Nurses in Canada say working during the COVID-19 Omicron wave has left them burnt out, physically and mentally, and an increase in abuse directed at health-care workers has pushed them to breaking point. According to a report from the Ontario Science Table, pre-pandemic, 20 to 40 per cent of health-care workers reported severe burnout. By spring 2021, rates had climbed to more than 60 per cent.
We asked one Toronto nurse to tell us what a typical shift looks like.
Leah Rosevar has been a nurse for 10 years and now works in triage in the emergency department at a downtown Toronto hospital.
This is the story of a Thursday night shift in January, as told to Ashleigh Stewart.
7 p.m.: I hide my badge as I walk into the hospital
I am tired and groggy when I pull into the hospital parking lot. It’s already dark.
The hospital looms in front of me; a hulking, grey mass. Just the sight of it makes me feel nervous, stressed and apprehensive.
I didn’t sleep well last night, again. I had another stress dream about work — the same kind I’ve been having since 2019. Either I’m reliving something I experienced that day, or everything is going wrong and I can’t keep up with the volume. I once chipped a tooth during one of these nightmares. I wake up with tension headaches. I hear call bells in my sleep.
I drive to work because it’s easy, but now it’s also for safety. In recent weeks, the abuse colleagues have been subjected to in public has really escalated. I take precautions now, too: hiding my badge as I get out of my car to pay my parking and going through the back door into the hospital, keeping my head down as I walk. If I leave after 11 p.m., I ask security to walk me out. It’s just how it is now.
I walk into the emergency department (ED) to start my shift with a knot in the pit of my stomach. It’s chaos, as usual. A man is yelling something nonsensical. People are arguing. Some are walking around with their masks half-on, or not on at all.
7:30 p.m.: My shift begins in chaos
I meet with another triage nurse to take the report from the dayshift staff; they tell us about the people in the waiting room and who should be prioritized.
People often belittle nurses or consider us unimportant. But I am the eyes, ears and heart of the health-care profession. I have four years of training under my belt to be able to systematically assess and determine which patients are “the most sick” and need to be seen first. My only goal is to ensure you get the highest standard of care.
Tonight, we’re two nurses short, which means eight beds can’t be used due to patient/nurse ratio rules. This isn’t uncommon.
The waiting room is full tonight, as it always is these days. COVID has contributed to this, but it’s not the reason most people are here. Many test positive while coming in with other complaints.
Omicron has clogged the hospital in many ways. More mildly sick people are coming in, because they’re worried about having COVID, but there are also more really sick people coming in – because they’ve delayed treatment because they’re worried about catching COVID. There are also higher numbers of post-op complications because people are being discharged too soon, to free up beds.
Patients are stuck on stretchers in the hallway
Tonight in the waiting room, we have one male with chest pain needing an urgent ECG to check cardiac activity; an elderly woman who fell and likely has a hip fracture, lying in a hallway on an offload stretcher by a sliding door that every single patient has to walk by; a mental health patient with suicidal thoughts and four unresponsive patients suffering likely fentanyl overdoses.
Two of the latter four patients have to stay with EMS (ambulance) crews because there are no available hospital stretchers and all the patient care rooms are full. Not only does this prevent EMS crews from getting back on the road, but their stretchers are also incredibly narrow and hard, so it’s not a nice experience for the patient.
Offload delays like this happen a lot; sometimes patients wait for a few minutes, sometimes several hours. One night, not long ago, a 60-year-old man lay on an EMS stretcher for six hours before we could get him a bed.
There’s also a high volume of other ‘lower-risk’ patients: three young, healthy people with abdominal or chest pain, several finger lacerations, a request for a COVID swab, people with cough/cold symptoms, some lower extremity injuries, one person with a headache, one with UTI symptoms, someone with a foreign body in their ear, several patients in early pregnancy with vaginal bleeding or pregnancy complications and several others who are homeless or had been kicked out of shelters.
This, right here, is the battleground of the hospital.
I face abuse and harassment on every shift
After I’m logged into the computer software, I start triaging patients.
Patients are screened for COVID when they come in with a questionnaire, but only tested if they are admitted. We try to isolate patients with plastic dividers, but it’s virtually impossible to socially distance when it’s this busy. This also makes people angrier — we get yelled at for the distancing rules and for not allowing visitors.
Half of the patients I try to screen tonight fail or refuse to answer my questions.
Because of ongoing construction at the hospital, our ED is also split between the ground floor and the 17th floor to make up for space we’ve lost. It makes everything so much harder.
At 9:30 p.m., a patient approaches the desk asking how much longer his wait will be. I try to explain that there’s no way to know, because of how many different factors affect this. His response is to yell at me and to tell me he’s been waiting 54 minutes and his family doctor told him to go to the ED “right away.”
I used to get scared when people started yelling at me like this, when you see the signs of a situation escalating. But lately, we’ve come to expect it. I am abused on every shift. People tell me I’m too young, make sexist comments, call me a b–ch – things like that. A lot of my colleagues have had racial insults hurled at them. Earlier this evening, one of my colleagues was told to “get back on the boat.”
Management had to fix the vital sign monitor to the wall because people kept picking it up off the floor and throwing it at us.
On one of my shifts in the mental health unit, the worst insult I got was a patient telling me to go to hell and that I’m boring. That was one of the nicest days I’ve ever had at work.
10 p.m.: People keep coming in, but there's no space
At 10 p.m., the EMS supervisor calls me, upset, because there are now multiple patients on offload delays with paramedics, stopping ambulances from getting back on the road. But the ED is gridlocked — there’s still a heavy volume of patients coming in and several people needing cardiac monitoring, which requires special patient beds and a specialist nurse. There’s nowhere for anyone to go.
The elderly woman who had a fall is still waiting on a stretcher in the hallway. The doctor has assessed her and ordered pain medication and X-rays, but the medication hasn’t been provided yet. We’re not supposed to give narcotics out in waiting areas where patients can’t be closely monitored.
The woman needs to go to the bathroom, but cannot safely get out of bed. We can’t use a bedpan, because there’s no privacy in a waiting room.
One resuscitation room is free, which is only supposed to be used for the sickest of patients, but because we’re so short of beds we often have to use them for moments like this.
We decide to move her in there, but as we’re preparing her, the phone rings to tell us a patient is coming in needing urgent care. The woman with the hip fracture must stay in the hallway.
In moments like these, I feel a sense of guilt and failure. I know she deserves so much better, but I can’t provide it. This happens every day. It’s morally distressing.
On arrival, the urgent patient, a young man found passed out downtown with significantly altered mental status, is lifeless. He’s quickly triaged and taken into the resuscitation room. Because he cannot open his eyes or speak on command, and is not responding to painful stimuli, several nurses and a physician have to assist, leaving other care areas without their assigned nurses.
It’s 11 p.m. and the evening shift staff have gone home now, leaving us even more short-staffed. I am now alone at triage.
The waiting room remains full.
1 a.m.: The police show up
Due to the lack of staff, and the resources required in the resuscitation room, movement within the ED is now virtually at a standstill.
One of the substance abuse patients who was passed out on a waiting room stretcher has gotten up and walked to the bathroom steadily, meaning he can now be moved to a chair or leave willingly — freeing up a bed. But he has nowhere to go. He says there are no shelter beds available, so we hold them overnight for social work to see in the morning.
Just after 11:30 p.m., a room finally becomes available for the hip fracture patient. By this stage, she’s wet herself. She’s embarrassed and apologizes for being a “burden.” I try to help get her cleaned up but I need to get back to triage.
There is nothing dignified about being treated this way. We, as nurses, carry the weight of that, too. We know the patient deserves better but resources are thin and we genuinely are trying to do the best we can.
It’s now 1 a.m., otherwise known as the time when things get really crazy. I’m almost six hours into my shift and haven’t had any kind of break yet.
We’ve had six ambulances arrive in the last two hours, mostly bringing people in with substance abuse or mental health issues. We don’t have enough security to release them, so police officers are now stationed in the waiting room too. One patient in their custody is a suicide risk and the other is homicidal, restrained and yelling profanities.
Tired patients take frustrations out on nurses
A couple of patients finally have a bed assigned and can now be transferred to an inpatient room, but the receiving nurse is on her break, so the ED stays gridlocked. That happens a lot – space frees up but the workload doesn’t slow down because of staffing issues. It’s a constant balancing act.
Several patients await imaging (there is only one ultrasound tech overnight for three hospitals) or await images to be read by the radiologist. Many other patients are awaiting consults from other specialties, such as gynecology — but the sole gynecologist is upstairs delivering babies, so these patients wait hours. They are tired, hungry and uncomfortable and they take their frustrations out on the nurse. We try to keep them calm but the negative comments don’t stop.
By 2 a.m., the waiting room is full of homeless patients with nowhere else to go, attempting to escape the cold with minor complaints, and people with substance abuse issues sleeping off near overdoses.
There are a few other severely unwell patients still waiting to be seen and one in the throes of a mental health crisis. A few patients start arguing with each other, requiring security to step in. A patient slams the ED’s bathroom door, knocking it off its hinges, and runs out of the department.
3 a.m.: The break room is 'full of cockroaches and mice'
I finally get my break at 3 a.m. We’re supposed to get two breaks in our 12-hour shift (one 45-minute paid and one 45-minute unpaid) but we tend to take them at once to make it easy on everyone.
I take a container of leftovers into the breakroom. The room is disgusting — it’s full of cockroaches and mice and never gets above 17 C, so we all wear jackets inside.
I feel tired, stressed out and dehydrated. There are ulcers on my ear from the personal protective equipment (PPE) and I have terrible acne from wearing a mask all day. I am miserable; mentally and physically drained. My tank is on empty, and it has been for months.
I am too wired to try to take a nap, running through all my patients in my head and trying to remember if I missed something.
I get back from my break and direct a sexual assault crisis nurse to the room of a victim we triaged earlier. Usually, by this time, the waiting room would be a lot quieter. But with the cold, COVID and the lack of shelter beds, it stays busy throughout the night.
Code White: A patient assaults a doctor
At 5 a.m., I hear yelling. A patient has been issued a Form 1, meaning the doctor thinks they need to be assessed by a psychiatric facility and cannot leave. The patient is angry and is threatening the doctor. Then she shoves him in the chest. The doctor stumbles back but stays on his feet.
One of the staff presses their panic button (we’re all required to carry one) and a Code White is called. Security comes to escort the patient to a room. The nurses try to de-escalate the situation while the physician orders medication.
Again, I’m no longer scared in these situations. I’m pretty desensitized to it because it happens so often. But it’s emotionally distressing, because it feels so unnecessary. If we had more resources, we could monitor patients enough to prevent those outbursts.
It’s now 6 a.m. Time to reassess the homeless patients who have been sleeping in the waiting room overnight. We give them TTC tokens but several don’t want to leave. But because they don’t have any medical issues, we have to escort them out.
One patient becomes violent and punches a security guard while being helped to the door. Another Code White is called. More security arrives to escort him out of the hospital.
7:30 a.m.: Shift over, I want to quit
At 7:30 a.m., after triaging another elderly patient who had a fall getting out of bed, my shift is over. I give my report to the incoming triage shift and leave exhausted and hungry, with red marks all over my face from the PPE.
I can’t wait to get home to sleep. But the fact that I have to come back and do this all again in 12 hours gnaws at me. Our roster is two days shifts, two night shifts, and then five days off. It sounds like a lot of rest time, but most of that is spent just recuperating from the trauma of the week.
I want to quit, every day. I love nursing, I just hate what it’s become. It’s a constant emotional tug of war.
Nursing is a calling. It takes years of training, skill and practice to become a competent nurse. I’ve worked so hard to get here and I finally feel confident in my skill set.
But the COVID pandemic has exposed the fragility of the Ontario health-care system and it is collapsing.
Constant nursing shortages mean additional stressors that, along with a pandemic, jeopardize patient safety and standards of care.
The clapping and pot banging was nice, back when people liked us, but “sincerest thank you”s do not pay bills. They do not cover the trauma experienced on the job.
My take-home pay last year was about $52,000. Most of my nursing friends have a second job.
My colleagues and I are mentally, physically and emotionally tired. The stress comes home with us. It affects our relationships. We are at a breaking point.
Medicine is a team sport and most of our players are injured or have quit because of unsafe working conditions, unrealistic demands and now, being abused for trying to keep people safe.
And still, I feel a huge sense of guilt. I feel like I’m letting the public down. I can’t provide the care that people deserve and it leaves me feeling unfulfilled; like a failure.
We have, for years, been told to do more with less. But we can’t anymore. We have nothing left to give.