31
Chapter 2
Presentation to the
32 Emerging Infectious Diseases
No Disaster Planning or Early Warning System ... 37 Who’s In Charge?... 37 Public Health Services ... 38 Conclusion ... 38
Introduction
ONA is the largest nurses’ union in Canada, representing 48,000 frontline registered nurses and allied health professionals, who work in hospitals, long-term care facilities, and in the community throughout Ontario. We also represent public health nurses who play an essential role in moni- toring compliance with the public health act and health promotion.
For eight years the health and safety of nurses and the public entrusted to their care, has not been a priority of government. During SARS we learned too many bitter lessons about the inadequacies of Ontario’s healthcare system, and the vulnerability of our frontline healthcare work- ers. We experienced insufficient infection control policies, unsafe practices, too little funding, ineffective communications, dangerous staffing levels, and an critical shortage of personal protective equipment that, had it been available, might have prevented unnecessary exposures and ultimately saved the lives of our nurses.
All of these issues link to government underfunding and to the fact that employers and the government ministries failed to live up to their statutory, legal, and moral obligations to protect the health and safety of healthcare workers, leaving public and workers at risk.
From the beginning of the SARS I outbreak, ONA advocated for a full and impartial public investigation, and insisted that nurses be a part of this investigation. The SARS crisis had a terrible impact on nurses’ lives and practice. Their voices must be heard. It is vital to identify what happened, what went wrong, and what measures must be put in place to ensure that the health and safety of nurses, other healthcare workers, and the public at large is properly protected. It is our expectation that the lessons learned from SARS will help create a culture that values the critical importance of workplace health and safety. In order to prepare Ontario for future outbreaks, and to ensure that we have the infrastructure in place to deal with them, it is essential to take a look at the broader systemic issues, such as compliance with and enforcement of the Occu- pational Health and Safety Act. We must also look at the nursing shortage.
The following list pinpoints elements that must be addressed:
There were inconsistent messages about how to prevent the spread of SARS.
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Presentation to the Commission to Investigate SARS 33 Immediate action was not taken when frontline registered nurses
signaled the alarm about a possible second outbreak
The economic, physical, and emotional impact of SARS on nurses and other healthcare professionals.
Through the private interview process you will be hearing in greater detail from ONA members and staff about the technical aspects of SARS and detailed occupational health and safety implications.
Hundreds of ONA members were quarantined both at home and at work. They were segregated from their families, friends, and coworkers
— and they were ostracized in their communities. We heard from well over 1,000 nurses directly impacted by SARS. ONA members developed SARS after caring for SARS patients. Recently a number of these nurses told the author that they continue to suffer severe emotional and physical repercussions of a disease that we still don’t know that much about. They fear their health will never be what it was. Tragically, two nurses died after contracting the infection while caring for SARS patients. Nelia Laroza was an orthopedic nurse at North York General Hospital, site of the second outbreak. She was Canada’s first healthcare worker to die from SARS when she succumbed in June 2003. Fifteen other nurses from her unit were also infected with SARS, as was her son Kenneth. Tecla Lin, who had more than thirty-five years of nursing experience, was among the first nurses to volunteer to work on a SARS unit at West Park Lodge, where fourteen infected healthcare workers were transferred. The loss of these two courageous nurses is a tragedy that must not be repeated.
Although SARS may be contained for the moment, it has not been eliminated. Today, frontline nurses believe, based on what they have seen in their workplaces, that Ontario is no more prepared for the outbreak of an infectious disease like SARS than it was in March or June 2003. In fact in some ways we are worse off.
We’re still not clear on what protocols are needed to prevent the spread of SARS and to protect frontline nurses when they care for infected patients.
There is still tension between those who wish to be pr oactive, and advocate that we should err on the side of safety, and those who are content to react once the illness reappears. We think that being proactive is crucial. We saw that a reactive approach cost lives.
This government failed to make protection of nurses and other health- care workers and the public a priority. Even before SARS, we knew the provincial Ministry of Labour lacked the commitment to exercise its powers under the Occupational Health and Safety Act. Their job, to conduct random, thorough inspections of healthcare facilities was simply not done.
We need to picture ourselves as nurses working on a SARS unit with no clear direction about which mask to wear, how to make it fit, how
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34 Emerging Infectious Diseases
often to change it, and what to do when supplies run out. Imagine the fear such professionals experience when intubating a highly infectious patient while wearing an inadequate mask, instead of the Stryker suit or other full protection they know they should have. Think of being told, like some nurses, that they should save their masks in a plastic bag from one shift to the next!
Our nurses tell us that throughout the SARS outbreaks, there was a steady stream of contradictory, confusing, inconsistent, and incorrect infor- mation about the means of transmission, infection controls, effective protective gear, and protective protocols healthcare workers needed to follow. This served to heighten nurses’ fears and concerns for their own health and safety, and that of their families. And yet, despite how vulner- able and fearful they felt, they stayed at their patients’ bedsides! One part- time nurse told me she was off for a few days, and was then asked to work on a unit other than her own. No one told her eleven nurses had called in sick. No one told her she needed to wear a mask. She got SARS.
Today, even though nurses are reporting for work, they still feel unsure, unsafe, stressed, and exhausted.
Ontario’s lack of preparedness was made worse by:
too few nurses and too many patients insufficient supplies
insufficient funding
the lack of a standardized infection control system and containment strategy for hospitals
inadequate implementation of Ministry of Health and Long Term Care directives for infection control
inadequate or nonexistent disaster planning or early warning sys- tems; no centralized decision-making authority
downloading of responsibility for, and lack of, public health services