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A nurse stands by with additional equipment outside a COVID suspect patients room in the COVID-19 intensive care unit at St. Paul's hospital in downtown Vancouver on April 21, 2020.

JONATHAN HAYWARD/The Canadian Press

During the COVID-19 pandemic, health care workers such as our nurses have been rightly hailed as heroes. The clanging of pots and pans by a thankful public, the shout-outs from politicians, and adulatory media stories have surely been nice gestures.

But once they are in their scrubs and out of earshot of the applause, the reality for nurses is something else entirely. They are overworked and understaffed, forced to endure subpar pay, the instability of casual hours, gruelling mandatory overtime and the cancellation of holidays, all while putting their physical and mental health at risk. This is compounded by the fact that the field is dominated by women, who have been disproportionately saddled with child-care duties on top of their careers during this pandemic.

So the news that tens of thousands of nursing jobs are unfilled across Canada should come as no surprise. Nurses are fleeing hospitals, long-term care facilities, home-care agencies and public-health agencies – and who can blame them?

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But what should surprise us even less is that, when the dust settles, it’s going to get a lot worse.

COVID-19 did not cause the nursing shortage, but the pandemic did supercharge the crisis. Demographics were and remain a factor: With the population growing older, the demand for health care is climbing steadily. The nursing workforce is aging, too.

But the work environment is a much bigger problem. Nurses are feeling abandoned and disrespected.

Perhaps there is a glimmer of hope in the news that nursing schools have record numbers of applicants. But the kind souls attracted to the profession by COVID-19 heroics might be in for a rude awakening: The physically demanding and mentally punishing shift work expected of nurses can keep them on their feet for eight, 12 or 16 hours at a time and haunt their dreams afterward. It is not for the faint of heart.

Like many public-policy failures that have come to light during COVID-19, the nursing shortage has been the subject of much thumb-sucking for decades. Report after report has been written, much earnest head-nodding has ensued, and then nothing really happens until a crisis hits.

According to the Canadian Institute for Health Information, Canada has 439,975 nurses: 300,669 registered nurses, 127,097 licensed practical nurses, 6,159 nurse practitioners, and 6,050 registered psychiatric nurses.

About 90 per cent of nurses who are licensed are working, and about 90 per cent of those working are involved in direct patient care. It’s a hands-on profession, not one for paper-pushers. (Mind you, one of the most frequent complaints of nurses is the suffocating amount of paperwork that keeps them away from the bedside.)

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We know nurses form the spine of health-care delivery. But do we have the right number of nursing positions in Canada? No one can really answer that question because we don’t have coherent health human-resource plans, nationally or provincially.

What we know is drawn from job postings – that thousands of the current positions are vacant. We don’t know how many qualified people have left nursing and given up their licenses, but that number is likely in the tens of thousands too. But none of these data are tracked in any systemic fashion.

A recent story in La Presse gave us a glimpse of the severity of the situation. Using access-to-information data, the paper found that 4,000 of Quebec’s 61,000 nurses left their jobs between March and December, 2020. In the same period a year earlier, 2,800 nurses quit. That’s a 43 per cent increase, year over year. Another 7,700 Quebec nurses are on sick leave – a 28 per cent increase in the past year.

To make up for the shortages, the province is turning to private agencies, which charge the government about $70 an hour while paying the nurses themselves $35 an hour. Some nurses are leaving the public system to work for such agencies despite the lower pay and fewer benefits, however, because they provide more control over their places of work and hours, and they are able to take holidays. (Quebec has mandatory overtime rules and cancelled summer and Christmas holidays for essential health workers.)

The quality of care can only ever be as good as the work environment of those who provide the care. Untenable work conditions will translate into patients suffering from neglect, as we saw so graphically illustrated in long-term care homes.

The COVID-19 pandemic has stressed nursing homes and hospitals to the breaking point. But that pales in comparison to what a severe nursing shortage will do.

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Nurses are the backbone of health care. We can’t afford to keep breaking their backs.

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