longer hours, less respect: life as a nurse in 2020

statistics and personal surveys point to a jump in overtime in parts of canada and an emotional toll from being on the frontlines 

• overtime work for nurses in quebec and ontario ballooned during the pandemic
• more than half of nurses surveyed reported being spoken down to by a colleague
• race and ethnicity play a factor is how a nurse is treated

 the covid-19 pandemic is adding extra stress to nurses with new reports and surveys casting a spotlight on longer hours and a lack of respect for the life-saving work that they do.on tuesday, statistics canada released a report comparing nurses’ overtime work this spring to the hours they clocked before the pandemic.it’s not terribly surprising that nurses who work overtime saw a jump in hours. but just how much more they’re working is significant: nurses’ average weekly overtime hours increased from 6.6 hours per week in april 2019 to 9.7 hours in april 2020 and from 5.8 hours in may 2019 to 10.3 hours in may 2020.the lengthening of the workday was largely driven by overtime in quebec and ontario. in quebec, average overtime hours surged from 6.2 hours in may 2019 to a staggering 16.9 hours in may 2020. in ontario, nurses’ overtime rose from 4.7 hours to 9.8 over the same time period.older nurses seem to be particularly hard hit. according to the report, the average weekly overtime hours doubled year-over-year for those aged 35 to 54. for nurses who were 55 and up, overtime hours also doubled from 4.3 to 8.3 hours. the report suggests healthcare systems may have been increasingly relying on nurses with more experience “to manage emerging case complexities related to covid-19” or because of provincial strategies to reintegrate retired nurses back into the workforce to meet demand.but how are nurses feeling about their work and how it is seen by patients and other medical professionals? a few weeks before the release of the statistics canada report, healthing surveyed registered nurses, nurse practitioners, and licensed practical nurses across canada to understand their role as essential workers. in an exclusive survey with figure 1, a knowledge-sharing app for medical professionals, thirty-eight nurses shared how they feel about their jobs, the worst things patients — and their colleagues —have said to them, and how race impacts how they are treated.here are some of their responses.

do you believe nurses are as respected as other healthcare professionals?

fifty-five per cent (21 respondents) said ‘yes,’ while 45 per cent (17 respondents) reported no. one nurse cited the passing of bill 124, ontario’s wage control legislation which provided a minimal raise, and bill 195, which authorizes the government to interfere with the collective bargaining rights of ontario’s unionized nurses and other members.“nurses are seen as the backbone.”“covid highlights that one’s designation in health care is not more important than the other. we are all frontline workers, and all at the same risk. one of the apparent differences is that nurses spend more time than doctors with their patients.”“we are front-liners, and respected well in my opinion.”“i feel we are being over-worked and burn out easily because of staffing shortages.”“nurses are trusted to be professional and caring.”“i think we are more stressed than other professionals.”“i believe people think nurses are much more expendable than the others hcp [healthcare practitioners]. i believe the thought is that there are 10 nurses for each one you lose whereas doctors aren’t as replaceable. nurses aren’t dime a dozen.”“nurses do way more than they ever get recognized for.”“we’re treated like servants by patients.”“respected on individual basis. subservient values persist.”“physicians receive more respect than nurses do from the patients and their families.”“nurses are not respected enough as hcps. everything seems to be the nurses’ responsibility. it’s all the nurses’ fault.”

have you been spoken down to on the job by a colleague?

only three respondents reported ‘never’ experiencing this while 10 said ‘rarely.’ twenty nurses reported ‘sometimes’ and five reported they have ‘frequently’ been talked down to.“bringing up a patient concern on rounds and was torn down by a staff physician in front of the residents.”“most of the spoken-down-to came from administrative positions from other departments.”“i have had physicians and other nursing staff speak down to me.”“i’ve been told to shut up, go to hell, and ‘how can you be so stupid?'”“i was told i make others uncomfortable because i’m good at my job.”“i was laughed at when i asked for break after seven-and-a-half hours without one.”“usually by an md.”“when they don’t know me or have had past interaction.”“conflicting views on the severity of covid. she believed it was blown out of proportion.”“it’s been a stressful time. people are a bit more restless here in canada too, not as bad as the states. in my province of b.c., we have dr. bonnie henry who everyone listens to, thank goodness.”“as an lpn [licensed practical nurse], we can be devalued due to having less education than an rn [registered nurse]. i had a charge nurse who would not even address me or talk to me as she did not value me professionally or as a person.”“nurses eat their young.”“been a nurse for 45 years, at beginning of career this was the norm, but not now.”

have you been spoken down to by a patient?

from cursing to abusive language, only two nurses reported ‘never’ being spoken down to by a patient. eight reported ‘rarely’ and 18 said ‘sometimes.’ ten nurses reported being spoken down to by a patient — double the number of nurses who reported frequently being spoken down to by a doctor.“some paternalistic ideology remains present in patients and families from older generations.”“most frequently by older male patients who speak to me like i don’t even have a high school level of education.”“i experienced this most in the emergency department.”“i describe working in the er as a nurse as being in an abusive relationship with the public.”“a few times while working in the er.”“patients not liking what they hear.”“i was just sworn at this morning for putting boundaries in place for a difficult patient.”“only a few times in seven years by dementia clients.”“i work with a lot of confused patients with head injuries.”“every day from patients who don’t get their way.”“i mostly dismiss them. there’s multiple factors: pain, personality, loss of autonomy.”“increased frustration due to inability to leave care home.”“‘my tax dollars are paying you’.”“patients have said, many times, ‘i pay your salary’.”

does race and ethnicity affect how you are perceived?

while the population of nurses of visible minority has been increasing over the years, the nursing profession in canada is still far from an equal representation of canada’s general population. in our survey, 20 out of 38 nurses reported that their ethnicity affects how they’re viewed and treated.“unfortunately, it probably does. i’ve witnessed a black nurse being judged by patients and their relatives solely based on skin colour.”“i wasn’t sure how to answer this, but i did witness patients treating a black nurse different than other nurses on the floor.”“as a black nurse, it is more frequently you are asked how long you have been a nurse.”“people still think black nurses are lazy.”“language barriers can cause frustration.”“different values, styles, communication and delivery alters perceptions.”“unfortunately nurses of colour don’t have the same respect.”“people assume nurses are generally from one country.”“i think it’s irrelevant. not where i live.”“racism is everywhere.”“sadly had multiple questions of competency of a colleague who was filipino — although he asked me to keep it quiet, i finally had enough.”

have you seen more conflict between healthcare practitioners since the start of the pandemic?

16 reported yes, some saying the pandemic caused many to have “snippy, poor attitudes.” confusion caused stress, but so have care plans and constantly evolving institutional policy changes. these are the common points of contention between nurses and other healthcare practitioners.“who has to care for covid or pui [patients under investigation].”“especially at the beginning of the pandemic, nobody wanted to care for the covid patients.”“differences in opinion about severity, how it’s handled, policy changes. pretty much threw an already toxic workplace into overdrive and made that environment impossible to work in and keep your sanity.”“workload intolerance due to relentless fatigue with the stress of being an essential service.”“between management and staff in regards to effective, safe ppe.”“where’s our ppe, why are we getting so many new admissions from the hospital to ltc, should some of us be working if we’re so stressed out.”“more work placed upon staff but no more staff. having to screen visitors, disinfecting etc.”“they want everything ‘now.’ lack of patience and disregard for the other 30+ people i’m caring for today.”“being frequently pulled to other units — given heavy loads and receiving patients [doctors] don’t feel confident in their knowledge caring for.”“some colleagues become agitated and confrontational, even condescending. others get their backs up and push back.”

do you think perceptions of nursing have changed as men have entered the profession?

only 13 nurses reported that the growing number of males nurses has changed the profession.“i have not noticed any difference between male or female nurses working besides patients thinking the males are doctors.”“i don’t think so, because nursing is still dominated by women.”“it’s still predominantly women and until otherwise nursing is still looked down on.”“not enough men in the profession to alter traditional views.”“only sometimes, not enough men in the profession yet.”“they aren’t respected at all.”“they’re given more respect.”“nursing professionals still don’t make the same amount or have the same benefits as male-dominant professions like cops.”“i think the men that have joined nursing are perceived as ‘soft.’ nursing has a long way to go.”“perceptions of nursing haven’t changed but there is still a perception of a male nurse being gay or too stupid to be a doctor.”“the only difference i’ve seen is less sexual harassment by patients.”“men bring a great dynamic to both nursing teams and patients.”“men are not our saviours. we are not damsels to be saved.”— updated with files from monika warzechadon’t miss the latest on covid-19, reopening and life. subscribe to healthing’s daily newsletter coming out of covid.