Sharon Tonner-Clarkson never imagined she’d leave her job as a personal support worker.
She’s worked in palliative care in Toronto for nearly a decade. It’s gruelling and emotional work, providing end-of-life care for her elderly clients, but she loves it — so much so she became a coach training new workers in the field.
“I love caring for people, first and foremost, especially at the end of someone’s life,” she says. “I love helping them facilitate the end of life that they want.”
Throughout the pandemic, she kept going to work — amid COVID-19 outbreaks and scares, witnessing colleagues getting sick, daily stress and constant policy changes. She showed up until she couldn’t. She’s now off on stress leave without pay.
“I’ve been doing this type of work for a very long time, but this whole pandemic and this whole situation has just really broke me.”
On her lunch breaks, she’d lock herself in her car, take her mask off and break into tears. One day, she says she just snapped and walked out.
“I left there in such a state I couldn’t even drive my car,” she says. “I couldn’t take it anymore. I had to get away.”
Now, she says she doesn’t think she’ll return to the job she once loved and dedicated her life to.
Global News spoke with other PSWs who said they are experiencing anxiety attacks, heart palpitations, and mental and physical fatigue. Some continue to work out of necessity despite their worsening mental health, while others have left the industry entirely.
In every facet of Canada’s healthcare system people — physicians, nurses, personal support workers and more — are leaving their jobs. Others are sticking it out until the end of the pandemic out of loyalty for their colleagues and patients, but as soon as it’s over, some say they’ll also walk away.
The fear is that there could be a mass exodus among Canada’s health care workers impacting the entire system for years to come. And as the third wave punishes and threatens to overwhelm hospitals across the country, the staff that are left are tired and struggling to keep up.
‘None of it was normal’
“At the beginning of the pandemic, everybody was ready and willing,” says Dr. Neeja Bakshi, internal medicine lead at the Royal Alexandra Hospital in Edmonton. “I remember getting so many emails saying, ‘Hey, I’m ready to come and help.’ I don’t get any emails like that anymore.”
Dr. Bakshi is also in charge of the hospital’s pandemic response and is tasked with scheduling physicians’ shifts on the COVID ward. She says, these days, it’s been harder to fill shifts.
“Everybody’s tired of it. It’s exhausting to work on the COVID unit,” she says. “Now I’m at a point where I feel like a salesman.”
Even the hospital’s new hires out of medical school are looking to take on less, she says.
“On one hand, (you have) a very well balanced physician. But on the other hand, it results in us not being able to staff all of our wards,” Dr. Bakshi says.
It’s a grim reality as hospitals race to increase their capacity to fight the third wave of the pandemic. ICU beds are filling up across the country, patients are younger and sicker, and with no end in sight, this latest wave of COVID cases has been punishing for the staff that remain.
“Your response time, your ability to empathize as much as you did in the beginning, all of that changes as you go through this day after day without any reprieve,” Dr. Bakshi says. “Physicians are exhausted, but I think it’s because it’s ongoing and never-ending.”
Dr. Bakshi actually holds the record for the most days spent on the COVID-19 ward at her hospital. But it’s taken a toll on her.
In January, Dr. Bakshi — who is also a mother of two young children — was diagnosed with post-traumatic stress disorder, or PTSD. It’s a mental health condition that can occur after a person experiences or witnesses a traumatic event.
“December, I describe it as chaos. It was just chaos. There were new patients all the time. There were patients crashing all the time.”
She was spending up to 18 hours in the hospital only to come back five or six hours later. Afterward, she started having difficulty sleeping, having nightmares, and replaying conversations she had with families after their loved ones had died from the virus.
Fatigue and apathy set in.
“My husband said to me, he said, “You’re not yourself. … Maybe it’s time to get some help.”
And that was it. She got help, and now hopes others in the medical field will do the same.
“None of what we went through was normal. We all showed up and did our jobs. … But we’re not OK and it’s OK to say that.”
Multiple physicians and nurses told Global News that in the medical field, people avoid admitting that they are struggling with mental health issues for fear they could have been viewed as weak or incompetent.
“You go through this traumatic event and if you ask for help it can be problematic,” says Dr. Dawn Lim, an emergency physician at University Health Network in Toronto. She says the culture needs to change.
Burnout had also become normalized in the profession, even before the pandemic, Dr. Lim says. But now, with more physically and mentally taxing shifts and changes in people’s home life due to the pandemic, burnout in medicine has reached crisis levels.
“We don’t feel that we as an individual can make a change because it’s such an overwhelming, systematic problem,” Dr. Lim says. “But the only thing you could do right now is to change yourself, how you ask for help.”
Nurses are at their breaking point
More than three-quarters of health care workers who had direct contact with patients who may be sick with COVID-19 reported worsening mental health during the pandemic, according to Statistics Canada.
Birgit Umaigba, a registered nurse who has been working in intensive care units across Toronto during the pandemic, says she’s exhausted and burned out, and it’s impacting the time she does have with her nine-year-old daughter.
“Sometimes I feel like I just zone out. I constantly have to remind myself of my own presence,” she says. “I just feel this weakness and a lot of times I can’t even play with her.”
A month ago she started having nightmares and trouble sleeping. And Umaigba says it’s not just her, her colleagues are experiencing the same thing.
“The amount of dead people we see… The Code Blues, the chaos is really affecting a lot of people.”
Even before the pandemic, nurses’ stress levels and workloads were high. A 2019 study by the Canadian Federation of Nurses Union found that nurses experience “widespread and severe symptoms of PTSD, anxiety, depression, burnout, and suicidal behaviour” at a rate higher than the general population.
Now, the pandemic has exacerbated things. Workloads have increased and nurses are being pushed to their breaking point and people are leaving the profession.
“I’m starting to see people leave … because of the huge, huge mental impact on us.”
A March 2021 survey from the Registered Nurses’ Association of Ontario found the same thing.
An “alarmingly high percentage” of nurses said they were likely to leave nursing for a different occupation after the pandemic, according to the survey. The most worrisome trend, that at least 13 per cent of nurses aged 26 to 35 reported they were very likely to leave — four times the normal rate of attrition for that demographic.
The culprits: being overworked, stressed, and a lack of employer and government support.
“It just put so much burden on us and people are asking, what’s the point?” Umaigba says.
Due to overburdened workloads, nurses are facing ethical dilemmas, explains Denika McPherson, a critical care nurse. Right now, she’s treating patients with COVID-19 while also studying to become a nurse practitioner at the University of Toronto.
“You have nurses that are faced with all these patients and they know their human limitations,” she says. “They’re in an inner turmoil because of this, which is also linked to nurses leaving.”
As hospitals across the country ramp up their capacity, adding new ICU beds to deal with the latest surge of COVID cases, some provinces like hard-hit Ontario are searching for thousands of nurses.
McPherson says investing in nurses is the solution. Hiring more nurses, reducing workloads, and providing nurses with more support would give nurses incentives to stay.
Despite the challenges they’ve faced over the last year, both McPherson and Umaigba plan to stay in the field.
“I actually love nursing,” says Umaigba. “It’s a rewarding profession, but I just really hope that we do have more support.”
Long term impact
Abi Sriharan, a professor at the University of Toronto who studies burnout in the medical field, says Canada’s health care workforce is facing a burnout crisis. This, on top of an already strained system pre-pandemic, is resulting in staffing shortages in every profession.
“You could expand the number of beds, but who’s going to take care of them?” she says. “If we don’t really address the health human resource situation, our system is going to fall apart.”
She says short-term stress leaves will not fix the root of the problem. Changing working conditions, compensation, and providing workers with more support, will.
“We need to rethink how we can recruit more people into the health workforce and then retain them in the workforce so we don’t run into a major health workforce crisis in the next two to three years.”
Dr. Bakshi is “very worried” about the hospitals’ capacity to treat the new, sicker COVID-19 patients they are seeing. There’s also a backlog of people with non-COVID-19-related illnesses seeking care.
“They’re going to need care and that’s going to translate into a system that cannot keep up,” she says. “Whether COVID is here or not, the capacity is still going to be tested.”
Dr. Megan McElheran, a psychologist in Calgary who has worked with military and first responders for two decades, says the situation medical staff have faced over the last year is not unsimilar to what military personnel face during conflicts.
“People are being psychologically injured and impacted while they’re still at war,” she says. “It’s typically not until the war is over that people can actually start to process and recover from what they’ve been through.”
Burnout, emotional exhaustion, compassion fatigue, and vicarious trauma are all on a continuum together, Dr, McElheran says. They’re different conditions, but are all reflections of what can happen when a person is exposed to unhealthy degrees of stress or exposure to trauma.
She says the type of trauma heath care workers are facing is “chronic” and “highly unpredictable,” and that the true mental toll the pandemic has had on workers has not yet been revealed.
“We need to be prepared to be there for the people who have been helping us to get through this,” Dr. McElheran says.
Tips to improve mental wellbeing
Early on in the pandemic, psychologist Dr. Mélanie Joanisse created a mental health resource workbook for health care workers.
She also provides counselling for medical staff at Hôpital Montfort in Ottawa. She says a lot of her clients are burned out and struggling, but that her usual toolkit of coping strategies isn’t available due to COVID-19 restrictions.
“As a mental health professional, you always say, ‘Social support, break isolation, that’s what’s going to help you cope.’ But then you have COVID adding so many layers and barriers to it that can be detrimental in terms of a person’s ability to cope.”
She suggests three things people can do right now to improve their mental wellbeing: identify things you’re already doing well and celebrate that; in the areas where you are struggling, access them in a non-judgmental, compassionate light; and finally, set realistic, specific goals for yourself or do activities that bring you pleasure and do them with the intent of doing something positive for yourself.
There are resources for health care workers available if you struggling right now:
Mental health resource list
Psychological First Aid for Frontline Health Care Providers
COVID-19: Resilience Support Toolkit
Ontario mental health resources for health care workers
CPA psychologists have volunteered to provide services to front line health care providers
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.
The Canadian Association for Suicide Prevention, Depression Hurts, Kids Help Phone 1-800-668-6868, and the Trans Lifeline 1-877-330-6366 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.