Birgit Umaigba begins a recent nursing shift by looking at the board, scanning the names of those who will be working alongside her that day in the intensive care unit. The first thing she notices is that the unit is short-staffed — again.
“A lot of the time, we’re short seven to 10 nurses every shift,” Umaigba, 32, said. Nurses have been calling in sick, she says, and they’re not being replaced.
But there’s no time to dwell on that. She dons her personal protective equipment and enters the rooms of her intubated COVID-19 patients. What would normally be a 10-minute check-up takes an hour, as Umaigba struggles to do the job of several nurses on her own.
In the back of her mind, she worries about bringing the virus home and infecting her 10-year-old daughter. But Umaigba says she’s left with no choice — her husband is stuck in Nigeria awaiting sponsorship, and she needs to put food on the table.
“We’ve all been working really hard, and a lot of us are tired,” Umaigba said.
Umaigba’s story is the story of many nurses in the Greater Toronto Area who have been under tremendous pressure as COVID-19 cases soared in the region this winter. They’ve been heralded by the province as “heroes,” but say they continue to do their jobs with limited resources. Now, many are close to their breaking point.
Some Ontario ICU nurses who care for COVID-19 patients, like Umaigba, are agency nurses whose workplace varies, with no access to paid sick days from their employer. Many permanent, unionized employees have limited access to mental health care through their benefit plan. Others fear asking for help at all due to stigma, and the mental health resources put in place by the province during the pandemic for health-care workers have been criticized by some as inadequate.
But now, nurses are speaking up about their mental health struggles after a 25-year-old registered nurse for Halton Healthcare, died by suicide on Jan. 21, almost a year after the first COVID-19 case was detected in the province.
“I’m fearful that the next suicide I hear is going to be someone that I know,” said Sara Fung, a Toronto registered nurse.
“The part that scares me the most is that this could’ve been me.”
Fung, 35, is familiar with the barriers nurses face when trying to access mental health care. In late 2019, she attempted to go on stress leave due to what she called “a crushing workload,” at the urging of her family doctor.
What followed was a lengthy and confusing process as she tried to get approved for paid leave, Fung said.
She said she was denied compensation from Ontario’s Workplace Safety and Insurance Board, and given little guidance by her management on how to proceed. This was Fung’s first time navigating the mental health-care system, and she did not have a previous diagnosis for mental illness, she said, which proved to be a barrier for approval. She tried to see a psychiatrist, but was told the wait would be four to six months.
Fung then tried to access the mental health benefits offered by her employer. She was entitled to just $500 in benefits to see a psychologist, which only covered two sessions. “It was just one struggle after another,” Fung said.
After three weeks at home without pay, Fung said she returned to work under pressure of losing her employment altogether.
“It was hard for me to seek help because of all the stigma,” Fung said. “When I did seek help, it was just met with more and more resistance.”
Nurses in Ontario have varied access to mental health care, depending on their employers’ union agreements and their status as full-time or contract workers. Vicki McKenna, the president of the Ontario Nurses’ Association, the union representing 68,000 registered nurses in Ontario, said some nurses have no benefits at all to cover psychotherapy visits.
For those that do have benefits, McKenna said, the coverage union agreements have drawn up in Ontario range from $200 to $800 a year — an amount that registered nurse Amie Varley argues is grossly inadequate for consistent, high-quality care, as psychotherapy visits in Canada come with an average price tag of $125 to $175 per session. Even $800 could be used up in a matter of weeks.
“You think working in a hospital, we would have better access,” said Varley, who has worked at several hospitals in the GTA. “But access is actually very poor.”
By contrast, in British Columbia, unionized nurses are all under a uniform plan, entitled to $900 in coverage for psychotherapy services, said B.C. Nurses’ Union president Christine Sorensen.
Some employers offer employee assistance programs, Varley said, but she argued it’s a short-term solution that doesn’t grant immediate access to a psychiatrist who can accurately diagnose and assist with a problem. The number of sessions is also limited, she added.
Both Varley and Fung maintained that the barriers to accessing mental health care for nurses are a systemic issue across Ontario, and this is exacerbated by a workplace culture that pressures many to be silent about their mental health issues.
Early in the pandemic, Ontario Health launched a pilot program out of its Mental Health and Addictions Centre of Excellence in April, tailored to assist physicians, nurses and others on the front lines, with five hubs across the province.
It remains unclear whether this resource will exist beyond the pandemic, though health ministry spokesperson Alexandra Hilkene said there are plans to expand it beyond the five.
The program has seen some uptake — with female nurses in their early thirties being the largest group — but stigma remains a barrier for those seeking help, said Dr. Kim Corace, a clinical psychologist who leads the Royal Ottawa Hospital’s COVID Frontline Wellness program, one of the five hubs.
Corace said the stigma health-care workers feel is double-edged.
Some are facing stigma from their own family and friends for working in close proximity to the COVID-19 virus, compounding their stress. At the same time, Corace said, health-care workers fear their colleagues may ostracize them for having a mental health issue.
Still, Corace said she’s been encouraged by the uptake across the province. Since its launch, almost 1,000 front-line workers have sought out one-on-one mental health support through this program, and 2,400 accessed online cognitive behavioural therapy as of Dec. 31.
The common reason for reaching out is crisis related to a particular situation or crisis, followed by depression, generalized anxiety and difficulties related to job and finances, Corace said. Around 35 per cent of frontline workers reaching out for help were doing so for the first time, meaning this pandemic program served as their first point of access for mental health care in the province.
“We’re reaching that group of people who are new to the mental health and substance use sector, and I think that’s important,” Corace said.
The program has no wait times for front-line health workers, but it has some limitations in certain hubs. At St. Joseph’s hospital in Hamilton, the COVID-19 Frontline Wellness program was only given enough funding by Ontario Health to hire one part-time psychotherapist, said Dr. Randi McCabe, the director of mental health and addictions program at the hospital.
This has led the hospital to borrow staff from its existing mental health resources, McCabe said, which has increased the wait times for the general public up to a month. The program has provided around 400 therapy sessions to frontline workers since its launch.
“We’ve had to pivot to provide this service, and it would be hard to sustain because it does impact other services,” McCabe said.
Corace said there’s no sunset date yet on the provincial program. As for whether it’s a resource that should exist beyond the pandemic, she said the uptake has proven there is a need for such services among health-care workers that will likely persist beyond COVID-19.
“There is going to be a very long tail at the end of this.”
Along with this mental health resource for front-line workers, Hilkene said the health ministry has spent $26.75 million in emergency funding to ensure mental health agencies have the resources for online and virtual services during the pandemic, which can be accessed by any member of the public.
“Since increasing access to online and virtual supports during these unprecedented times, we have seen thousands of Ontarians from all walks of life reach out for help — including many of our front-line heroes,” Hilkene said.
She added the province recognizes front-line workers “are working long hours in stressful situations at a time when most other Ontarians were forced to stay home and maintain physical distance.”
Looking for long-term relief, the Ontario Nurses’ Association is preparing to head to the bargaining table in March with the Ontario Hospital Association, which represents 138 hospitals in the province, to ask for more resources. But union president McKenna said she is aware of the obstacles.
Bill 124, a piece of legislation passed by the Doug Ford government in 2019, sets limitations on public sector wage increases to a maximum of one per cent a year in total compensation for three years. The ONA has since launched a charter challenge against the law.
“It’s all about the dollars at the end of the day,” McKenna said, though she argues a benefits plan that includes uniform mental health coverage for nurses would be less costly in the long run.
McKenna added that nurses’ frustration also comes from being heralded as “heroes” over the course of the pandemic by the Ontario government, but their “actions haven’t demonstrated it to them, and they feel disrespected.”
For uninsured contract nurses like Umbaiga, lack of access to paid sick days has also weighed heavily on their minds. Umbaiga said she’s had to isolate twice due to COVID-19 exposure since the pandemic began in March — both times without pay.
While federally there is a $1 billion Canadian Recovery Sickness Benefit program, Harry Godfrey, a spokesperson for Ontario Labour Minister Monte McNaughton, said $800 million of this benefit remains unused. He added McNaughton is working with the federal government to ensure there are no delays in payment or barriers to access, and that more employers can be aware of this program.
As the program’s kinks are sorted out, Umaigba continues to work in the ICU, aiding COVID-19 patients with limited support. She says her stress has been downloaded onto her young daughter, whose anxiety rises each time her mother comes home with a risk of COVID-19 exposure.
Umaigba says she’s relied on her local church community for support, with monthly get-togethers over Zoom. But her biggest wish remains to successfully sponsor her husband in Nigeria, so she and her daughter can feel less alone.
“I shouldn’t have to worry about who will look out for my daughter if I have to isolate again,” Umaigba says.
“Even though I have faith and hope in God, I still have this fear of ‘what if something happens to me?’”
Nadine Yousif is a federally funded Local Journalism Initiative reporter for the Toronto Star