Dear Colleagues: Welcome to our Friday, July 10 report – now in the sixth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. You can refer to earlier update reports here, including thematic pieces in my blog. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. Feel free to share this report or these links with anyone interested – they are public.

Nurses’ mental health, leave of absence and return to work experiences: Introducing a new partnership initiative

The mental health and wellbeing of nurses and other health providers is of paramount importance to RNAO. We are delighted to present an article from Abby Ayoub (University of Ottawa), Sheri Price (Dalhousie University), Melanie Lavoie-Tremblay (McGill University), Kelly Lackie (Dalhousie University) and Ivy Bourgeault (University of Ottawa) introducing the nursing case study of the Healthy Professional Worker Partnership. The partnership originated in this research study.

Nurses face significant mental health issues from high rates of work-related stress, anxiety, depression, burnout and PTSD. A recent report from investigators at the University of Regina in collaboration with the Canadian Federation of Nurses Unions found that 81.7% of nurses surveyed reported experiencing critical incident stress at least once during their career.  This translated into symptoms of burnout and compassion fatigue from overwork and exposure to prolonged stress. Several work-related factors all contribute to making nursing a demanding, stressful and difficult profession, including heavy workload, lack of resources, poor relationships with supervisors, long work hours, high rates of physical and psychological violence, negative and unpleasant working environments.

These challenges predate COVID-19.

The global pandemic has made concerns for both the health and mental health for nurses even more critical. In addition to the usual challenges at work, nurses find themselves dealing with added stressors, such as lack of access to personal protective equipment (PPE), fear of infecting family members, isolation from family members, increased emotional and physical exhaustion coupled with the inability to take time off just to name a few.

Nurses are hailed as heroes; their work considered essential, but at the same time, the time and energy they put into their work remains devalued.

Case in point is the Ontario Conservative government’s Bill-124 which capped provincial workers’ wage increase, including benefits, to 1% for the next three years. Nurses, a frontline female-dominated profession, were subjected to this Bill while other frontline (male-dominated) professions, including police and firefighters, were exempt.

Why are nurses expected to do more with less? It should come as no surprise that turnover rates, absenteeism, and early career attrition are very high in the nursing profession. The lack of recognition takes a toll on nurses’ mental health.

The Healthy Professional Worker Partnership, a multidisciplinary and collaborative research initiative on mental health, leave of absence, and return to work issues for professional workers began to look at these issues before COVID-19 broke out. Our team is looking specifically at the case of nurses, and how their circumstances compare with other professional workers within health care and outside of health care.

Mental health, leave of absence, and return to work are longstanding issues within the profession of nursing. In a pilot study, we found that mental health is affected by several factors including personal, familial, work and organizational challenges. They can also influence nurses’ decisions to contemplate or take a leave of absence from work. These factors can also support or create barriers to return to work after a leave. Furthermore, a nurse’s gender (being predominantly women) and other characteristics such as race, Indigeneity or age likely influence how these factors affect mental health, the decision to take a leave of absence, and how one can return to work.

Taking a leave of absence is a challenging and frustrating process, but even more so for mental health. Required forms ask nurses to indicate a specific event, date and time that led to their personal injury, but how does one pinpoint exactly when they became so burned out they could no longer continue? That is, the policies and processes of taking a leave of absence are not well-adapted to mental health issues. This makes it harder for nurses to take a leave when needed.

Further, if nothing changes at work while on leave, it is remains difficult upon return. The choice nurses often face is to return (or not) to the same toxic environment as issues around organizational work context, such as work overload, understaffing, lack of resources, violence, etc., remain constant.

Through support from the Registered Nurses Association of Ontario (RNAO), one of our partners, our research team will be hosting a webinar in August to discuss our preliminary findings and approach to our next phase. We welcome nurses to share their experiences – both pre-COVID and during this ever evolving COVID context.  We will be pleased to sign up volunteers to participate in an interview or fill in our short online survey.

Our partnership ultimately aims to identify interventions to better support nurses’ mental health and facilitate healthy return to work.

Nurses spend their days caring for others. It is up to us to find better and more sustainable ways to support their care and mental health.

RNAO update: RNAO is proud to contribute to this partnership and research study. On Monday, August 10 RNAO will deliver a webinar for nurses to meet with the researchers and hear more about the study. You can already register for this webinar here.

Connection: Updates, voices and opportunities to engage

Support Zimbabwean nurses arrested and fired for protesting deteriorating pay and working conditions during pandemic

Dr. Denise Gestaldo has brought to our attention the struggle of Zimbabwean nurses. On 6 July, the Zimbabwean government arrested 13 nurses at the Harare hospital. They were protesting their deteriorating pay and working conditions. Those nurses have since been released on bail -- but have been dismissed from their jobs. With the inflation rate hovering around 1000%, the cost of living has risen so rapidly that public sector salaries are now almost worthless.

The Zimbabwean Nurses Association (ZINA) is calling for an upward salary review and outstanding COVID-19 allowances, as well as adequate provision of personal protective equipment (PPE). But the government announced that it would not be engaging in any form of collective bargaining for the next three months. ZINA president Enock Dongo reacts to nurses arrests in a video here.

RNAO urges each reader to support the nurses of Zimbabwe in demanding that the government cease intimidating and harassing health care workers and instead listen to their legitimate demands and concerns.

Send your message here, and please share this message with your friends, family and colleagues.

RNAO continues to pursue family reunification in LTC

RNAO held a webinar on July 6 on Reuniting families and residents in LTC: What will it take? We heard from family members and discussed their urgent call to allow them to be with their loved ones. We also shared RNAO’s work on ECCO 3.0, Bill 175 and the Nursing Home Basic Care Guarantee. You can watch the webinar here.

Liz Braun was one of the journalists attending the webinar and who wrote about it. She mentions that during the webinar, family members spoke of the experiences they’ve had trying to get back into nursing homes to tend to family members. The stories are heart-rending, disturbing and often infuriating. After four months of being deprived of family company, many residents are declining rapidly health-wise.

RNAO will continue to speak out and push Ontario’s Medical Officer of Health to issue a clear and immediate directive that will require LTC homes to allow family members to be with their loved ones. You can hear my interview with Zoomer radio here. RNAO will issue a position statement on family reunification next week – stay tuned!

RNAO is also continuing to pressure the government to act by July 31 to implement the Nursing Home Basic Care Guarantee. Please add urgently your signature demanding that the government act to provide proper staffing in LTC! Please sign here.

Update on webinars

RNAO has held weekly COVID-19 webinars every Monday evening since March 30. The last one, on July 6, was on family reunification in LTC (see item above). Attendance is always anywhere between 200 and 350! The COVID-19 Webinars: Together We Can Do It! are free and open to all.

We are now decreasing the frequency of webinars. There will be no webinar on Monday, July 13. For the remaining of July and August, there will be three webinars a month. The information for the upcoming webinar, as well as the archive for earlier ones, can be found here.

The next webinar will be on Monday, July 20, 6:45-8:00 pm. As updated earlier, RNAO has launched a task force to tackle anti-Black racism within the nursing profession. The task force is co-chaired by RNAO immediate past-president Angela Cooper Brathwaite and Chantal Sorhaindo, RNAO member and NP at Toronto’s St. Michael’s Hospital. The webinar will offer an update on the work of the task force and an open consultation with participants. Details will be posted here.

On Monday, August 10 the webinar will provide a brief update on health system transformation and focus on nurses’ mental health and wellbeing (see item above). Please register here.

If you have not had a chance to watch previous webinars, here are a couple of them:

• On July 1, we hosted Dr. Jennifer Kwan, a family physician and one of the organizers of #Masks4Canada. She spoke about what we need to do to have a successful re-opening of the economy, and the role that COVID-19 surveillance, good data and masking have in achieving that. You can watch it here.
• On June 22 we discussed the Impacts of COVID-19 on Indigenous Communities with three guest speakers: Ontario Regional Chief RoseAnne Archibald; Mae Katt, Nurse Practitioner with Temagami First Nation; and Marilee A. Nowgesic, CEO of the Canadian Indigenous Nurses Association. You can watch it here.

#Togetherwecandoit

MOH EOC Situational Report

As announced above, we will be posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you will be able access the Ministry’s guidance without having to wait for my COVID-19 report. Again, the link is here and you can check it every day.

Since this report will come out once weekly, that will provide a more timely access to Ministry guidance.

For a more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.

Here is a segment from the latest Situation Report #167 for 10 July: 

No actions are reported today.

Staying in touch          

Please continue to keep in touch and share questions, comments and challenges. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten <pgbatten@rnao.ca>. Due to the volume of comments and questions, we are responding as fast as we can. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and around the world. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent information, calmness, determination and swift actions. 

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO

RECENT BLOG ITEMS:

3 July -   RNAO launches task force to tackle anti-Black racism within the nursing profession – go here.

3 July -   Rather than praise, let’s protect our nurses – go here.

3 July -   Nurses celebrated diversity during Pride month – go here.

26 June - Nursing Home Basic Care Guarantee – go here.

26 June - Masks for all – the policy imperative in Canada – go here.

18 June - Annual General Meeting – an exhilarating week! – go here.

12 June - Petition on masks for Canada – go here.

12 June - LTC: RNAO releases list of 35 reports and recommendations dating back 20 years – go here.

6 June   - Statement – RNAO stands together with our Black sisters and brothers – go here.

3 June   - Adapting harm reduction during a pandemic – go here.

29 May - Foot care nurses – go here.

29 May - Update on pandemic pay; pandemic pay in consumption and treatment sites – go here.

28 May - RNAO Calls for Immediate Action in Response to the Canadian Armed Forces’ LTC report – go here.

26 May - Update on VIANurse – go here.

26 May - Ending homelessness: Will you join us to build a COVID-19 recovery for all? – go here.

24 May - Technology as a solution: Opportunities and pitfalls of COVID contact-tracing apps – go here.

21 May - Debunking PPE myths with Dr. Jeff Powis: Which masks should health care workers wear during COVID-19? – go here.

20 May - RNAO response to announcement of an independent commission into Ontario's long-term care system – go here.

19 May - With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks – go here.

14 May - Nursing Week update – go here.

14 May - Pandemic puts health system to the test: Nurses have answers for shortfalls – go here.

14 May - Disappointment for not being included in pandemic pay – go here.

13 May - RNAO saddened by the loss RN Brian Beattie to COVID-19 – go here.

13 May - End racism and prejudice – go here.

12 May – Enhancing Community Care for Ontarians (ECCO 3.0) – go here

11 May - Nurses share their successes and challenges during National Nursing Week – go here.

10 May - A story of hope, ingenuity, support and genuine care for an LTC resident – go here.

7 May    - Counting the missing deaths: Tracking the toll of the coronavirus outbreak – go here.

5 May    - Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer – go here.

5 May    - Addressing differential access to virtual care due to technology inequities – go here.

3 May    - Being person-and-family-centred during COVID-19 – go here.

1 May    - Migrant agricultural workers and the COVID-19 crisis – go here.

30 April - COVID-19 pandemic in provincial institutions and correctional centres – go here.

28 April - Supporting First Nation Communities during COVID-19 – go here.

27 April - Responses to COVID-19 for persons experiencing homelessness in Toronto: An update – go here.

25 April - Lessons learned through a COVID-19 nursing home outbreak – go here.

25 April - Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID – go here.

23 April - Working with seniors in long-term care requires specialized knowledge – go here.

22 April - Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction – go here.

21 April - We Require Expanded and Accessible COVID-19 Data in Ontario – go here.

20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here.

18 April - COVID, Trump and the World Health Organization – go here.

16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here.

15 April - COVID-19 and the Challenges in Homecare – go here.

14 April - Reprocessing Of N95 – An Update – go here.

14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here. 

13 April - Practical Tips for Safe Use of Masks – go here.

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here.

Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.

Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.

Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.

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