A June 2023 BC Nurses’ Union rally celebrates the government agreeing to minimum nurse-to-patient ratios and raising awareness for unsafe working conditions, such as workplace violence.

Image Credit: Michelle Gamage, Local Journalism Initiative

Union leaders say B.C.’s health-care workers have seen some minor improvements but there’s a long way to go before they feel respected, valued and safe.

The Tyee spoke with leaders from the BC Nurses’ Union, which represents 48,000 members; the BC General Employees’ Union, which represents 90,000 members, of which 20,500 work in health care; and the Hospital Employees’ Union, with more than 60,000 members.

Health-care workers are still feeling overworked, undervalued and pushed towards burnout, both leaders said.

BCGEU, which represents health science professionals such as social workers, counsellors, care aids and administrative staff in facilities, says members are starting to see some workload relief as provincial programs that focus on recruitment and retainment increase staffing numbers in remote and rural areas, said Scott De Long, vice-president of community health with the BCGEU.

Lynn Bueckert, secretary-business manager for the Hospital Employees’ Union, said, “The last couple years have been tough,” but that investments in health care are starting to show some benefits for workers.

She said initiatives having a positive impact include rural retention initiatives, investment in hospitals and the addition of thousands of new care aides through health care assistant programs.

Nurses are similarly hoping for workload relief this fall, which is when the province said it will move ahead with implementing nurse-to-patient ratios regulating the total number of patients a single nurse looks after, said Adriane Gear, president of the BCNU.

There are around 6,000 unfilled full-time nursing positions in B.C. and even more vacancies when you take into consideration sick leave or short-term leave, Gear said.

The implementation of nurse-to-patient ratios will increase the nursing shortage because more nurses will be needed to meet the minimum staffing requirements, she said. A growing population is also adding to the demand for nurses.

The nursing shortage was not caused by the current government, Gear said, but rather “because of policy decisions made by previous governments.”

“Contracts were ripped up in the early 2000s for health-care workers.... I learned about [the nursing shortage] in nursing school 30 years ago,” she added.

In 2018 the BC NDP repealed BC Liberal legislation implemented in 2002 that was designed to cut health-care costs by allowing health-care jobs to be contracted out to non-unionized third-party businesses.

More than 8,000 union workers, many of the members of the Hospital Employees’ Union, were estimated to have lost their jobs due to bills 29 and 94, and those who remained saw their wages almost halved.

Since the legislation was repealed by the BC NDP, around 5,000 health-care workers are once again directly employed by the government and health authorities. Wages have increased but have not returned to their 1990s levels, nor have they kept up with inflation. The Hospital Employees’ Union says it is continuing work to return thousands of its members to direct employment by health authorities.

Gear said it’s very easy to point fingers at leaders and be critical of how they governed during the COVID-19 pandemic, but “considering what they were left to deal with, considering the pandemic, I think that they are demonstrating a commitment to a public health-care system,” and that leaders made the best decisions they could based on the information that was available at the time.

Despite the NDP’s attempts to address the problem, nurses today are facing “impossible workload situations” where staffing isn’t adequate to provide essential care for patients, Gear said.

“It’s not once in a while you have a really tough shift,” Gear said. “It’s this habitual chronic situation where it’s the exception, not the rule, that you have enough staff.”

This creates physical fatigue and moral distress for nurses and impacts the care patients receive.

Sometimes empty shifts are being filled “with nurses that actually don’t have the required qualifications, additional education or training” to take over the position, Gear said.

This could include a nurse hired on to a surgical unit being redeployed to the emergency room.

“We wouldn’t do that with a pilot,” Gear said. “We wouldn’t say, ‘You’re flying this type of plane and, surprise, tomorrow you’re going to fly a jumbo jet — but don’t worry, a plane is a plane, right?’”

Even with redeployed nurses, most facilities are still working short-staffed, she added.

In smaller communities and long-term care facilities, Gear said, this can mean nurses work back-to-back 16-hour shifts because they know there is no one to relieve them. If they clock out at the end of their shift, their community is left without a health-care provider.

BCGEU members are similarly overworked and are regularly operating in “crisis management” scenarios, De Long said.

Community health workers might drive between communities to see patients but only get 15 minutes with each patient, or will spend precious time searching for parking spaces in urban settings, De Long said. They’re also responsible for paying for any parking tickets they incur, he said.

Scheduling might send them back and forth across town several times in a day but, in fairness to the schedulers, they were likely given 60 patients to reschedule at the start of their shift because someone called in sick, he added.

There’s also the emotional toll of working with a population that uses substances, he said. Twenty years ago, if you saw someone lying down you might think they were taking a nap in a park, but today you have to immediately go into an emergency response mode and be prepared to try to reverse an overdose.

BCGEU workers feel “trapped and stuck” because there’s little room for upward mobility in their careers, De Long said. The province is overlooking an experienced workforce that has dedicated its commitment to health care, he said.

Why not introduce programs to, for example, train outreach workers to become social workers? Without government support, outreach workers can’t afford to stop working and pay for school to advance their career, he said.

No break after COVID

Nurses and health science professionals are exhausted after working through the pandemic and have yet to catch a break, both union leaders said.

“Nurses went to work every day and had to perform under some really difficult circumstances,” Gear said. “We’ve moved to the other side of the pandemic but working conditions have not improved. If anything they’ve gotten worse in some ways, primarily because we don’t have enough nurses.”

BCGEU workers weren’t allowed to work remotely even though their jobs could have been done from home, De Long said.

The government also “missed the mark” when it came to debriefing employees after the extremely stressful early years of the COVID-19 pandemic, De Long said.

“People were living in a state of hyper-vigilance at all times,” he said. “They were told to mask up and go deliver the care needed, while being worried about running out of personal protective equipment. Community health workers were given two to three masks to last them for the week.”

De Long said workers were sent a letter thanking them for working through the pandemic.

“What an empty feeling when you gave your heart and soul working countless hours of overtime to get through the crisis — and you get a letter that says thank you. That’s it. There’s not a sense that the employer sees the value of our workers,” he said.

De Long said he’d like to see more supports for workers, such as implementing 10 sick days for all instead of five, expanding the Health Career Access Program to create opportunities for upward mobility and allowing work-from-home flexibility when possible, and to debrief what worked and didn’t work during the acute COVID-19 years.

“Who knows when the next pandemic will come around and there’s valuable lessons to be learned,” he said.

Temporary solutions taking away from permanent ones

To deal with the nursing shortage, B.C. has been relying on agency nurses.

Agency nurses work for private companies and sign contracts for positions at public health facilities but are not employed by the health authority. This gives them more autonomy over their schedule, pays more hourly and protects them from being redeployed, Gear said.

Gear said the government’s reliance on agency nurses is “hugely problematic for the nurses currently in the system.”

Everyone is happy for the extra set of hands, but “we’re creating a two-tier staffing solution” that improves things for private agency nurses but not for public health authority nurses, she said.

“If health authorities and government are willing to pay all this additional money towards agency nursing, then why not invest in creating better working conditions and retention initiatives for existing nurses?” Gear asked.

Gear also takes issue with the “privatized nursing” strategy that allows for-profit companies to “take advantage of the situation and charge taxpayers an exorbitant amount of money, which doesn’t all get passed on to the nurse.”

What the BC NDP has gotten right

Gear said “many, many nurses” report workplace abuse, aggression or threats from patients or patients’ families weekly or even daily. To improve workplace safety, the government brought in relational security guards, which has improved workplaces, she said. Not all facilities have security guards, she added.

The BCNU negotiated nurse mentors during their last collective agreement and “it’s proven to be extremely successful” when an experienced nurse is able to support new grads or internationally trained nurses, Gear said.

Nurse-to-patient ratios are attracting nurses to B.C. — the government just needs to move ahead with implementing them, she added.

“We can improve the health-care system. We can improve the conditions of work, which ultimately improves the conditions of care,” she said.

De Long said the current government engages with unions more than previous governments.

“It doesn’t mean we get what we’re asking for all the time, but they are listening and that makes a difference,” he said.

— This story was originally published by The Tyee.

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