Healthcare workers facing violence, PPE shortages, burn-out

It’s not enough to call them “heroes”, we need to listen to their voices – and act

Healthcare workers facing violence, PPE shortages, burn-out
The lack of PPE in the workplace could be a stressor for healthcare workers, alongside the threat of violence…

As we move into the tenth month of the pandemic (the first official case of COVID-19 in Canada was declared on Jan 25), healthcare workers – frontline, essential workers – have been engaged in a battle with the virus that seemingly has no end in sight.

Healthcare workers on the frontlines have been tirelessly working to contain the spread of the virus and treat those infected, nevertheless there have been alarming reports of violence towards frontline workers increasing amid the pandemic.

Moreover, healthcare workers are a high risk of contracting the virus themselves. Since the initial outbreak, infection levels among healthcare workers in Canada have consistently been high. According to data from the Canadian Institute for Health Information (CIHI), as of July 23, 2020, healthcare workers made up 19.4 per cent of the total cases of COVID-19 in Canada.

Access to PPE

Early on in the pandemic, healthcare workers were plagued by massive PPE shortages. This was not just a problem affecting Canadian workers, but workers on a global scale as the demand far outweighed the supply. It seems as if, sadly, this is an issue which healthcare workers continue to face, despite provincial and federal efforts to increase supply.

The Canadian Medical Association (CMA) published the results of a survey it conducted at the end of the summer. The CMA found that 54 per cent of physicians continue to encounter challenges when trying to acquire PPE. 68 per cent of those surveyed said that they worry that suppliers will not have sufficient stocks of PPE and 62 per cent of respondents expect orders to be delayed.

Commenting on the results, Dr. Ann Collins, CMA president, said “we continue to see outbreaks throughout the country and with resurgences of COVID-19 now before us, it's imperative that governments ensure our front-line workers are protected, not only in hospital settings but also in community practice settings, as they form our first line of defence against this pandemic.”

Indeed, as we now enter the second wave of the pandemic and approach influenza (flu) season, access to PPE is more important than ever. Access to flu vaccines is also a concern among physicians. 86 per cent of physicians surveyed by the CMA said that they were concerned that the flu season will put an additional strain on the healthcare system.

Long-term care

In addition, long-term care homes throughout Canada, though especially in Quebec and Ontario, have been the scene of endless outbreaks. Under Operation LASER, the Canadian Armed Forces (CAF) deployed medical personnel (nurses, medical technicians, etc.) in long-term care homes throughout Ontario to assist with worker shortages. Following an inspection, the CAF released a report on the state of long-term care homes, which premier Doug Ford described as “gut-wrenching”.

In July, Ontario announced that it would invest $1.75 billion in funding over five years to improve the conditions of long-term care homes.

This is a large concern for unions, with the Ontario Public Service Employees Union (OPSEU) making various statements, as well as the Registered Nurses’ Association of Ontario (RNAO), who released a report entitled Long-Term Care Systemic Failings: Two Decades of Staffing and Funding Recommendations which details troubles in the province’s long-term care sector since 1999.

Indeed, it seems as if COVID-19 has exacerbated issues in the sector that have actually been simmering for years. Professor Jim Brophy of the University of Windsor describes long-term care as a “tinderbox”.

“We did two studies on violence,” he says, “and the second one was specifically on long-term care. We asked people to describe their workday and it was unbelievable. These working conditions have been deteriorating, and they’ve been deteriorating in an atmosphere in which healthcare workers feel their voices and their concerns are not being heard.”

Mental health

It is perhaps no surprise, then, that healthcare workers in Canada may be developing mental health issues. The lack of PPE in the workplace could be a stressor for healthcare workers, alongside the threat of violence (which existed before the pandemic) and systemic issues which pre-date the pandemic such as with the long-term care sector.

Brophy says that while the pandemic itself is novel, from the point of view of healthcare workers it’s something they know, from their experience with SARS for instance (during the 2002 – 2004 outbreak). Even before COVID-19, Brophy says with regards to healthcare workers, “their day to day real life experience was that they felt powerless […] with little or no support – and even the fear of reprisals, that if they said anything public about it they would be fired or disciplined.” The pandemic has reinforced these feelings in a dramatic way, he says.

He says that workers may not feel protected, may feel powerless and may feel as if they don’t have adequate support. Brophy also raises the point that financial concerns are an additional stressor for those with lower salaries and few (or no) benefits.

This is why, Brophy says, “the level of demoralization, of burnout, is very, very high.” With the pandemic, he says, “you have an already demoralized workforce being asked to put their own lives on the line without adequate support.”

What can be done to address these issues? With the current climate, it may be hard to build a precise plan. Nevertheless, being in the midst of a second wave, it is essential now more than ever to give healthcare worker the support they need. Efforts need to be made on a provincial, territorial and federal level – not just for the pandemic, but for the foreseeable future.