Nurses across the Northwest Territories say staffing levels in the territory's healthcare system are now dangerously low. How does it feel to watch crises unfold from within that system?
When Alex – not their real name – began work as a nurse in a mid-sized N.W.T. community, fresh out of school, he loved it.
In those first weeks on the job, he learned quickly and made close friendships.
But as the months went by, the nursing team dwindled. Colleagues said burnout and chronic exhaustion were taking a toll. As Alex became one of the few nurses remaining, he began to understand.
“I was still very young in my nursing career and was quickly doing a lot of things that I don’t want to say were beyond my scope, but just a lot more managerial things, things that I probably didn’t have enough experience to be navigating. And then suddenly," he said, "everyone was gone.”
In nursing, the on-call system works by placing some nurses first on call and others second on call.
Nurses that are first on call can be woken through the night to attend to patients and are expected to continue work at 9am the next day. That arrangement might ordinarily be expected on one or two weekends a month.
On nights where a nurse is second on call, they are expected to fill in when the first-on-call nurse is occupied.
Staffing levels in his health centre dropped so low that Alex found himself either first on call or second on call every night of the week.
Days became a sleep deprived blur, he said, punctuated by moments of acute anxiety when thrown into life-or-death situations with some patients. On some nights, he was the lone occupant of the building. The health of the entire area became his responsibility alone.
“This a community with thousands of people, a very busy health centre. I remember thinking to myself, like, how am I going to do this alone?" Alex recalled.
"I started planning: 'Okay, if it gets really bad, maybe I can call the RCMP. They know how to do CPR.'"
Eventually, Alex says he had to leave the field to protect his mental health and well-being.
In larger communities, nurses describe being so sleep-deprived that they felt terrified of making mistakes that could result in losing their licence – or devastating consequences for a patient.
“They’re leaving the nurses extremely short," said Taylor, also not their real name, who recently left a nursing position at Yellowknife's Stanton Territorial Hospital. We protected nurses' identities throughout this article to allow people hoping to maintain careers in the field to speak candidly about an employer.
Stanton has operated with a raft of nursing vacancies for years. Nurses have already complained publicly on several occasions about conditions.
In any hospital, Taylor said, "when you have critically low staffing, at the end of the day, people do suffer from that. There has to be a decline in care."
Adrian, again a pseudonym, is currently employed at Stanton. "It's a disaster waiting to happen," they said, "and not because of the lack of good nursing staff, not because of lack of experience. It’s just that there are not enough of them and they’re exhausted.”
At Stanton, operating room nurses say the staffing shortage has led to the cancellation of a number of elective surgeries. They say nurse-to-patient ratios are "unsustainable" and "unsafe."
"Leadership are aware of concerns being brought forward by staff working in the operating rooms/surgical services at Stanton," said David Maguire, a spokesperson for the N.W.T.'s health authority.
"Maintaining the capacity for urgent and emergency surgical care is a priority while we work to stabilize staffing in this area. We will be engaging with staff in this area and have already put measures in place to mitigate impacts of workload on staff."
Last month, the N.W.T. government said Stanton's operating room services would be reduced to 50 per cent capacity until at least 2023. Maguire said the health authority is trying to move staff internally, pursue new recruitment strategies and find agency staff to fill gaps.
But there is so far little sign that efforts are reducing pressure on existing staff. Thirteen of the N.W.T.'s 33 communities are on some form of reduced healthcare service this month, according to the health authority's tracker, up from 11 in July.
On the days when working as a nurse in these conditions isn’t harrowing, it’s simply depressing.
“I’d go to work and everyone would be miserable," said Adrian. "You would work all day knowing that you were going to have to stay late, too. There would be times when nobody would come to relieve you. A lot of people with young kids end up having to quit."
Going above and beyond, nurses said, has become what feels like a baseline expectation from management.
The Union of Northern Workers this month issued a press release based on a letter from nurses that raised serious concerns about the Stanton operating room.
"These nurses are struggling mentally, physically, and emotionally to provide critical emergency services with less than half the nurses the OR unit should be staffing," the union stated.
Linda Silas, president of the Canadian Federation of Nurses Union, said the same concerns are being raised across Canada and internationally.
"They are taking advantage of a workforce that truly believes in what they do," Silas alleged.
"When you’re a nurse, it’s in your DNA. You want to be there for patients. You want to be there for your community. And your own health, your own life often takes a backseat. And governments abuse that."
Silas says that while her organization is actively lobbying the federal government for change, there are short-term solutions that can help take the pressure off nurses.
"We're hearing from both nurses and doctors that they need support staff. We need unit clerks who can help with requisition forms, charting, computer work. We need porters, we need cleaning staff, we need people who can stay with patients that are anxious or violent. All of that needs to be done, and it can be done quickly," Silas said.
"In my 30 years of doing union work, I have never seen nurses so mad. So I don’t know what’s going to happen in the next few months. And that’s why we’re putting pressure on all levels of government."
But while the nursing shortage is a nationwide issue, some N.W.T. nurses have maintained for years that the problem in the North is also a systemic failure of leadership.
In a recent letter seen by Cabin Radio, nurses addressing staffing at Stanton state: "Leadership in our hospital lacked foresight [and] did not adequately prepare for the consequences of our unit being severely understaffed."
The nurses state managers knew maternity leaves and retirements were coming up but did not act quickly enough, posting vacancies far too late for adequate cover to be available on time.
Several nurses said specific individuals had remained in positions of power for too long despite concerns being raised, allowing a culture of what they term degrading, bullying and toxic behaviour to flourish.
"There's not a lot of accountability anywhere in the system," said Alex.
"It's very easy to fail upwards in the North. The same managers are just being shuffled around to different positions and, until they deal with this issue, they can keep bringing people in but they won't be able to hold on to them."
The N.W.T. has specifically targeted increased retention in ongoing efforts to address the nursing shortage. For example, an incentives package announced in August covers travel to the N.W.T. for two loved ones of healthcare workers scheduled to work during the coming holiday season.
But nurses say despite these offerings, they perceive the main focus of the government to be recruitment of fresh workers. They say a simple bonus for anyone who had to work during the incredibly challenging conditions of the past year, to acknowledge those efforts, would go a long way.
"It's incredibly frustrating," said Taylor. "There is nothing being done for staff members who are working more than 40 overtime shifts in one year to keep hospitals and health centres running, nothing we're offering them out of appreciation.
"The rate of staff turnover we have is not sustainable, and it's not like we're an Ontario or Alberta where there are thousands of other nurses to choose from. It's much harder, when you lose a nurse here, to gain another one."
For people attempting to address the shortage from the government side, the issue looks circular: the more nurses that leave, the worse things get for those who stay. In short, the territory is losing nurses because there aren't enough nurses. So their response is that to address poor working conditions for nurses, the N.W.T. needs to prioritize hiring more nurses.
"We know that staff in the system have – over the past two years and more – given incredible amounts of time and gone above and beyond to ensure continued delivery of care and services to residents," said Maguire, the health authority spokesperson.
"Significant challenges related to staffing are present throughout the system and ongoing service impacts will continue to be a reality while we fill gaps and work toward longer-term sustainable staffing."
But Adrian sees it differently. To them, that way of addressing the crisis is tantamount to perpetually buying new dishes instead of washing the ones already in your kitchen. Rather than facing systemic change, Adrian says the N.W.T. is allowing healthcare consulting to practically become its own industry.
"They haven't listened to us," they said. "They keep hiring these people, creating these new jobs, all to figure out how to address this problem, and nothing is going to come of it besides someone else getting paid $100,000 a year to write down what we all already knew.
"Nothing is happening. And this bonus if you refer a friend thing? It's just an insult."
Adrian and Taylor said a new management team is needed, retention bonuses should be given to current nursing staff, and a culture that values nurses needs to be strongly encouraged in N.W.T. health centres.
"There was no recognition by management for the amount of sacrifices we had to make in our personal lives," one nurse said.
"They don't look at staff as people, just as bodies who can work."
Caitrin Pilkington, Local Journalism Initiative Reporter, Cabin Radio