A Quebec hospital orderly’s resignation letter has sparked a widespread discussion about the state of health care in the province.
Danika Paquin wrote an open letter to management at the Centre hopsitalier régional de Trois-Rivières, the government of Quebec, and “any other person who has the power to make a difference” explaining why she abandoned her career after five years serving patients. In the letter, Paquin described a system based on overwork, inefficent hierarchy, and the impossibility of accomplishing all of an orderly’s tasks in a shift without cutting corners and sacrificing patients’ comfort and well-being.
Paquin said she quit because the job was “destroying” her, physically and psychologically.
"I'm not looking for pity, I ask only a little empathy, listening and recognition, understanding, support, but especially the desire to make you realize ... I'm trying to save my colleagues and patients in hospitals."
She described the challenge of serving between 12-16 patients per shift, with tasks that included feeding them, changing their bedsheets, helping them go to the bathroom, changing adult diapers, cleaning up messes, and helping them regain some independence after being bed-ridden most of the day. Those tasks, she said, were performed with patients who were paralyzed, confused, overweight, conencted to pumps and tubes, or just plain aggressive. And that was all in the first hour of the day.
Paquin said if the idea of accomplishing all of that in the hour before breakfast seems impossible, imagine trying to do it well.
“I love my job when my patients work things out by themselves so they’re able to stimulate their autonomy. BUT I can also carelessly take them by the scruff of the neck while shouting “Go! Let’s stand up”. It will go much faster.”
I also love my job when my patients have their private parts and hands cleaned up when they go to the bathroom (it’s much cleaner), BUT I can also hide it all with new incontinence briefs, without washing their hands. No one will know, and it will go much faster.”
Paquin said that level of detail is necessary in every task she performed on shift, but there wasn’t enough time, let alone the likelihood of unexpected events that required significant attention as well, such as:
- spilled water
- spilled feces or urine
- tasks performed for nurses
- “A patient who uses the call bell regularly because it is hot, cold, improperly installed, it stings him in the back, is worried, etc.”
Paquin's letter details the myriad tasks orderlies are expected to perform throughout the day, and the list is amazing in its depth and breadth:
- bathe patients
- feed them multiple times
- clean up after meals
- shave patients regularly
- help her patients get to and from the bathroom an average of 39 times a day
- prepare patients for exams
- prepare patients for departure or admission
- distribute snacks for diabetics
- perform staff tasks (such as cleaning the staff refrigerator)
- replenish linen and cleaning carts
- disinfect all wheelchairs and stretchers after use
- send soiled linens to the laundry
- clean up errant utensils, dishes, etc.
And, she reiterated, if she wanted to do all of these tasks with attentiveness, the job became that much more impossible.
I like to clean with care my patients. Lather, rinse, wipe, cream (they deserve it), but I could also use only the no-rinse soap that does not eliminate the smells and feels nothing and dry very quickly, leaving the humidity, no one would know, it would go faster!
On top of all this, Paquin said the morale amongst orderlies is low because of “lack of solidarity” amongst colleagues on shift. She complained that nurses and doctors didn’t know the names of the orderlies, talked behind their backs about tasks that weren’t done, and made them feel uncomfortable when they were assigned to new areas in the hospital.
The last straw came when Paquin, a single mother, was asked to work a night shift and then return the next morning for a day shift in another part of the hospital. She said the hospital wouldn’t help her find a shift replacement, allow her to use a vacation day, or help her contact anyone who could switch shifts.
“Here is the solution I received, in a tone of voice as pleasant as the stomach flu: ‘Find yourself a babysitter like everybody else!’”
Instead, Paquin wrote, she quit.
Although she wrote it last September, Paquin’s letter has found new life since it was posted on Facebook last week. It's been shared thousands of times. The comments on the Facebook post, and in a story about the letter in the Journal de Montreal, echo her complaints from a variety of veterans of the health care industry. Some people simply replied with the number of years they’ve worked as orderlies and felt the same about their jobs, while others found deeper meaning in the post.
“Wow! I shared with my daughter who is an orderly and lives exactly the same thing ... she could write this text! She is young and dynamic but wanting to save the system, she’s exhausted! She will be relieved to see that she is not alone.”
“This is absolutely absurd. Far too many patients for an orderly, you get reprimanded if you change diapers too early because she must be full, or if you spend too much time with the same patient.”
"This is really well said. That explains much of our reality unfortunately :( I’ve been an orderly for 13 years and it is much more difficult than it was at the beginning. When I started, there was a more normal pace. I also often think about doing something else. It's a shame, because I like my job, but if it does not change, they will lose a great gang! It's really not a winner for them, in the end.”
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