This article is the first in a series of stories on nursing and COVID-19. These stories will comprise an important part of the informal story-sharing that the SBNH Partnership Grant will be doing throughout the year, working to give greater visibility to SBNH and to nurses’ individual experiences of challenges, strengths, leadership, and healing during the pandemic.
Rachel Prudhomme and Robin Grantner graduated this spring 2020, receiving MSc(A) degrees in nursing. Both Rachel and Robin held positions on the Strengths-Based Nursing and Healthcare (SBNH) Partnership Grant during the last two years of their studies. Professor Laurie Gottlieb, SBNH Project Director, and Tina Gelsomini, SBNH Project Officer, took the opportunity to have a conversation with them to reflect on their time as nursing students and to discuss what it is like to prepare to enter the nursing workforce in Montreal, the epicenter of the COVID-19 outbreak in Canada.
Rachel and Robin are graduating from the Direct Entry (DE) Program at the Ingram School of Nursing, which gives students from a non-nursing background the opportunity to enter the profession with a first degree at the master’s level. Rachel’s and Robin’s first degrees were in Communications Studies and Political Science, respectively, and they left established careers – Rachel in film production, and Robin in communications and cultural administration - to pursue careers in nursing. They are excited to transition from student nurse to professional nurse – but they never could have foreseen the circumstances under which they are now graduating.
The transition from student to professional nurse is always riddled with some anxiety; however, new nurses graduating into this public health crisis face the additional challenges of joining a workforce that is overburdened and exhausted and a healthcare system that has been profoundly disrupted. Even though Rachel and Robin now find themselves thrust into a workforce with high demands, with each nurse expected to assume a tremendous level of responsibility, they are eager to begin their nursing careers.
As graduates of the DE program, Rachel and Robin are not yet licensed to practice as RNs. An emergency measure was passed by the Ordre des infirmières et infirmiers du Québec in April to allow student nurses to practice before receiving their usual interim nursing license, but it was initially unclear which students were eligible for this measure. While waiting to receive clearer information and a temporary nursing license, they applied to work as orderlies in long-term care facilities (CHSLDs), eager to put their skills to use and contribute to combatting the pandemic in any capacity. COVID-19 accounts for the majority of cases of both morbidity and mortality amongst the elderly in these facilities. But despite the dire situation and desperate need for staff, the process of securing a position as an orderly was surprisingly complicated and difficult. Even as Premier Legault called for emergency support from the military, trained and qualified workers such as Rachel and Robin were butting up against barriers as they sought to offer their help. This created a profoundly frustrating sense of disconnect and communication breakdown between the need and the reality of available workers.
Rachel and Robin are keenly aware of the needs and demands of the healthcare system and have a strong identity as nurses already, yet they have been stymied by overburdened bureaucratic systems. Although Rachel finally was able to begin working as an orderly, Robin – despite signing a contract – waited weeks without receiving a work assignment, following up continually. Robin expressed, "Even though it’s a bit scary, I’m still totally committed. I feel like I’ve been in a holding pattern. I want to start, but there are practical and logistical roadblocks. The main feeling is just – let me work, please!”
Of course, this process of transition is not without mixed feelings and internal struggles. Rachel and Robin are excited to become nurses, having intentionally chosen to transition into the career, yet the environment that they will enter is in crisis mode and the workforce they will join is exhausted and stretched. Where will their support come from? Will they have the resources they need to provide the quality of care they want to? There is a wide gap between the ideal practice setting a nurse would want in which to start their career, and the reality of the conditions, demands, and expectations of those on the front lines of the health crisis.
Says Rachel, “We spent time in the past three years thinking about when we would actually start working as nurses… the stress of having all that responsibility, the uncertainty of no longer being protected from some of those more difficult decisions… [Yet what we expected] would have been way easier than what we’re going into right now. Because we’re also going into a system that is in crisis, that’s understaffed. So even the very basic level of orientation that we might have gotten is going to be up in the air.” “I have competencies and knowledge,” adds Robin, “But I also want to make sure for myself and for the people I’ll be responsible for that I’m acting safely and that I have resources to rely on.”
Amidst all of the stress and anxiety, Rachel and Robin have both found a source of comfort and strength in the stories coming from nurses on the front lines. As Robin states, “Every day I check my social media to see who else has shared a story and what I can learn from it." While frightening, hearing nurses’ stories has enhanced Rachel and Robin’s understanding of the importance of this work and their commitment to nursing – a reminder, as Rachel says, of “the intelligence, leadership, compassion, and ‘badass-ness’ of nurses… how much they want to give the best care possible, how willing they are to fight, speak up, and protect their patients, themselves, and their colleagues.” Sharing these stories builds solidarity, mutual understanding, and mutual support between nurses and other healthcare workers, and creates a shared vision and sense of purpose. “That has been so important, and has really grounded me,” says Rachel, “[It’s] made me feel like I have these beautiful friendship and colleague supports who are going through it together.”
"There is this hope that with crisis comes change,” says Rachel, “and that there will be an opportunity… to use that momentum to create a better system.” Robin adds, “In nursing you can really be focused on the moment, the day-to-day, because that is what matters – [but] all those little things add up to something bigger. It is really interesting to take a step back, look to the future, and see what is possible.”
Rachel held a position as an orderly in a Montreal CHSLD throughout the month of May and will begin her first nursing job in a palliative care unit in mid-June. Robin began working in an intensive care unit (ICU) on June 1.
