Lucy clearly remembers hearing a patient’s call bell go off while she was in an isolation room. 

“When you're in an isolation room, you can't just drop something and walk out,” Lucy said. “You're in full PPE and you're in the middle of…dealing with an acute issue.”

As a nurse working in a Vancouver Island hospital, she was in the middle of yet another shift where there were too many patients and too few nurses. On this night in late January 2022, she had eight patients to manage by herself. There were just three nurses on the floor to care for about 25 patients; ideally, there’d be six.  

By the time she could answer the call bell, it was 15 minutes later and the patient, who had needed help getting to the bathroom, was sitting in their own faeces. 

“The person right away started yelling at me saying that I took too long to get there,” she said. The night only got worse from there. The patient had lost all trust in Lucy’s ability to look after them, and they’d told their family as much. While trying to attend to all the patients she had to manage by herself, Lucy also started getting phone calls from these family members, one after the other, letting her know she was a horrible nurse. 

“It's so hard because you're really trying to split yourself between all of the people that are needing you and trying to decide where to go and where to be at that time,” Lucy said. 

The incident is not isolated. Patients often get angry with nurses, usually when their food or bathroom needs aren’t met in a timely manner because nurses are short staffed—Lucy says it happens to her every week. 

After two years of caring for people at constant risk of catching a deadly virus, nurses across Vancouver Island are facing ever more harsh workplace conditions—which not only impact their own mental health but also the level of care patients receive—despite the Omicron wave starting to subside. Compounded with chronic mispayment issues and little to no concrete steps to alleviate the pressure, Island nurses are starting to speak out despite a deep fear of professional repercussions. 

Capital Daily regularly heard from nurses in Victoria and across the Island that they wanted to talk publicly about their deteriorating workplace conditions but couldn’t because of a deep fear of being reprimanded for it at work, or losing their jobs. So we created a Google Form where nurses could come forward and anonymously share their stories for an article. Over the course of several weeks, 10 nurses responded with written testimonies and several, like Lucy, shared their contact information so we could follow up with them. Many said they weren’t comfortable writing down their information, for fear that it could be traced back to them by their employer. 

None of the nurses we spoke to said they were aware of a concrete internal policy saying they would be penalized for talking publicly about their workplace experiences without first consulting their managers, but that it was more of an ingrained, cultural fear. 

“I was told by a lot of coworkers that if you go to the media, and Island Health finds out, they can fire you, you'll lose your pension, you'll lose your benefits, you'll lose everything,” said Christina, a nurse who has worked in Island hospitals for five years. “It was a big fear I had because so many coworkers said this to me.”

“It’s all about maintaining confidentiality,” said Lucy, who has been a nurse at Island Health hospitals for 14 years. The fear is that someone might reveal something about a patient that could identify them, thus breaching patient confidentiality. According to Lucy, many nurses are so afraid of breaking confidentiality, they don’t say anything at all. 

To protect the identities of nurses and patients alike, the names of all nurses have been changed and no details that could identify a patient have been included in this article.

Wages: not enough and not on time

There has been no dearth of headlines recently about the severity of the nursing shortage in BC. The results of a BC Nurses’ Union (BCNU) survey released in January showed 68% of union members said staffing was inadequate at their workplace in the three months prior to the survey. 35% of all nurses—and 51% of ICU and emergency ward nurses—said their experiences during the pandemic made them more likely to leave the profession in the next two years.

Among the nurses we spoke to, each one said they already consider leaving nursing and know many colleagues who have. Lucy thinks about finding a different profession at least three times a month. Christina knows nurses who’ve left to find tech jobs, go into marketing, and create careers in advocacy. One colleague is leaving to become a police officer—they’re both stressful jobs but the latter pays much better. 

The issue of higher wages has always been something the BCNU has been negotiating. Union president Aman Grewal said she can’t reveal everything they will be asking the province for because they’re entering a bargaining year, but more money does incentivize more people to go into work and relieve some of the pressure. 

On many shifts, one nurse is expected to manage 12 or more patients at a time. But on stat holidays, when nurses get paid overtime hours and there’s an incentive to take extra shifts, Lucy says her department is relatively well staffed. “Those days seem a little bit nicer, a little bit lighter.”

Even the wages they’re supposed to get now are not always meted out correctly. Several nurses have said they find consistent errors in the amount they’re paid by Island Health, and that corrections can take up to eight months. According to Christina, these are usually cases where payment for overtime work or a missed meal break don’t show up on a nurse’s paycheque.

Taylor, another nurse who works at an Island hospital, says she never used to track how much she was being paid until she began hearing stories from other nurses. Between October 2021 and March 2, she says there are still 16 shifts for which she hasn’t been paid correctly.

“It’s become an extra job just to ensure we’re being paid properly, in a time when we are all already at the end of our rope,” Taylor wrote in her testimony. “I have absolutely considered leaving nursing; I do on a weekly basis.”

Both Taylor and Chistina say they and others have complained about this issue to their managers and to their union representative, but to no avail. BCNU president Aman Grewal says she isn’t aware of specific incidents, but encouraged nurses to reach out to their regional council members.

“I’m not aware of any particular situations,” Grewal told Capital Daily. “I am sure that yes, that would probably be true. In any system, there are usually some sort of payroll concerns, but eight months is a significantly long time to be addressing something like that.”

In a statement, Island Health denied any overarching payment issues within the organisation, blamed mistakes on staff, and said when there are issues from within VIHA, corrections are made as quickly as possible.

“There is no widespread payroll accuracy issue within Island Health. In some situations, the ‘error’ is related to employees or their department not completing appropriate documentation properly or missing pay period deadlines,” reads the statement. “Island Health has a well-established process for employees to submit pay queries. Each query is investigated and, if appropriate, corrections are made. The length of time required to resolve a pay query is unique to each specific situation, as there are a variety of factors that can affect the time it takes to properly investigate and resolve pay queries.”

‘Things have not eased up’

The fact that hospitalizations due to COVID-19 are declining after a record-breaking Omicron wave doesn’t mean things are getting any easier for nurses on the frontlines, according to both Grewal and all of the nurses we spoke to. 

While COVID is one reason hospitals are full, so is the lack of access to family doctors Lucy points out. People have also been arriving at the hospital, having avoided treatment during the pandemic or had procedures cancelled. 

In mid-March, the president of the BC Orthopaedic Association, Cassandra Lane Dielwart wrote a letter to health minister Adrian Dix, seeking a meeting after the minister stated that the surgical backlog from earlier in the pandemic has been cleared. 

“This in no way reflects the experience for most orthopaedic patients or surgeons in the province,” Dielwart wrote. “On the day of the announcement, I personally received six phone calls, 12 emails, and over 30 text messages from surgeons across the province, from multiple hospitals, in every health authority, stating their astonishment and disbelief, with the statements that were made about surgeries being back on track.”

The continuously rising overdose rate due to the drug poisoning crisis and the staff shortage in itself are other reasons, Grewal says.

“Things have not eased up,” Grewal said. “The workload is still there, and it's still higher than what it was pre-COVID.”

Besides higher wages and a resolution to payment issues, the biggest ask among nurses is a regulated nurse-to-patient ratio to make sure they aren’t continuously overwhelmed with too much work.

“The response from the union has often been [that] it's hard to mandate ratios when we don't even have enough nurses to begin with, so we can't mandate something that isn't there,” Christina said. “So I think their concern right now, and their focus, is getting more nurses into the field.”

There is potential good news on that front: In February, the BC government announced they will be adding 602 new nursing seats at post-secondary institutions across the province, to add to the 2,000 existing seats—a move the BCNU called a “promising step” but said they’ll wait for more details in the coming months. 

“We've got internationally educated nurses who are here in the province waiting for their credentialing to be done,” Grewal said, adding that she has been committed to getting the province to speed up that process for several years. 

The union has also advocated for access to appropriate PPE, like N95 masks, for nurses over the course of the pandemic. The work isn’t done on that front—the BCNU survey found that 36% of members say their employer has restricted access to PPE and in 73% of those cases, this means the protective gear is kept under lock and key—but Grewal says more nurses now have N95s available to them because of this advocacy. 

The toll

On top of concerns for their own safety, the fact that patients don’t get proper standards of care because there aren’t enough nurses to meet their needs is something that weighs heavy on nurses’ minds.

Christina listed examples of the choices she has to make regularly in her testimonial: having to walk away from a patient having an acute panic attack because she was the only nurse available; having to make someone wait for hours for pain medication because seven other patients needed help first; being the only nurse left to manage six ringing call bells, or the only nurse to meet the needs of an entire department. 

“I’m losing sleep. I have anxiety and feel afraid before every shift not knowing what I am going to walk into,” Lucy wrote in her testimonial. “I leave shifts crying more than ever before. I am fearful that something completely preventable and awful will happen every day because we are so short staffed and just human.”

Better mental health coverage in their contracts is another major priority, according to the nurses we spoke with. At the moment, there are limited resources and many, like Taylor, have a benefits plan that covers 80% of up to $900 for counseling services. 

“An average counseling session is typically $150/hour; this provides us with 6 sessions a year,” Taylor wrote. “We have a nursing Facebook group and the supportive conversation between us is alive almost daily asking for and offering tips on ways to support ourselves, searching for free or affordable services to access.”

Their experiences are on par with findings in the BCNU survey. 82% of union members said their mental health had gotten worse during the pandemic, and 65% said it impacted their physical health. 

“I've been running on empty for years and I've been on the verge of mental and physical breakdown for months,” Christina wrote.  “I feel like no one is doing anything to help nurses.”