Two nurses at a health clinic in Joliette, Que., were fired Tuesday afternoon after an Atikamekw woman revealed they had taunted her with racist insults.
The incident occurred in the same regional health network where, six months ago, another Atikamekw woman — Joyce Echaquan — died not long after recording the racist treatment she received from hospital staff.
Jocelyne Ottawa, 62, said she was treated with disdain by two nurses at the clinic in Joliette, about 70 kilometres northeast of Montreal, which she visited last Friday to have a bandage changed on her foot.
“One of them told me, when she saw my name in the folder: “We’re going to call you Joyce, for short,’ Ottawa recalled in an interview with Radio-Canada.
“Then they asked me if I could sing them a song in Atikamekw.”
Ottawa also said that one of the nurses took her cellphone and that, when Ottawa realized it was missing, the nurse said: “I have it in my hand.” Ottawa told her: “You have no business looking at my cellphone.”
Firings meant to send message, health authority says
Ottawa said she felt humiliated and intimidated and, later, posted a message on Facebook about her experience.
“I told myself: ‘Why are they saying this to me? Is it to mock Joyce, once again?'”
The regional health authority, the CISSS de Lanaudière, which operates the clinic and the hospital, initially suspended the nurses without pay pending an investigation.
In a statement released late Tuesday afternoon, the health authority said the nurses had been fired.
“The comments made by the two employees showed a disregard for the code of ethics of the nursing profession and the code of ethics of our organization,” Caroline Barbir, the interim head of the CISSS de Lanaudière, said in the statement.
“The CISSS de Lanaudière has a zero-tolerance policy about behaviour that is racist, discriminatory and intimidating. I want that message to be heard loud and clear.”
Ottawa’s revelations renewed concern about the way Indigenous people are treated by health-care workers in Joliette and across Quebec.
Echaquan died in the hospital after she used her cellphone to film staff making derogatory comments about her. The video, which was posted live to Facebook, was shared around the world.
The previous head of the Lanaudière health authority was removed from his post last December in the wake of Echaquan’s death.
Quebec’s Indigenous Affairs Minister Ian Lafrenière said Tuesday it’s clear there is more work to do. But he maintained the government’s controversial position that systemic racism does not exist in the province.
Change will take time, he said, and training will need to be implemented across the province and even then, attending a course won’t solve everything.
“I’m so sorry. I’m so shocked. I’m so disappointed … Can we guarantee that it won’t happen again? The answer is no.”
The two nurses who were fired were among more than 4,200 CISSS employees who attended a cultural safety awareness session, an approach put in place in November. Further training is planned for health-care professionals across the province.
Nancy Bédard, president of the province’s largest nurses union, the FIQ, said her organization is committed to the fight against violence and racism, whether based on gender, race or cultural background.
“We strongly denounce any gesture and any behaviour conveying intolerance or racism. “
The case for Joyce’s Principle
For Sipi Flamand, deputy chief for the Atikamekw Council of Manawan, the latest incident is further proof the province must adopt what is called Joyce’s Principle, which aims to guarantee that Indigenous people have equitable access to health and social services without discrimination.
“As long as Joyce’s Principle is not adopted, there will still always be systemic racism and the Quebec government has the obligation to recognize it,” Flamand said.
Ottawa said she returned to the clinic on Monday, despite being unsettled by her earlier experience.
“I have no choice. I need care,” she said.
“I’d like to tell them that we, Indigenous people, are human beings in our own right. And we have a right to get the same care as any other individual no matter their race.”
Ontario’s nursing regulator says it is investigating two nurses who travelled to Washington, D.C., last week to attend a rally by a group of their peers that has made unsubstantiated, conspiratorial claims about “COVID fraud” and hospitals’ alleged role in misrepresenting the coronavirus pandemic.
Kristen Nagle, a neonatal ICU nurse from London, Ont., and Sarah Choujounian, a registered practical nurse from Toronto, travelled to the United States last week despite current public health directives to avoid all non-essential travel in order to help mitigate the spread of the novel coronavirus.
The College of Nurses of Ontario confirmed the two nurses, who have participated in events protesting COVID-19 public health measures in Canada, were already under investigation and said it is aware of their recent trip to D.C. to attend an event organized by Global Frontline Nurses (GFN).
The group’s members claim hospitals around the world are misreporting cases of the virus and needlessly placing patients on ventilators and diagnosing people with COVID-19 in order to make money off the crisis.
“I can advise that CNO is investigating these members and that we are aware of the information indicated,” said spokesperson Angela Smith in response to CBC News questions about the investigation.
Smith said regulations prevent the college from providing details on the status of the investigation.
Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, calls the views promoted by Global Frontline Nurses “pure conspiracy theory.”
“It’s damaging because what people need is factual information,” Grinspun, who has filed a complaint against Nagle with the college over her past activities, said in an interview.
“When you hear this from one of your own, and in this case, two of our own, one RN and one RPN, it’s shocking.”
GFN’s members gathered on the steps of Capitol Hill in Washington, D.C., on Jan. 6 hours before thousands of supporters of U.S. President Donald Trump descended on the Capitol to try to stop the certification the presidential election results by violently overwhelming police and storming into the building.
According to a press release issued ahead of the GFN event, the intent was to “share insight about COVID fraud and corruption inside hospitals.”
Attended past anti-mask events
Nagle and Choujounian have attracted the attention of American media for attending the GFN event at a time when the U.S.-Canada border is supposed to be shut to all non-essential travel.
The two nurses are no strangers to public controversy. Both have participated in rallies against wearing masks and government-mandated lockdowns during the COVID-19 pandemic.
Since that rally, Nagle has been placed under investigation by the college and her employer. A spokesperson for LHSC said she will remain on unpaid leave pending the results of the hospital network’s probe.
Erinor Jacob-Levine told CBC News in an email that LHSC is aware of Nagle’s trip south of the border.
“We want to assure our community that we take this situation and the new events that have come to light very seriously,” Jacob-Levine said.
“While we are not able to address the specifics of an internal investigation due to privacy, safeguarding the health of our patients and their families, staff and physicians is of the utmost importance and remains our top priority.”
Toronto nurse says she was fired from nursing home
Choujounian currently works for S.R.T. MedStaff, according to the Ontario College of Nurses. The company describes itself as “a leading provider of nursing and personal support services to over 30 hospitals in the Greater Toronto Area.”
Carolyn Acton, vice-president of patient services and operations at S.R.T. MedStaff, said in an email that the company could not discuss Choujounian’s travels because of privacy considerations.
However, she said policies are in place to prevent staff who have travelled outside the country from coming in contact with patients.
“Currently, any staff who has travelled outside of Canada is required to self-isolate for 14 days and to contact Public Health,” Acton wrote. “At the end of the 14 day isolation period, we re-screen staff and also require that they are cleared by Public Health prior to being reinstated for work.”
A YouTube video shows Choujounian telling a crowd at an anti-lockdown rally in Toronto in November that she was fired from her job at Norfinch Care Community, a nursing home in the North York neighbourhood of Toronto, for “speaking the truth” and sharing her opinion about the pandemic online.
Sienna Senior Living, the company that owns Norfinch Care Community, confirmed to CBC News on Monday that Choujounian is “no longer an employee” at the nursing home but wouldn’t provide further details, citing privacy reasons.
Nurses facing ‘death threats and harassment’: GFN
Jeff Louderback, a spokesman for Global Frontline Nurses, confirmed the two Canadian nurses attended the Jan. 6 event but told CBC News via text message that Nagle and Choujounian were “not available for interviews” because they have been subject to “death threats and harassment.”
CBC News attempted to contact Choujounian on social media and received no reply.
Attempts were also made to reach Nagle through her social media accounts and through her brother on social media but were unsuccessful.
The nurses documented their trip and the GFN event on social media.
A group of nurses, including two who are now under investigation by Ontario’s nursing regulator, gathered in Washington D.C. last week. Video captured from the Instagram account of Kristen Nagle of London, Ont. 1:58
They were seen together with other GFN members in one video posted on Nagle’s Instagram account last week. The video was made private following media reports about the trip but was seen by CBC News while it was still public.
In the video, Nagle and Choujounian are seen with at least five other people, none of whom are wearing masks, inside what appears to be a hotel room.
They recount attending a Trump rally that was held last Wednesday south of the White House before some of the supporters moved to the Capitol.
“I keep getting messages wondering if we’re OK. We are all safe,” Nagle says in the video before passing her phone to Choujounian, who talks about carrying a pro-Trump flag for fear of being mistaken for a supporter of the far-left group Antifa because she was dressed all in black.
Turning a desperately ill COVID-19 patient onto their stomach may seem simple enough to the uninitiated. It’s not.
In this case, at Quebec City’s Hôpital de l’Enfant-Jésus, it requires a total of seven people crowded around an intensive care bed.
We often hear about how demanding it is for hospital staff and long-term care workers to handle the added workload foisted upon them by the coronavirus pandemic. Here’s just one illustration.
After draping a sheet over the patient, the edges are rolled into the sheet underneath. A pair of pillows are now snug to his chest, and the rolling begins. First, the patient is slid to the edge of the bed. On three, he’s turned to his side. Another three-count, and he is softly delivered onto his stomach.
The room empties. Everyone has work to do.
The Quebec capital has seen a massive spike in coronavirus infections in recent weeks, and a trio of nurses say they’re worried by members of the public trivializing the illness.
To help convince people to take the coronavirus more seriously during the upcoming holidays, they opened their doors to Radio-Canada.
Their names are Cathy Deschênes, Jennifer Boissonnault and Lindsay Vongsawath-Chouinard. Their aim: to show what life in the hot zone looks like.
Each of them agreed to wear a small camera so the public could see how a typical day unfolds. They filmed their colleagues and their patients, and illustrated how the pandemic has made the job harder and more complex.
(scroll up to view the video)
Their point is not to elicit sympathy. As Deschênes says: “It’s difficult, but we love our jobs.”
Instead, they want to show the devastating path some COVID-19 patients are called upon to travel: patients who require more and more staff at their bedside, and need ever larger amounts of treatment time.
And each one of those treatments involves special planning and safety equipment. The ICU rooms have sliding doors, which makes it easier to maintain hot, warm and cold zones. And maintain them, they must.
Each shift has a nurse in charge of making sure the hygiene procedures are being followed and that personal protective equipment, like N95 masks and shields, is worn correctly.
“No one in our department has contaminated themselves (with the virus), we’ve had no outbreaks in intensive care and we’re very proud of that,” Boissonnault says, at one point.
The average age of the COVID-19 patient in the unit is between 60 and 75.
The province has 390 intensive care beds dedicated to COVID-19 patients (20 for pediatric cases), and Enfant-Jésus, in the Maizerets area northeast of downtown Quebec City, accounts for 22 of them.
The unit is not short of business.
Of the 610 COVID-19 patients the hospital has treated so far this year, 90 were in intensive care. And 144 people who entered the hospital with the disease never made it home.
To work in an intensive care unit is to accept that not every patient can be saved, but COVID-19 is rough even for a group of people who must become inured to tragedy.
Public health restrictions mean it’s often not possible for patients’ relatives to be by their bedside, so when things take a turn for the worst, the only hand to hold usually belongs to a nurse, orderly, doctor or other staff member.
At one point, a family is forced to make the devastating decision to halt treatment on their intubated loved one. Two nurses each hold a hand as he is prepared for ‘comfort care’ — palliative measures.
“We’re with you sir,” says Boissonault, holding his left hand. “We’re taking care of you.”
The typical hospital stay for a COVID-19 patient lasts 17 days, but in the ICU sometimes it can stretch to 40 or beyond. Attachments form. When someone dies, there are often tears. There have been weeks when that happens four or five times in just one section of the unit.
People infected with this virus can sometimes take a sudden, catastrophic turn.
“To give comfort to a patient whose family can’t be there with them in their final moments, to be the ones who take their hands in ours during their final moments … it’s troubling,” says Vongsawath-Chouinard, her voice cracking.
So when there is good news, it is celebrated.
Recently, a patient from the Saguenay called Daniel Bouchard made enough progress to be released from the unit to a regular COVID-19 ward in the hospital.
It was his 65th birthday. He had been there eight days, some of them touch-and-go.
The nurses and medical staff got him a card and a small cake. He thanks them in a raspy voice and is overcome with emotion, weeping in his wheelchair as a nurse rubs his shoulders.
“Your tears say a lot,” Boissonnault says.
Safety measures oblige, the gathered staff had to sing Happy Birthday from the next room.
“Thanks so much, you’ve been an all-star team,” Bouchard says.
Minutes later, it is time to leave. Outside the room, scrub-wearing staff line the hall.
(WARNING: This story contains graphic descriptions that may disturb or offend some readers.)
There are close to 450,000 nurses in Canada. Some work in hospitals, some in long-term care homes, some are privately hired, but they all share one commonality. Since the beginning of COVID-19, they have been on the front lines of an international pandemic that has taken more than 1.4 million lives worldwide, including 12,000 in this country.
The work they’ve done has been arduous and a risk to their personal safety and health, but they have persevered. The National talked to three nurses in three different provinces about their experiences, and these are their stories.
Clarice Shen, Toronto
Clarice Shen, 25, is an acute care nurse at Toronto’s Sunnybrook Health Sciences Centre. In January, just a year out of nursing school, she was caring for a patient who was exhibiting symptoms of a virus that didn’t even have a name yet.
He turned out to be the first patient to test positive with COVID-19 in Canada.
“There was a lot of uncertainty, but as a team, we kind of came together and supported ourselves,” Shen said.
When it became clear the hospital needed to expand the intensive care unit, Shen volunteered to work in the ICU to support the staff there. She’s been on 12-hour shifts in the ICU ever since.
A number of the things she has experienced when dealing with COVID-19 patients were new to her.
“From a nursing standpoint, the fact that a lot of patients with the virus get sick really, really fast — they can present to the hospital with very mild symptoms, and they can progress very, very quickly to the point where mechanical ventilation is needed — I was really taken aback. Because it is really traumatic to be put on a ventilator,” Shen said.
In her time in the ICU, Shen has helped care for dozens of COVID-19 patients and says most people don’t realize how hard it is to be intubated.
“I was caring for a patient on a ventilator and he had this thing where his body just on and off twitched, where his teeth would bite down on the ventilator. And his teeth were actually coming out, like, he bit off part of his tongue and his teeth were coming out, and there was blood everywhere,” Shen said.
I never imagined that I’d be in a position to tell someone ‘you can’t visit your loved one in the hospital.’– Clarice Shen
As hospital rules changed, Shen has had to tell the families of seriously ill patients that they could no longer visit, or that they must cut visits short. She says she’s tried to address the frustration she deals with daily by maintaining compassion.
“I never imagined that I’d be in a position to tell someone ‘you can’t visit your loved one in the hospital,'” Shen said.
“I try to help them understand what it is that we’re trying to do … helping them feel that I’m on their side, even though the situation might be really challenging.”
And Shen has held the hands of many patients in the ICU while they passed. Too many times, she says, a patient’s condition has worsened and they’ve succumbed to COVID-19 so quickly that their families couldn’t get there in time.
Clarice Shen, an acute care nurse at Toronto’s Sunnybrook Health Sciences Centre, describes how she creates a connection with patients in the intensive care unit who are often suffering, frustrated and scared. 0:25
One recent instance sticks in her mind, when she was at the bedside of a woman who died before her two daughters could get to the hospital. Chen was covering a break for the nurse who was the patient’s primary care provider, so she didn’t know the patient very well.
“All I could really tell her is that I loved the colour of her nails, and that her hair was beautiful, and that her daughters loved her. So I eventually just told her over and over again that her daughters wished that they could be here,” Shen said.
“It’s important she didn’t feel alone. I mean, it’s an honour and a privilege that I can be there for patients in their final moments.”
As cases reach record highs in Toronto and the city finds itself in a second lockdown, Shen says she wishes people could see what she sees in one shift in the ICU. She thinks it would scare them as much as it does her, and help keep them vigilant against contracting or spreading the virus.
“You know, last week you had two COVID patients in the hospital. And this week you have 15, and two waiting in the ER, and you have no beds in the ICU. And then you’re trying to get people out of the ICU who would benefit, potentially, from a few more days of staying there, because you need that bed. So, that is scary for me,” Shen said.
Meaghan Thumath, Vancouver
Meaghan Thumath is a registered nurse who wears many hats.
She works with homeless and marginalized communities in Vancouver’s notorious downtown East side. She also teaches nursing, does clinical research, and participates in international deployments with The World Health Organization that have included work on Ebola and other outbreaks overseas.
Since the outbreak of COVID-19, Thumath has been harnessing her experience to care for patients in Vancouver who are largely without other options.
“Sometimes that can look like a homeless camp. Sometimes it’s a single-room occupancy building that’s owned by a private owner. Sometimes it’s a homeless shelter, and sometimes it’s a supported-housing facility,” Thumath said. “We find people where they are.”
I think if you can treat people with dignity, and be trauma-informed and understand sometimes people might be scared, generally people are extremely grateful.– Meaghan Thumath
Thumath’s patients are often dealing with many more issues than just possible exposure to COVID-19.
“So we are seeing a sort of twinning of the overdose crisis as well as COVID-19. And then on top of that, people are still struggling with HIV, and Hepatitis C, and other infections,” Thumath said.
She points out that asking homeless people to self-isolate or quarantine when they are exposed to COVID-19 presents added challenges that most Canadians with a place to live can’t begin to understand.
Part of her job is also training shelter workers in best practices for when people with symptoms show up on their doorsteps.
Thumath says she does the work, and takes the personal risks associated with it, because of how rewarding it is.
“It’s a huge honour, because people are so grateful for your help. I think if you can treat people with dignity, and be trauma-informed and understand sometimes people might be scared, generally people are extremely grateful,” she said.
Meaghan Thumath, a nurse who works with homeless and marginalized communities in Vancouver as well as on risky international health deployments, says she and her colleagues have to be ‘flexible by nature.’ 0:18
The personal risks she takes are significant. Thumath recently returned from a trip with the World Health Organization to South Africa, assisting with the pandemic response there.
She says that experience helps her better understand what her patients are facing.
The toll her work has had on her family is something that weighs on her as well. Thumath is married and has two children. She writes goodbye letters to them every time she is deployed somewhere in case she doesn’t return.
“I’m grateful to my husband for being supportive, but it does weigh on me,” she says. “That’s the hardest thing — a drawer full of letters to them just in case I don’t come back.”
Shaye Fleming, Calgary
Shaye Fleming has been off work since September. That’s when the 29-year-old caught COVID-19 while on a regular shift as a cardiac nurse at Calgary’s Foothills Medical Centre.
“It’s been over two months now, and I’m just starting to feel a little bit back to normal,” she said.
“I still get quite short of breath, and this isn’t like me, you know? I usually can run, walk, like, usually I’m quite active.”
The ongoing impact of the virus has left Fleming frustrated, and feeling another emotion she says she wasn’t expecting.
“I’ve been experiencing a lot of anxiety with it as well. When you’re young you think you’ll be fine, and I was one of those people that wasn’t worried about getting it. And so the fact that it has been a prolonged recovery period, and I’m lacking a lot of that stamina that I once had, yeah, it’s been hard for sure,” she said.
Fleming has tried to return to work twice, but was unable to both times. Her symptoms have continued to be too debilitating.
… That shame of not being able to go back to work when I felt like I should have been OK, that makes you feel pretty shameful as well.– Shaye Fleming
She hopes to try again this week. Not being able to go back to work has only added to her stress, she said.
“I haven’t been able to be there, and be a support for my co-workers and my colleagues,” Fleming said. “So, you know, that shame of not being able to go back to work when I felt like I should have been OK, that makes you feel pretty shameful as well.”
As cases spike in Alberta and around the country, Fleming says she hopes people heed social distancing requirements and listen to public health officials. But she adds that regardless of how people approach the pandemic, nurses will always be there to care for them if they fall ill, even though providing that care means a risk to their own health.
“We will care for your loved ones and for you, regardless of what you believe in and what you value at the moment during this pandemic,” she said. “Nurses will always be there for you.”
Shaye Fleming, a cardiac nurse at Calgary’s Foothills Medical Centre who caught COVID-19 during one of her shifts, describes how contracting the virus has given her respect for how serious and debilitating it can be. 0:33
Some essential workers in Ontario say they’ve been denied health-care services because their jobs put them at risk of contracting COVID-19.
Hinda Hassan, an ICU nurse at Grand River Hospital in Kitchener, Ont., said it happened to her during a scheduled massage therapy and chiropractic appointment last week.
She was given a COVID-19 screening questionnaire at a Waterloo, Ont., clinic that asked if she had come into contact with confirmed cases of the novel coronavirus.
Hassan checked yes and clarified that this contact was due to her job at the hospital, where she’s required to wear personal protective equipment.
She said she was told to come back after being tested for COVID-19.
The Ontario Ministry of Health released a COVID-19 patient screening guidance document in June to ensure that “all health providers are following the same screening protocol” and to “help ensure consistency when dealing with suspected or confirmed cases of COVID-19.”
A ministry spokesperson said in a statement that the document is only for risk assessment and that it’s up to individual regulatory colleges to decide how to proceed if a patient screens positive.
Anyone who feels they have been denied service unfairly should take it up with their relevant regulatory college, the spokesperson said.
Hassan said there is no practical way for her to take time off work while she awaits a result. And, she said, it was tough news to hear given that she has put her own health and safety on the line during the pandemic.
“If you need my service, I can’t say, ‘Hey, you’re high risk. I’m sorry. I can’t take care of you.’ But then here you are — you’re denying me those rights,” she said. “It felt a little frustrating.”
Clinic apologized for denying service
The College of Massage Therapists of Ontario said someone like Hassan shouldn’t have had problems, based on the province’s current screening guidelines.
“An ICU nurse who works with COVID-19 patients (wearing appropriate personal protective equipment) should absolutely be able to receive massage therapy treatment, assuming they are not showing symptoms of COVID-19,” a spokesperson said.
A spokesperson for the College of Chiropractors of Ontario declined to comment on individual situations but said its professionals follow Ministry of Health screening guidelines.
The clinic has since called Hassan back, apologized and updated its policies. She said she’s happy it made the change, and she plans to make another appointment.
Vicky MacLean, a fellow ICU nurse in Waterloo Region, in southern Ontario, said a similar situation happened in her family.
At the beginning of June, MacLean said, she tried to book a speech therapy appointment for her toddler but was screened out because of her contact with COVID-19 patients.
MacLean said she was offered a virtual appointment, but she felt her two-year-old wouldn’t be able to focus during an online session.
After reaching out again last week, MacLean learned that the clinic had updated its screening policies based on provincial guidance, and she booked an in-person appointment.
She said she was “overwhelmed with joy” at the news but wishes she had managed to get an appointment sooner.
“We’re doing everything we can at home, but … she would be much further along if she’d had speech therapy,” MacLean said of her daughter.
Vicki McKenna, president of the Ontario Nurses’ Association, said she hasn’t heard of similar problems from other nurses. But she said she’s sorry to hear that such incidents are happening.
“Nurses, they’ve been under incredible stress over the last number of weeks, as many people have,” she said. “They deserve services as well — and certainly their families.”
‘I don’t see why my wife is punished’
It isn’t just nurses who’ve been denied service, said Bob Heans, of Fergus, Ont.
He’s a long-haul truck driver and often drives through the United States.
Heans said his wife recently made an appointment for a dental checkup, but when she mentioned his work as a long-haul driver, she was told she had to isolate from him for 14 days before she could be treated.
Heans said he doesn’t think that was fair to either of them.
“Being a truck driver, we’re probably all scared senseless for our family enough,” he said.
“I probably wash my hands 100 times a day, probably go through two bottles of hand sanitizer in like two or three days,” he said.
“I don’t see why my wife has to be punished for this because I’m a long-haul truck driver.”
Stephen Laskowski, head of the Ontario Trucking Association, said the industry has worked hard to protect drivers from COVID-19 and doesn’t think they’re at an elevated risk because they travel south of the border.
“Long-haul truck drivers spend a lot of their time alone inside their trucks. Trucks are sterilized before drivers get in, when they come out,” he said.
“We’re very proud as an industry of how proactive we’ve been.”
Laskowski said he’s heard other reports of drivers being turned away from health-care services, and that’s a concern because they need to have periodic medical exams to renew their licences.
The association is currently trying to find out how widespread the issue is, he said.
Dental college seeking clarity
Heans’s situation demonstrates a “long-standing issue” with current provincial screening guidance, said Kevin Marsh, a spokesperson for the Royal College of Dental Surgeons of Ontario.
Marsh said dentists — like massage therapists and other health-care providers — also use the province’s screening template, which includes a question about whether a patient has travelled outside of Canada in the last 14 days.
“Long-haul truck drivers who travel into the U.S.A. will always screen positive to this question. So will many pilots,” Marsh said in an email.
“As a result, their family members will always come into question, as they have close contact with someone who screens positive.”
The dental college has asked the provincial government for more clarity regarding people in these categories, but it has not yet received a response, Marsh said.
Skipping the dentist
For now, Marsh said dentists can provide emergency dental care to patients who screen positive for COVID-19, but for non-essential appointments, patients still have to either get tested or isolate for 14 days.
Heans said that means he and his wife will simply skip the dentist for the foreseeable future.
“I guess we have to,” he said.
As for Hassan, she said she’s happy with how her situation was resolved but hopes it will shed light on a situation that other essential workers may be going through. Essential workers who find themselves in a situation like hers shouldn’t be afraid to push back, she said.
“I think just have a discussion around it,” Hassan said.
“In some cases, it’s going to take some navigation, and that’s how a decision is going to be made.”
More than 600 nurses worldwide are known to have died from COVID-19, which has infected an estimated 450,000 health-care workers, the International Council of Nurses said on Wednesday.
The death toll among nurses more than doubled in the past month from 260 on May 6, according to its figures, which are based on data from more than 30 countries.
“In the last two months, we have seen the number of deaths of nurses as a result of coronavirus around the world rise from 100 to now in excess of 600 and we think worldwide the number of healthcare workers who could be infected by the virus is around 450,000,” Howard Catton, chief executive officer of the Geneva-based ICN, told Reuters Television.
“These are numbers that keep going up,” he said.
Canadian Brian Beattie, 57, was among those who have died. Beattie, who died last month, worked as a registered nurse at Kensington Village, a 76-bed long-term care facility in London, Ont.
Brian Beattie, who worked at a long-term care home dealing with a coronavirus outbreak in London, Ont., has become Canada’s first registered nurse to die from COVID-19 complications. 2:07
The pandemic’s true cost among health professionals was not known, the association said, renewing its appeal for greater protection for them and systematic collection of reliable data.
On average, seven per cent of all cases of COVID-19, the sometimes deadly respiratory disease caused by the novel coronavirus, are among health-care workers, which means that nurses and other staff are at great personal risk, “and so are the patients they care for,” it said.
Infection rates vary
Extrapolating from more than six million reported cases produced its estimate of some 450,000 infections among health-care workers.
Infection rates among health-care workers vary greatly between countries, with fewer than one per cent in Singapore and more than 30 per cent in Ireland, it said. Spain and Germany have recorded low numbers of fatalities among health-care workers despite large outbreaks, the group added.
“Why do the rates of deaths among nurses appear higher in some Latin American countries?” it asked, referring to the region that the World Health Organization (WHO) says has emerged as the new epicentre for the pandemic.
“Why are some countries reporting disproportionate deaths among black, Asian and minority ethnic HCWs [health-care workers]? This is an issue raised directly by the Philippine Nurses Association to ICN, concerning Filipino HCWs in the U.K.,” it said.
The ICN represents 130 national associations and more than 20 million registered nurses.
Canada’s doctors and nurses are demanding that the federal government do more to protect front line workers against COVID-19, calling a critical lack of personal protective equipment (PPE) “outrageous and unacceptable.”
Organizations representing front line workers delivered a blunt warning Tuesday that lives are at stake, and pleaded for more transparency and urgent federal action during a virtual meeting of the House of Commons health committee.
MPs on the committee are holding regular hearings via teleconference on the government’s response to COVID-19.
Dr. Sandy Buchman, president of the Canadian Medical Association, said Canada was caught flat-footed by the pandemic and now everyone is scrambling to ensure public health capacity can meet an expected surge in demand.
Calling it a “dark reality,” he said he’s hearing from physicians that the inadequate supply of surgical masks, N95 respirators, face shields, gowns and gloves is even more alarming than initially thought.
“The toll that is paid for this uncertainty weighs heavily on health care workers across the country,” he said.
“They are scared. They are anxious. They feel betrayed. They don’t know what supplies are available.”
Buchman said he’s concerned about the problem of keeping enough doctors and other health professionals on the job, given the heightened threats they face of sickness and physical and mental burnout, and the risk they might refuse to work due to a lack of protective gear.
Physicians working in hospitals handling COVID-19 cases don’t know how long current supplies will last, and many are being asked to ration or re-use supplies, he said, adding that anxiety is heightened by a lack of information and transparency around inventories.
‘Lives are on the line’
“Asking health care workers to be on the front lines of this pandemic without the proper equipment is unacceptable. Shortages must be addressed immediately and information about supplies must be disseminated. People’s lives are on the line,” he said.
“Would we expect a firefighter to enter a burning building, risking his or her life, without adequate protective equipment to keep them from harm? Physicians and other front line health care workers have a call to duty. They are willing to place themselves in harm’s way. But they have rights too – and that is their right to be protected when they put themselves at risk of harm.”
Dr. Alan Drummond of the Canadian Association of Emergency Physicians also conveyed “disturbing” reports about shortages and rationing of protective equipment.
“The pandemic has not peaked and the virus will be with us for some time. We need to continue to build our supply and distribution chains coast to coast so all front line staff have the appropriate PPE to provide care safely,” he said.
Preserving masks per shift
Drummond said “preservation” measures, such as limiting nurses to two masks per shift, might be considered rationing.
He also cautioned against “excessive anxiety” and said he hopes the government will deliver on its promise to deliver more protective gear and supplies.
Linda Silas, president of the Canadian Federation of Nurses Unions, said she finds it “striking” that, just a few months ago, governments and managers deferred to the clinical and professional judgment of health care workers to decide what’s needed to keep patients and workers safe — yet now they’re “locking up personal protective equipment to keep it away from health care workers.”
“When faced with this level of uncertainty around a new coronavirus, especially around something so fundamental as how it spreads, we should start with the highest level of protection for health care workers – not the lowest,” she said.
“Front line workers across the country who are directly involved in the care of presumed and confirmed COVID-19 patients are not being provided with the PPE they need to do their jobs. That’s simply outrageous and unacceptable in a world-class health system like ours.”
Silas said that, since its inception in the wake of the SARS outbreak, the Public Health Agency of Canada has not made workplace safety a primary focus and has “failed over and over to consider and appropriately protect the health and safety of health care workers. “
She said the government should invoke the Emergencies Act to ensure supplies and equipment are deployed where needed across the country.
Buchman said he salutes the government’s call to enlist retired professionals and others to help in the battle against COVID-19, but he also warned that older people are at greater risk of experiencing severe symptoms if they become infected. He said that must be considered in the context of a shortage of PPE supplies.
“We do have to be careful about what we’re asking,” he said.
Internal documents, obtained by the New Brunswick Nurses Union and shared with CBC News, show universities weren’t trying to enrol more nursing students all these years — they were trying to afford the ones they already had.
“We’re in the midst of the crisis,” said Paula Doucet, president of the nurses union.
“Had they listened to us many years ago and put precautionary measures in place, we probably wouldn’t be having this conversation today.”
It was something that we needed to uncover.”– Paula Doucet, New Brunswick Nurses Union
With a critical shortage already looming back in 2005, the province entered an agreement with the University of New Brunswick and the University of Moncton to graduate more nurses.
The province would give them about $ 15,000 annually for each new nursing seat created. The universities were to add 100 seats to their year one classes.
But the number of students didn’t rise. It fell — a puzzling outcome that finally pushed the union to take the “extreme” step of making a right to information request to get answers.
“We kind of questioned over the years, because of the number of graduates that were coming out of the program … the numbers weren’t there,” said Doucet.
The union obtained several documents related to the 2005 agreement. They include emails between the universities and the Department of Post-Secondary Education, starting in 2018.
In the correspondence, the schools cite financial challenges related to the nursing program and question their ability to increase enrolment. They also express frustration at the lack of communication with government.
The documents also include the text of the 2005 agreement, which was never released publicly.
In addition to the funding for new seats, the agreement recognizes the high costs of training nursing students and says the province will give universities $ 3,300 annually for each nursing student they already have.
But in the emails, the universities tell government the costs to nursing faculties have exploded in the past 15 years, and the funding hasn’t been sufficient.
“There is no way we could contemplate increasing enrolment,” reads one message from UNB.
Why is teaching nursing so expensive?
Nursing is one of the most expensive programs to run at any university, because the costs increase rather than drop for each student taken on.
For example, it costs $ 24,000 to offer nursing to one student for one year at UNB, about three times the cost of a student in the arts and science program.
The University of New Brunswick and University of Moncton received provincial money for years to address the nurse shortage and create more seats for nursing students. But instead of creating seats, the universities dropped some. What happened? 3:00
Even with tuition being slightly higher than for other degrees— currently at $ 8,411 — the universities say they absorb an annual deficit of about $ 12,000 per nursing student and have always had to take money from other parts of their budgets.
What makes nursing so pricey is the hands-on training, which makes up more than a third of class hours.
It’s done in small groups of seven, which means rather than paying one professor to lecture to an auditorium full of students, dozens of additional experts have to be hired each semester.
The current nursing shortage has only compounded the problem, by driving up costs to hire those clinical experts.
Hospital nurses don’t have time to train students the way they used to, so universities have to recruit more professors instead.
Over the past 15 years, the costs to the faculty of nursing have risen twice as fast as those of other programs, according to an email from U of M to the province written in January 2019.
The emails show the universities expressing concern to the previous Liberal government.
Over the years, as part of the 2005 agreement, both UNB and U of M had to return money to the government when they missed targets for increased enrolment. U of M had to repay all of it, UNB half.
In 2018, the schools tell the province the agreement isn’t working and ask that it be revisited. They are told to wait until after the October election.
Then in January 2019, after the Progressive Conservatives have come to power, UNB submits a proposal to the province to address the nursing shortage.
It would see the province cover the entire shortfall, about $ 12,000 per nursing student, and UNB increase enrolment to full capacity — 800 students in its four years of the bachelor program, up from about 500 currently.
The university explains its costs rose from $ 16,800 per nursing student in 2011-2012, to $ 24,000 in 2017-2018.
That’s a 43 per cent increase over six years — or six per cent annually.
“The current provincial nursing shortage has magnified these costs since floor nurses are unavailable to be released from regular duties to supervise clinical training,” UNB writes.
Around the same time, UNB’s nursing faculty was asking school administration to scrap its licensed practical nurse bridging program because of money struggles. The program had been created in 2013 as an effort to address the nursing shortage.
But the school’s emails to the Department of Post-Secondary Education, and its request for a meeting to discuss the proposal, go unanswered.
“I think this makes three requests for a reply, with none,” George MacLean, UNB’s vice-president of academic, writes in March 2019.
Then suddenly, the school learns of the cuts coming its way.
While focusing on enrolment to defend the cut, Health Minister Ted Flemming said nothing of the other consequence of ending the agreement: the universities lost the $ 3,300 for each existing student to help with clinical training.
They need to invest, but there needs to be some accountability.– Paula Doucet, New Brunswick Nurses Union
“The minister said funding was cut because we never met the seat target,” wrote Karen Cunningham, UNB’s vice-president of administration and finance in an email.
“Absolutely no acknowledgement that clinical has a high cost and that is also cut in this decision.”
The cut, coupled with a PC-imposed tuition freeze, plunged UNB into a $ 2.5 million structural deficit, the emails reveal, with the university contemplating its options.
“I fear that we will be unable to continue to protect our people to the same extent now, however, with the result that many essential services to students and administrative support will suffer,” Eddy Campbell, UNB president at the time, says in an email.
Hundreds of future nurses turned down
All this was happening as UNB continued to have long wait lists for its nursing program, with hundreds of students being turned away each year.
Upon learning the 2005 agreement was being done away with, Campbell warns that nursing seats will decline in the fall.
Enrolment of first year nursing students fell to 136 in September 2019, the lowest number in more than a decade, and some 20 students fewer than last year.
“Funding has never been sufficient and this is part of the reason it became unsustainable and enrolment caps became necessary,” UNB wrote to the province when it was pleading for more money.
“With reasonable funding, there is growth possible within UNB’s structure.”
For Paula Doucet, it’s been a frustrating process learning why more nurses haven’t been graduating from New Brunswick’s universities.
“It was very disheartening, but it was something that we needed to uncover because the math didn’t add up,” she said.
In July, the Higgs government announced its 10-year nursing strategy, with $ 2.3 million this year focusing on bringing nurses from other countries and provinces, and $ 500,000 for the bridging program for licensed practical nurses to become registered nurses.
To Doucet, those are Band-Aid solutions.
“I really don’t think they understand the complexity as to why we have the nursing shortage that we do.”
Doucet said nursing programs are underfunded, but she believes there needs to be some accountability as well to make sure more nurses come through.
“The universities are not producing enough,” she said. “For supply and demand, we are nowhere in the ballpark of doing that.
“They need to invest, but there needs to be some accountability that the money that the government is giving universities is earmarked specifically for the faculty of nursing.”
No plan for new seats
The government doesn’t have any plans to increase funding for nursing faculties.
A spokesperson for the Department of Post-Secondary Education said it has asked the universities to fund their nursing programs within the regular operating grants they receive each year.
UNB gets $ 115 million from the province and U of M gets $ 66 million.
When asked why its nursing strategy didn’t specifically target the issue of nursing seats, the province said it was a question of efficiency.
“To address the current and future nursing shortage in our province, government is taking action to quickly train more registered nurses to work in the health care system now, versus only relying on new graduates in four years,” said Leigh Watson, communications officer for the department.
The bridging program that allows licensed practical nurses to jump to year three of the bachelor of nursing program now has 26 registered students.
While the health authorities say they need to hire 520 new nurses annually, the province disagrees with that number, and has estimated an additional 130 a year will do.
There are currently about 8,000 registered nurses in New Brunswick.
Earlier this month, the province’s auditor general came down on the 2005 agreement, questioning why $ 96 millions in incentives had been handed out to universities, without the promised increase in the number of nursing students.
CBC News reached out to both UNB and U of M for an interview, but they did not make anyone available.
The Nurses Association of New Brunswick, a regulating body for nurses, also declined to be interviewed, saying that without details about funding and the needs of the universities, it could not offer much to the story.
Alberta could lose more than 750 front-line nurses under a “massive downsizing” at Alberta Health Services (AHS), says the United Nurses of Alberta.
The nurses’ union said it learned of the planned cuts Friday morning after the lead negotiator for AHS, Raelene Fitz, called a meeting “unexpectedly” to inform the union that it plans to eliminate 500 full-time-equivalent (FTE) nursing positions over a three-year period beginning April 1, 2020.
Cutting 500 full-time-equivalent positions would mean layoffs for more than 750 front-line registered nurses because many nurses work part-time hours, the union said.
The plans were disclosed “in advance of bargaining for UNA’s 2020 provincial collective agreement so that the union would have time to absorb the information and respond accordingly,” the union said in a news release.
Alberta Health Services confirmed it shared information Friday with the UNA and two other unions — the Alberta Union of Provincial Employees and the Health Sciences Association of Alberta — “regarding potential impacts to unionized staff of measures to enhance the efficiency and performance of the health care system.”
Decisions are still being made, but AHS was required to disclose the measures as part of the collective bargaining process, it said in a statement.
‘Alternative service delivery’
“In many cases this restructuring could also include alternative service delivery models that help deliver services efficiently while keeping jobs in the Alberta economy,” AHS said.
UNA president Heather Smith had sought an immediate emergency meeting with Health Minister Tyler Shandro.
But Steve Buick, a spokesperson for Shandro, said the minister has no plans to meet with the unions because “that would be interference in bargaining that hasn’t even started yet.”
The government had promised “not to touch front-line health workers,” Smith said in a news release.
“We do not believe Albertans will support this plan, and they should tell the premier so.”
Premier Jason Kenney was at a business conference in Lake Louise on Friday, where reporters asked him about the cuts.
“We’ve always been clear that getting our province’s finances back in order will require some reduction in the size of the overall public service, and that we hope to achieve that primarily through attrition,” Kenney said. “My understanding is that’s the goal of AHS management.”
He said the recent Alberta budget increased the budget for health care by $ 150 million, “so there’s actually no overall reductions in the AHS budget. We’ve kept our commitment. But they do have to find efficiencies to deal with the growing cost demands that come from an aging population.”
Reductions through attrition
The nurses’ union released a copy of a letter sent by AHS to UNA Friday morning.
“While our budget has remained stable, Alberta’s growing and aging population means we need to be more efficient and focused in terms of health-care spending,” the letter says.
It says that before April 1, AHS will use an “attrition-only” approach to reducing staffing numbers.
It is looking at the possibility of contracting out home-care services including nursing, palliative and pediatric care. “This would impact approximately 60 FTE,” the letter says.
It says there are “no specific plans at this time” to close acute-care beds as continuing-care beds open, but that “this work may commence in 2020.”
AHS says in the letter it will consider “all options available” to meet organization needs in the future, including “changes to staff mix, service redesign including changes and repurposing of sites, relocating services, reducing or ceasing the provision of services.”
Smith told CBC News she is “incredibly disappointed” with the information relayed by AHS.
“People in this province believe the premier and the [United Conservative Party] were elected on the conditions of assuring the public that health and education front-line workers would not lose their jobs, and certainly this speaks something very different.”
Opposition NDP health critic David Shepherd said nurses have consistently talked about facilities being understaffed.
“When they need to take a sick day there is no one to cover,” Shepherd said. “They are under increasing pressure and … it is taking its toll on people’s health, both physical and mental.”
The position on staffing reductions outlined by AHS is only the beginning, Shepherd said Friday, speaking to reporters.
“They’re going to war with front-line health-care workers in the province of Alberta instead of providing them with support and the resources they need to address the growing pressures and workload,” he said.
The regulatory body for Manitoba nurses has found local nursing students are sometimes graduating from local schools without adequate English skills — but a plan to introduce mandatory language testing before writing their final registration exams is being put on hold.
Some nursing students say the $ 320 test is too expensive, and some post-secondary institutions fear it will affect recruitment and create uncertainty for students investing in nursing programs.
The College of Registered Nurses of Manitoba announced earlier this year that as of Jan. 1, 2020, every prospective nurse would have to pass an academic English test before taking a registration exam.
This came after years of study revealed multiple examples that called into question whether nurses were graduating from Manitoba programs with full proficiency in English, according to the college, the regulatory body for about 14,000 registered nurses and nurse practitioners in the province.
It found seven cases where language proficiency was identified as a factor in unsafe nursing practices.
“We have reason to believe that completion of a nursing education program in Canada is not a valid measure of English language proficiency at the level required for safe registered nursing practice,” the college wrote in an executive summary released earlier this year.
Test paused after pushback
The test the college wanted to mandate was the International English Language Testing System, a standardized international proficiency test that would have assessed prospective nurses’ abilities in English-language listening, reading, writing and speaking.
However, the regulatory body told CBC News in an interview that its plans for the requirement on hold after several nurses came forward with concerns.
“We heard from a lot of individuals … and we learned of a lot of unintended consequences of things that were perhaps not at first contemplated,” said Katherine Stansfield, the registrar for the College of Registered Nurses of Manitoba.
Those consequences included the $ 320 cost to write the test, lack of academic support for those who may not meet the requirements, and concerns raised by post-secondary institutions, she said.
Students who have already taken the test will be reimbursed by the College of Registered Nurses, as will students who were penalized for not cancelling the test in time, Stansfield said.
None of the money from the cost of the test goes to the College of Registered Nurses. It is privately administered.
1st in Canada
The policy would have been a first in Canada. While it is typical for a regulatory nursing body to require proof of English proficiency, it is not typical to refuse to accept graduation from a local school as proof.
“I think Manitoba was the first to realize there might be an issue here,” Stansfield said. “I know our regulators across the country are very interested in what we were finding.“
She couldn’t comment on why some Manitoba nursing graduates might be leaving school without an acceptable level of English proficiency.
“I can’t answer it because I’m not an educator. I know that the world of health care has become incredibly complex over many years, and that’s not news,” she said.
A spokesperson for the University of Manitoba — which offers undergraduate, graduate and nurse practitioner programs — said the school is committed to ensuring students are prepared for entry into the nursing profession.
“UM’s nursing program is offered entirely in English, and English-language proficiency is required in order to succeed in the program,” wrote a university spokesperson in a prepared statement.
A detailed executive summary released by the College of Registered Nurses went over various examples it has documented over the years regarding the English level of nursing graduates.
The College of Registered Nurses found:
Students with language proficiency issues were being given extra time to write university exams due to mandates from the school’s accessibility services.
A number of applicants for registration who had completed Manitoba entry-level nursing education programs later failed additional English language proficiency tests.
“Communication” was the among the top three most frequently identified reasons for complaints received by the College of Registered Nurses.
Some Manitoba students requested testing accommodation for the nursing registration exam due to language proficiency issues.
The U of M nursing faculty reported that a lack of proficiency in oral English was creating significant problems for students in the four-year nursing program.
Nursing programs opposed policy
The five post-secondary institutions in Manitoba with nursing programs joined forces to oppose the new policy, arguing it could impact enrolment and create unnecessary fears for prospective students.
That opposition was led by led by L’Université de Saint-Boniface. The University of Manitoba, Red River College, Brandon University and University College of the North were the other schools involved.
“We told the College [of Registered Nurses] that we had serious reservations about the policy as it was being proposed — that it would create uncertainty for students,” said Peter Dorrington, vice-president of academics and research at Winnipeg’s Université de Saint-Boniface.
“They shouldn’t find out toward the end of their program if they had the right level of English.”
Dorrington is a member of the working group established by the College of Registered Nurses that will have until early summer to figure out an alternative solution to test.
One solution may be to test students at the beginning of the program rather than toward its end, Dorrington said.
Test takes time, money: students
CBC spoke to one new graduate who expressed concerns about the cost of the test — $ 320 on top of the more than $ 500 new graduates have to pay for their registration exam with the college.
“We felt it was insulting and a cash grab and will defer people from wanting to study in Manitoba because of the extra cost and stress of another intensive exam,” said the student, who the CBC has agreed not to name.
The test also requires study in order to pass, even for those whose first language is English, the student said.
The Manitoba Nurses Union also expressed concern the new policy would have affected recruitment.
“Manitoba has a critical nursing shortage,” union president Darlene Jackson said in a prepared statement.
“This [proposed test] is problematic, as it poses additional barriers and may significantly delay the (re-)entry of qualified nurses into the workforce.”
Stansfield said the working group will look at a number of alternatives to the test, but remains committed to monitoring the situation.
“Where we can assure the public is that we have not backed away from our public safety mandate,” she said.
“And there are many, many ways that we monitor practice and we require nurses to demonstrate that compliance over the course of their whole career. And that hasn’t changed.”