Published on: April 25, 2016 | Last Updated: April 25, 2016 9:22 AM EDT
Nurse Julie Prince in Igoma, Tanzania, on September 2012 while on a medical mission with World Partners Canada.
Late in 2014, Julie Prince’s life started to unravel.
After a shift at the hospital where she worked as a nurse in the
labour and delivery unit, she would spend hours sobbing on the couch,
haunted by images of dead babies.
Prince had worked as a nurse since 2002 in neonatal intensive units
in seven hospitals in the United States and Ontario, and later in a
labour and delivery unit in southwestern Ontario. Only a dozen years
into a career she loved, she felt oppressed by the accumulation of death
she had witnessed.
“I’ve always loved babies. But going into it, I didn’t realize how sad it would be,” she said.
Julie Prince in Leogane, Haiti, in March 2010 after a devastating earthquake.
By the end of the year, Prince could not even drive past the
hospital. She was diagnosed with depression and elements of PTSD a few
months later.
Earlier this month, Ontario passed a bill that recognizes PTSD as an
occupational illness for Ontario first responders, covering police,
paramedics, corrections workers, dispatchers and First Nations emergency
response teams.
That adds up to about 73,000 workers.
Who it doesn’t include are the province’s nurses, unlike similar legislation in Manitoba.
Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario,
says there are about 140,000 nurses in this province, and they deserve
to be covered.
Nurses are exposed not only to the trauma of what they witness, but also
to the violence of patients, says Doris Grinspun, CEO of the Registered
Nurses’ Association of Ontario.Alex Urosevic, Toronto Sun
Nurses are exposed to the traumatic things they witness — suffering,
dying patients, massive bleeding, wounds caused by trauma, exposure to
horrific infectious diseases.
Grinspun says she was involved during the deadly SARS outbreak of
2003. “I know for a fact that two nurses never went back to work. But
the great majority continue to work. Very few just leave. Many are
living with chronic PTSD.”
Meanwhile, nurses are also punched, beaten, stabbed and verbally abused by patients.
The Ontario Hospital Association reported more
than 6,400 incidents of workplace violence in the province’s hospitals
in 2015, said Erna Bujna, a health and safety specialist with
the Ontario Nurses’ Association.
Earlier this month, a patient attacked a
female registered nurse at the Waypoint Centre for Mental Health Care in
Penetanguishene with two screwdrivers taken from a shop in the
vocational services area. The nurse suffered a stab wound to the back as
well as facial injuries. The nurse manager who tried to intervene
sustained puncture wounds and a broken nose, and two other staff members
were injured while trying to restrain the patient.
In Ottawa, a registered practical nurse was assaulted in September
2015 in The Royal’s recovery unit at its Carling Avenue campus. Few
details have been released, but the hospital said it conducted an
immediate debriefing and offered employee assistance to the workers.
Three workers at The Royal were beaten in a June 2012 by a male patient
being treated for schizophrenia.
And yet, nurses seeking Workers Safety and
Insurance Board benefits for PTSD must prove that their condition is
related to their workplace. “Nurses should not have to continually
relive these horrific and traumatic events to prove entitlement to WSIB
benefits,” Bujna told the province’s standing committee on social policy
last month.
Bujna believes there are two reasons why
nurses are not included in the province’s new PTSD bill. First, WSIB is
funded by employers. If hospitals have to pay more, it will end up
costing the province.
“In my opinion, the government is trying to
control the number of allowed WSIB claims so health care employers won’t
have to take responsibility for preventing the illnesses, and (it)
keeps their WSIB costs down.”
Second, nursing is a female-dominated
profession, and Bujna said she sees sexism in leaving nurses out. “There
is just greater attention on male-dominated workplaces.”
In response to an inquiry about why nurses are
not included in the legislation, Labour Minister Kevin Flynn’s
spokesman, Craig MacBride, said Flynn recently met with nurses on this
issue and last year created a Leadership Table on Violence in Healthcare
with Minister of Health and Long-Term Care Eric Hoskins.
Bill 163 is “intended to respond to the needs
of those who need it most – first responders, including nurses in
correctional facilities, who are at least twice as likely to suffer from
PTSD because of their work.”
MacBride said all Ontario workers are covered
for PTSD through the WSIB. “Bill 163 simply creates a more responsive
process for those who are most likely to face traumatic experiences on a
regular basis.”
But nurses are asking: If they’re not first responders who face traumatic experiences, then who is?
“There is no question our nurses are also
first responders, and in our female-dominated health-care workplaces
they experience and witness as much — if not more — traumatic events
than the men in the male-dominated workplaces that were covered by this
law,” Bujna said.
Nurses are with their patients for 12 hours at
a time, especially in ICU settings and sometimes childbirth, Prince
said. It leads to a whole other level of bonding and exposure than other
first responders, she says.
When Prince heard the nurses were being excluded from the legislation, she wrote a blog that told the poignant story of her descent into crippling depression and anxiety.
She had worked in neonatal intensive units,
not only with premature babies weighing only a pound or two, but fragile
newborns born with genetic syndromes. Prince came to see her role as
going through a journey with these families, building a relationship
with the people who were in her unit for as long as eight months.
Julie Prince holding the hand of a baby born at 24 weeks gestation. The
little girl, who survived, “just keeps on fighting,” says Prince.
Many babies did not survive. Prince collected mementos for the
parents, tiny footprints, boxes containing the baby’s quilt, a tiny knit
hat.
“It is a privilege to walk with people through death,” she said.
When a baby is withdrawn from life support, it’s the nurse who hands
over the baby to the parents to be held for the last time, Prince said.
It’s the nurse who takes the baby back from the parents and brings the
baby to the morgue and lays its body wrapped in blankets on a cold metal
shelf. Sometimes, the family decides not to be there when a baby
is taken off life-support.
And while people associate the maternity ward with happy moments,
Prince found that working in labour and delivery brought “a whole other
level of intensity and stress.” There were miscarriages and difficult
births. She coached women to deliver babies that had died in utero.
“I want people to recognize what nurses do on a daily basis and the
repeated traumas and sorrow that they are exposed to,” said Prince. “I
want the government to acknowledge that the risk of trauma exposure and
PTSD is clearly there, and when nurses do need the assistance, for it to
be available.”
Prince could feel herself getting burned out. By mid-December 2014,
she said, she was plagued by overwhelming grief and anxiety. “I didn’t
want to take care of anyone anymore.”
PTSD was never mentioned as a risk for nurses while she was in
nursing school. Debriefing has been studied as a valuable tool to help
defuse stress. Fellow nurses know when a colleague has had traumatic or
sorrowful day. But “there is literally no time to debrief,” Prince said.
“Somehow we have to establish a culture among nurses that encourages
this and that makes room for this. We need administration in hospitals
to recognize what their nurses face on a daily basis. We need them to
prioritize the mental health of their own.”
Prince doesn’t regret a moment of her nursing career. “Every loss has been a deep, deep privilege.”
She now works with a Community Care Access Centre as a nursing care
co-ordinator. Her PTSD treatment has been successful, but it was hard
work, she said. Part of that was the “exposure therapy” of returning to
the hospital. I took her more than a year to return to the childbirth
unit to hand in her badge.
“My colleagues had no clue,” she said.
