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They saw suffering and death and braved COVID-19 in long-term-care homes. Ontario nurses recount the horrors of the frontlines that left many with PTSD symptoms

They saw suffering and death and braved COVID-19 in long-term-care homes. Ontario nurses recount the horrors of the frontlines that left many with PTSD symptoms
Canada
Working inside Ontario nursing homes hit hard by COVID-19 during the pandemic’s first wave, 60 per cent of front-line nurses experienced symptoms of post-traumatic stress disorder.

The data point, found by an Ontario Nurses’ Association (ONA) survey sent to 3,300 members, is bleak. What is sobering are the stories behind it.

Throughout the pandemic, long-term care nurses struggled in homes that had low staffing, as residents with COVID-19 choked to death, with lungs functioning as if they had been “filled with cement.”

Other nurses were devastated by the number of resident deaths. One said she is unable to forget the man in his 70s who lay in bed, curled in a ball, sobbing as he died alone.

Another nurse who worked through a deadly outbreak that she likened to a war zone said she now cries for no reason. “It’s embarrassing,” she said.

The stories and data come from the ONA, which gave the Star an early look at its survey of long-term care nurses who worked through the pandemic from March to October.

ONA president Vicki McKenna said the devastating impact of COVID on front-line nurses has only worsened since the first wave.

“Many members (said) that they are considering leaving the sector, or even leaving nursing altogether. As nurses, we care about our residents – they become like family,” McKenna said.

“Working through outbreaks has been deeply traumatizing for many nurses. Many say that they still have not had time to process or grieve because the workload is still extreme.”

In addition to reviewing the survey results, the Star also interviewed four nurses who worked through the pandemic.

ONA sent the survey results along with recommendations for change to Ontario’s Long-Term Care COVID-19 Commission. It also submitted a third report, called Fatal Choices, written by a senior advisor to the SARS Commission, which concluded that a “litany of failures” led to the high number of COVID deaths in long-term care.

The recommendations call for increased funding and staffing, noting that residents with increasingly complex medical conditions need at least four hours of daily direct care, of which 20 per cent must be provided by Registered Nurses.

ONA is recommending all health-care workers get proper personal protective equipment (PPE), including N95 masks that can protect against airborne viruses. It also wants the government’s response to the pandemic to be guided by the “precautionary principle” noted by Justice Archie Campbell in his review of the SARS outbreak.

The precautionary principle says when there is reasonable evidence of a near threat to public harm, efforts to reduce risk do not need to wait for scientific proof.

As it has previously demanded, ONA is calling for an end to privately-owned nursing homes.

“The not-for-profit sector performed better than for-profit on nearly every question we asked,” McKenna said.

Donna Duncan, CEO of the Ontario Long-Term Care Association, which represents for-profit and not-for-profit homes, said she disagrees with ONA on the “root causes” of COVID impacts on homes, adding that OLTCA’s members, “regardless of ownership, are committed to complying with the directives and to supporting the health and well-being of our staff, residents and essential caregivers.”

Duncan said the PPE supply was a “significant challenge early in the pandemic before LTC homes were prioritized.” Shortages continue, Duncan said, although some homes have created an alliance that sourced and shared 15 million pieces of PPE in seniors’ homes.

In its recommendations to the commission, ONA noted the deaths of thousands of residents and at least 11 front-line workers, including , Ont.

“As horrific as these numbers are,” the report said, “the true extent of the damage wrought by the pandemic on long-term care residents, their families and staff may never be known, and cannot be measured solely by lives lost.

“The real tragedy is that it did not have to be this way.”

The survey questions examined access to PPE, workload, leadership, and the personal impact of working through the pandemic.

The survey responses highlight anecdotes heard throughout the pandemic, especially in homes with larger outbreaks. They showed that nurses working in homes with more than five COVID cases felt “inadequately protected,” particularly in some privately-owned homes.

“The experience of the nurses relayed through the survey show that homes that experienced outbreaks, especially medium and large outbreaks, were associated with problematic PPE use, heavy and inappropriate workloads, poor management decisions around the health and safety of residents and staff, and a heavy toll on nurses,” the report said.

“And while the personal toll on nurses was great, it was especially so for racialized nurses.”

The Ontario Nurses’ Association surveyed its members last September and October, asking for their experiences dating back to March. The survey was sent to approximately 3,300 ONA members. Of those, 1,185 answered part of the survey while 766 finished the survey, although some were allowed to skip certain questions so the number of responses varies. ONA has 1,877 members working in municipal and not-for-profit homes and another 3,774 in for-profit homes. ONA said the survey’s margin of error is 1.29 per cent 19 times out of 20.

In homes with outbreaks, 38 per cent said they were told to wear the same mask when treating sick and healthy residents.

Of 174 surveyed nurses who worked in a home that had more than five COVID cases, 88 per cent said they experienced restrictions on the use of the N95 mask, which offers better protection than a surgical mask.

Nurses were asked about the leadership in their home.

In homes with more than five COVID cases, 40 percent of nurses said there was a delay in isolating the healthy from the sick. And, 44 percent of 434 nurses who worked through an outbreak said they felt inadequately protected. This sentiment was more common among those of the respondents who worked in for-profit homes.

Nurses interviewed by the Star said some nursing home chains that had already gone through serious outbreaks didn’t take swifter or stricter measures the third or fourth time around.

With the exception of one nurse, who quit her job last spring after a colleague died from COVID, the nurses did not want their names used. Nurses sign a non-disclosure agreement when hired and fear losing their jobs for speaking out.

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Later, when her home was hit with COVID, the nurse said managers did not wear masks or enforce the use of PPE in the small, old building with poor ventilation.

“Months after the first wave of the pandemic I had to force (the proper use) of PPE,” she said.

Infected residents were still living with the uninfected, often in shared rooms with just a curtain to separate them, she said.

“There was a resident with COVID who kept spitting, all over me, on the floor, on the walls,” she said, her voice breaking.

“I can’t believe that I came out of it without being infected. It felt like a bomb had gone off and there was fallout all over, but nobody was coming to save you. You were on your own.”

The nurse said she knows that even if the home took every precaution it still might have been hit with a serious outbreak. What bothers her is that the chain had experienced significant outbreaks in other homes yet management in her home didn’t push for swift, precautionary measures to limit the spread.

“I was always very strong,” the nurse said, “but a couple of weeks after the outbreak, I found myself breaking down very easily. It profoundly changed me. It was the most frightening thing I have experienced.”

A nurse in an eastern Ontario home that was part of a large chain said her home struggled with several outbreaks. Early in the pandemic, staff were given dust masks — lightweight masks not meant to protect against a virus like COVID, she said. Nurses had to “fight” for N95 masks, she added.

“We were used to seeing death but not like that,” she said. “One night I went upstairs and saw a lot of residents who were dying. Just dying.” The home, she said, offered staff little support. “They told us to just do the best you can. The best you can? I often wonder, how can they sleep at night?”
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