implementation of safe staffing ratios. That's one of the recommendations in the toolkit that we released on nursing retention around safe staffing. Other jurisdictions are following suit and very interested in evidence-based staffing and ratios. It's really about engaging nurses. Nurses have the solutions. They have the innovation if we just provide the platform for them to actually share their ideas about what would

make a difference, whether it's mental health and wellness supports or increased flexibility or reducing the administrative burden of nurses so that they're not tied up doing non-nursing tasks, which occupies a lot of nursing time. And I think that results in the lack of eye contact. They can feel, when you hear that, that lack of eye, I mean, that's the horrors story that I think people are afraid to see, right? That they need care. They end up in the hallway of an emergency department, they're in pain, they're trying to

catch somebody's eye and people won't look at them because they're already overburdened. That can lead to people thinking that, that the healthcare system is breaking, that they might lose faith in that system. If this is a problem that is not fixed, what worries you most about how patients, those people on those gurneys will feel the impact?

I think my worry is that people won't engage in care, that people won't actually access healthcare. I mean, we certainly have very big challenges in the healthcare system, in the systems across the country. My worry is that people will be reluctant to actually seek care when they need care because they're not getting the care that they need or they feel that they won't be treated in a humane and decent way.

And that, I think, should be a worry for everyone in Canada. Peggy, talk just finally about that, you know, seeing some hint of light at the end of the tunnel. Do you see that as well? I do, I do. Yeah, in two and a half years in this role in talking to nurses, nurses are very engaged. They have the solutions. We just need to listen to them.

We'll talk again. I'm glad to have you here back on the program. Lee, thank you so much. Thank you for having me. Lee Chapman is Canada's chief nursing officer. If you are a nurse or you have been receiving care like so many of us have in hospitals, we would love to hear from you and your experiences in and around that system that, as we've heard, is in some distress. Can we put it that way?

You can email us, thecurrent, at cbc.ca.