Long-term care nurse details heartbreak of not being able to give 'that extra bit of attention' to residents
For Nancy Healey-Dove, residents are family members — and she wants to treat them that way
CBC's series Concerning Care takes a closer look at home and respite care in Newfoundland and Labrador, which has Canada's oldest population. It focuses on a shortage of workers, the emotional and financial toll of loved ones providing care to family members and issues that home-care workers themselves face
It all started with a colouring book about Nurse Nancy, gifted to Nancy Healey-Dove by her sister.
For the then four-year-old, that namesake became the inspiration for the rest of her life.
"That put it in me," said Healey-Dove. "My dad and my mother always instilled in us to do everything we can for people."
Now Healey-Dove is a registered nurse of almost 31 years and a nurse practitioner of 11.
She's spent over eight of those in long-term care in central Newfoundland where, above her desk, a sign reminds her daily of why she does what she does: "Our Residents Don't Live in Our Workplace, We Work in Their Home."
"It's extremely rewarding because these people become our families. It's not like in acute care, [where] someone's in and out in a few days," said Healey-Dove.
"We make such great connections with the families and the residents that every day is worth it. Every single day is worth it. Even the hard days."
And of those, there have been more in the last few years, she said — mainly due to staffing issues, impacting nurse practitioners, registered and licensed practical nurses, and personal-care attendants, alike.
They work together for residents' well-being — as a nurse practitioner, Healey-Dove manages residents' medical needs. Dietitians monitor residents' weights, physiotherapists their mobility. personal-care attendants turn and reposition, bathe and feed them. The recreation department tries to keep residents active, with singalongs and church services.
Those are the basics, said Healey-Dove. The "extras" include sitting down with residents and having conversations, holding their hand, curling someone's hair or looking at picture books.
"They deserve that extra bit of attention. And it's not extra. Holding someone's hand is not extra," she said.
"We don't have the staff to do everything that we want to be able to do for our residents. And I see that and I see that in my colleagues' faces."
It's a dilemma that makes Healey-Dove and her colleagues feel guilty, impacting their mental health — and causing many to ponder a move.
Better wages, work-life balance
Healey-Dove herself debated leaving mid-pandemic and while she hasn't yet, she plans to go in about a year and a half, before she turns 58.
To stop her colleagues from doing the same, she said, a return to a full-team approach as well as more staff to help alleviate system pressures are needed.
"We need to make the jobs more attractive. And let's face it, being more attractive often includes money. We're not martyrs or saints," she said. Existing staff are leaving more quickly than new nurses follow, she added.
"If you had a better working wage, better working conditions, more work-life balance — and to have that work-life balance, you need the extra staff. So it's really a catch-22."
To address issues in the system, the provincial government announced a review of long-term and personal-care homes in February, and bonuses for existing and new staff in March.
But Registered Nurses' Union president Yvette Coffey says more is needed to solve the staffing crisis — a long-term care strategy and more retention efforts.
"What we're seeing is more people leaving the system, health-care workers, to go with private agencies, to either retire early or to leave nursing altogether," she said.
Nurses employed by private agencies, Coffey said, often take on fewer responsibilities while receiving two or three times more pay — causing frustrations for public nurses.
"It hurts. It burns. And it causes our members to stop and reflect and think, 'Why am I staying here, slugging it out, working short, working mandatory overtime, working 24-hour shifts, when I could be working with a private agency, making more money?'" said Coffey.
It's a "broken system," she said, in which one RN could care for as many as 40 to 110 residents at a time, on different units — sometimes even more.
While the union is pushing nationally for 4.1 hours of care daily per long-term care resident and new voluntary standards published in late January suggest the same, a lack of a national mandate means that goal is far from becoming a reality.
"When families make a heart-wrenching decision that they can no longer care for their loved ones at home and they have to go to a long-term care facility, the expectation is that they're going to be cared for in a manner that you would care for your own family," she said.
"Realistically, that's not what's happening today in our long-term care facilities because we just don't have the people and we just don't have the hours of care."
Coffey said the toll the situation takes on staff is evident — showing up as burnout and physical and mental stress.
The situation that isn't much different for licensed practical nurses and personal-care attendantss, said Newfoundland and Labrador Association of Public and Private Employees president Jerry Earle.
The union represents about 4,000 LPNs and PCAs across the province, and 75 per cent of them work in long-term care facilities.
"I've had LPNs, PCAs call me, crying on the phone … really upset, knowing that when they went off shift, there were things that they could not do," Earle said.
"The system right now is still significantly stressed," he said. "During the pandemic, LPNs … and other health-care workers done their very best and continue today to try to provide care in a system that is under immense pressure."
That pressure leads to an increase in both physical and mental injuries — which in turn impacts facilities when those workers' shifts need to be covered, said Earle.
Earle hopes the provincial government's long-term care review will include a look at the staff-to-resident ratio, something he said unions have been lobbying for for years.
According to provincial long-term care operational standards last updated in 2005, there is no set staff-to-resident ratio but a system to determine staffing numbers, "in accordance with the Department of Health and Community Service guidelines."
In a recent statement to CBC News, Eastern Health said the region's long-term care facilities operate according to those standards.
"The staff-to-resident ratio is not a set number throughout all units, floors, and facilities; it will depend on various factors such as the number of occupied beds on the unit, type of unit (e.g. complex-care unit), and human resources," says the statement.
Earle said the standards are outdated.
"Their staffing ratios that were determined in excess of a decade ago, just does not meet up to the demand of residents today," said Earle. "These long-term care facilities provide levels of care that you don't find anywhere else."
Healey-Dove wants to continue to provide that care. Amid discussions about numbers, ratios and beds, she wants families to know that she looks at residents through a different lens.
"I, and many of my colleagues, do not consider their family and loved ones as beds and as numbers because I think that is the ruination of us all," she said.
"These are souls. These are humans. And they deserve our love and commitment."
Concerning Care tells the stories of the people introduced here, along with others, on various platforms — including on Here & Now, CBC N.L.'s website and on the radio.
If you have a story to share, contact us at [email protected].
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