This casual nurse says N.L.'s incentives aren't worth joining a health-care system 'at war'

A registered nurse working on a casual basis in St. John's says it would take a "war-like effort" for her to take a permanent position in Newfoundland and Labrador's health-care system. 

The province's health-care system is deep in crisis: St. John's hospitals are chronically over capacity. Emergency rooms, including the Health Sciences Centre's, face staff shortages and — in rural Newfoundland — have been peppered with closures all summer. A quarter of the province's population don't have a family doctor. 

Madeleine Smith moved to Newfoundland from New Brunswick about a year ago to begin her nursing career in long-term care and the cardiac unit at the Health Sciences Centre.

Smith said she got into the profession because of her desire to help people but said a lack of investment in the health-care system has made day-to-day staffing unpredictable, taking a toll on the elderly and most vulnerable patients.

"You never know going in, what level of staffing there's going to be.… That really affects how our days play out," she said. "On short days you're really trying to get just as much as possible done, but sort of under impossible circumstances."

Number of casuals

Nurses working on a casual or temporary basis like Smith make up just over 28 per cent of Eastern Health's nurses. There are 966 casual or temporary nurses with the health authority, compared with 2,442 active permanent ones.

In Central Health, 188 of their 676 registered nurses, or nearly 28 per cent, are in casual or temporary positions. In  Western Health, about 25 per cent of their 855 registered nurses — 224 of them — are casual or temporary.

Labrador-Grenfell Health did not respond to CBC News's request for information about casual nurses.

In a statement, a spokesperson for Eastern Health said casual/temporary nursing employees work that way by choice.

"Many have been offered permanent positions but declined," says the statement, the health authority estimates about 400 workers in their casual pool are retired workers who are not interested in full-time or permanent work.

Smith said she's remaining as a casual nurse because it gives her more control over her schedule and rest time. 

According to her contract, she said, as a causal she cannot be mandated to work longer than a 12-hour shift, unlike permanent employees, who can be forced to stay for up to 24 hours.

"For me as a new nurse, I mean, there's so much learning involved in the role that it's really important not to burn out."

She said many nurses she works with are also increasingly preferring to work casually.

"The situation as a permanent staff, at times, is untenable," she said. She knows nurses who have been denied family days off to move and have had leave requests to attend events like weddings rejected as well.

Incentives not enough

In August, the provincial government announced a suite of incentives for nurses, including a retention bonus, a $3,000 signing bonus for casual nurses to take permanent positions, bursaries for nursing students, mental health supports and promises to explore child-care support outside regular hours.  

Smith says it would take a lot more for her to sign on as a permanent employee.

"I do feel like what they're offering for casual nurses is not necessarily enough to entice more nurses to sign on for permanent positions, '' said Smith.

"It's really about having a sense of confidence in our government and our society to sort of address the healthcare crisis head on.

"I really do feel like our health-care system is kind of at war and we've put our elders and our most vulnerable on the front line, so for me it would take like a war-like effort." 

'Need to become better': health minister

Health Minister Tom Osborne said Smith's comments were understandable, given the shortage of health-care workers across Canada.

"We need to become better at recruitment, we need to become better at retention," he said.

"What we see in this province is no different than what you're seeing in other provinces. However, people don't want to hear me compare us to other jurisdictions, they want us to find solutions and we're focused on finding those solutions." 

Osborne said the Health Department's recruitment and retention staff are in Ontario this week to try to attract more nurses to Newfoundland and Labrador.

The minister also said they, along with population growth and immigration staff, will be in the United Kingdom and elsewhere abroad in an attempt to recruit workers.

"We will not stop until we have the adequate staffing levels within our health authorities," said Osborne, who also promised more incentives for health-care workers

Interim Eastern Health CEO Ken Baird said overcapacity issues at the hospital put pressure on the emergency room because there were no beds to transfer patients into after they were admitted.

"It has been a sustained period where we've had some difficulties with flow," said Baird. "What it means is our staff are working extra hard because they have more patients than we normally plan for under care."

Dr. Greg Browne, Eastern Health's chief of staff, said nurse staffing levels at the Health Sciences Centre's emergency room have stabilized since a plea for ER staff was sent out last weekend. 

In the short term, Baird said, Eastern Health is using travel agency nurses to fill gaps. Long-term relief could come from recruiting internationally educated nurses, he said.

"With the programs that the province has in place, we currently have over 3,000 applicants which our recruitment team is in the process of reviewing," he said.

He also expects 21 people from a bridging program for internationally educated nurses to graduate later this year. He says 35 people in the program are already working in the health-care system as care attendants while they study. 

Read more from CBC Newfoundland and Labrador