At the beginning of the pandemic when the world was isolated in our respective homes, we would stand on our porches, banging pots and pans together at 8 a.m. or 8 p.m. to collectively thank our neighbourhood nurses and doctors as they returned home from their 12-hour shifts at hospitals. We hailed them as heroes.
The problem with heroes is when things start to go wrong, when they haven’t saved the day (because of circumstances beyond their control), and perhaps when they need help themselves, heroes get pushed off their pedestals.
By the summer of 2021, in the middle of the pandemic, the Alberta government’s attitude towards health care workers had changed from supportive to dismissive, and in some cases, even combative. Between the government taking a hard line in contract negotiations, to not prioritizing medical personnel for vaccines, nurses were becoming disheartened and disillusioned. Many health care workers felt their situation had become untenable.
In order to obtain this interview, I promised anonymity and changed the name of the nurse who consented to speak with me. If her identity was released, she would face reprimands.
I agreed to maintain her privacy because capturing the voice and stories of those on the frontlines during this pandemic is vital to an accurate historical record. Only this nurse’s personal details and some identifying details of her employment have been changed.
This interview was in early August of 2021 and was two-and-a-half hours long. While the topic was generally how Covid is being dealt with and felt in hospitals, the history of nursing in Alberta that Stephanie Smith shared strongly impacts how hospitals are currently managed.
This story will be published in two parts.
Part One
Stephanie Smith has worked as a registered nurse for 30 years. She graduated from nursing school just as former premier Ralph Klein [1992-2006] was decimating the nursing field in Alberta. Like many others in her cohort, she moved to the United States in order to work as a nurse. She has worked in big city hospitals and community hospitals, under private and public health care, taking care of both the affluent and the indigent.
Smith said, “I still like going to work in the morning. I like working with the people I work with. The politics and the bureaucracy, those are the things that we tolerate to be able to go in and do our jobs and be with the people.”
Covid is not Smith’s first experience with a highly infectious and politicized disease. “I’ve been around for a lot of different infections: HIV and SARS and Legionnaires and so on. The scary thing about Covid is just how transmissible it is.”
An enduring image of the pandemic is medical staff dressed in personal protective equipment (PPE). “Universal precautions are what we would do for any respiratory illness. It includes eye protection, different levels of masks—there are the medical masks and then the N95 masks, then full isolation gowns and gloves. So for a confirmed or positive Covid patient, we’re doing our full PPE. It doesn’t matter whether it’s Covid or TB or any of the other droplet infections, we’re using the higher rated mask, as well as all of the other gear. For somebody who’s not on respiratory or droplet precautions, we wouldn’t be wearing the goggles. We can add or subtract different layers or different levels of protection.”
Some of Smith’s colleagues contracted Covid from work, but said, “It’s actually hard to tell, because there’s the whole Freedom of Information [and Protection of Privacy Act] (FOIP).” Smith shared her opinion. “It is actually just a way to not tell people what’s going on. [FOIP] is supposedly designed to protect the individual, but what it is functionally doing is exposing people [to Covid infection] because they don’t know what the risk is.”
“Am I afraid? I think the chances of me getting Covid before I was vaccinated and winding up in hospital on a ventilator were quite high. What I’m hearing from the ICU docs are the patients that they’re seeing are unvaccinated. Those are the ones who are winding up in the ICU on a ventilator.”
Politics
“The government has tied their ship to minimizing the danger [of Covid],” stated Smith.
Smith speculated that the provincial government was in denial about the risks and consequences of the pandemic. “It is tough when the top layers are in denial. It would cost too much politically and financially. It would represent them giving up control. They just can’t deal with the fact that somebody else’s idea contradicts their thoughts. So even if it’s a worse outcome, it has to be their way or the highway. I think that’s a political trap of any political party. You have to stay on brand or you’re out.”
She continued, “I talked to the guy who designed the pandemic plan; he was so frustrated.” Smith was referring to David Redman, former head of the Alberta Emergency Management Agency.
“In Alberta, we had a pandemic plan on the books. There was a plan. It wasn’t politically based. It was medically based and financially based and when the pandemic hit, they threw it away. It’s insane that this is civil defence—a public health plan—and they threw it away and went with something they made up on the spot. And changed continuously based on whatever political motivation they had at that moment.” Smith emphasized, “It is all reactive.”
“Overall, the government dictates to AHS (Alberta Health Services) what they have to dictate to us and then the managerial level filters all of that through with the various levels of experience and integrity, and then that affects our day-to-day stuff.”
Politics and contract negotiations
Despite the ongoing pandemic, and the resulting exhaustion medical personnel experienced, the Government of Alberta went into contract negotiations (scheduled every four years) with fists flying.
“Technically, we have not had a contract for two years,” Smith said. News reports on the negotiations reported proposed rollbacks. “They want to rollback our wages. They want to clawback our wages till last April. They would garnish our cheques.”
To be clear, the government’s opening salvo on contract negotiations proposed that nurses return income they already earned.
During the summer of 2021, AHS began advertising in Ontario for nurses to come to Alberta, ostensibly to cover gaps in staffing. The contract nurses were offered higher wages than Alberta nurses ($75 per hour compared to $48.37 per hour for Alberta’s most highly specialized nurses), a housing allowance, as well as all the negotiating points Alberta’s nurses were asking for in contracts.
“He’s [former premier Jason Kenney] absolutely going after women because he doesn’t think that they can fight back. This whole ‘we’re gonna bring in nurses from Ontario to help with our shortages’ isn’t about shortages. This is about strike-breaking because he’s afraid we’ll strike in the next couple of months and he’ll have to bring in people to break a strike.”
Smith continued, “They’re already talking about three per cent cash rollbacks and changes to our shift differential.” She explained further. “They’re talking about being able to move us anywhere they want without us having a say.”
“I haven’t worked on a ward in 20, 25 years. And yet they want the ability to say, ‘You go to the wards, you go down to emergency, or you go over to ICU and you help out.’”
Smith said the government doesn’t understand that nurses are specialized in the kind of work that they do. She said, “The whole mentality that a nurse is a nurse is a nurse isn’t true.”
Traditionally, managers have to be registered nurses. “One of the things that the contract proposes are they want to put in any registered professional. So we could have a paramedic or respiratory therapist or a pharmacist in charge of nursing,” Smith said. “It is crazy. But from a business point of view, it makes a lot of sense because it saves money on the front line.”
Not having a registered nurse as a manager actually increases costs, because anyone else doesn’t understand how a hospital runs. “That they’re [the government] not seeing is the amount of waste that’s happening. They’re not seeing how much money we’re paying for supplies and how many middlemen there are.”
Alberta’s physicians concluded their own contentious negotiations with the province in March of 2021. However, Smith felt the lack of their support in the nursing contact negotiations. “The docs just had a contract. And now there’s radio silence. They’re not talking at all about supporting [nurses]. We’re not hearing them comment on the staff shortages. We’re not hearing them comment on the negotiations. It’s like they’ve been told that, ‘Here’s your contract. We will give you a decent contract if you stay out of the rest of this.’”
Smith clarified, “That’s just conjecture. I have no idea if there’s a gag order on them, but I suspect there is just from the side comments that the docs have made. But if they’re happy, then they got a good contract. They were so upset that we had a lot of doctors leave the province. But they seem happy now. They’re not mad enough to do anything about it. That might be a difference, and might only be semantics. But they’re not angry enough to do anything. They’ve reached a tolerable level of discomfort. And they’re not vocally supporting nurses.”
According to a Jan. 27, 2022 news release from the United Nurses of Alberta, after “one of the most prolonged and arduous negotiations in the provincial nursing union’s 44-year history”, nurses reached an agreement with the Government of Alberta. Before the pandemic began, there were 210 vacant nursing jobs in Alberta. By the end of 2021, there were 805 job vacancies. A year later, that number has not been updated, despite quarterly reports in every previous year.