St. Catharines Site, Niagara Health System. SUPPLIED

Nurse wants concrete action to improve mental health of front line workers

For nurse Annie Mazmanian, the last 17 years of her career have contained many highs and lows. From years of study to become a Registered Nurse (RN), to training and mentoring new nurses, to working in the front lines of the ICU during the Covid-19 pandemic, her dedication to her patients and her job never wavered.

What did suffer though, was her mental health and wellbeing. Due to her own work experiences during the pandemic, as well as the experiences of her fellow nurses, Mazmanian believes that the highly stressful and unpredictable working conditions for nurses during the pandemic have “brought some light to what is already a broken system within Canada, especially Ontario.”

Registered Nurse Annie Mazmanian. SUPPLIED

She hopes that by speaking about the long term issues that nurses face in the profession, they will be seen less like idealized heroes, and more like human beings.

From a young age, Mazmanian knew that she wanted to become a nurse. As a child, she became interested in the healthcare profession through her interactions with her father, a surgeon, as well as observing various healthcare workers and her mother taking care of her grandparents, who lived in the same house.

Mazmanian said that after growing up around her elders, it was hard to see the elderly community hit so hard by Covid-19. She describes her lowest and saddest moments during the pandemic in a voice that was both strong yet trembling with emotion.

“There’s no visitors allowed during Covid,” said Mazmanian. “As the only nurse in the room, you are holding up an iPad so that family members can say goodbye to their loved one. The patient is usually unconscious or sedated —you start to understand the true meaning of isolation.”

For Mazmanian, overcoming her own struggles with mental health issues and work-related anxiety has emphasized the need for greater awareness of mental health struggles, anxiety, exhaustion and burnout in the nursing profession. She also wants to call attention to ways to improve the healthcare system and provide better practical support for nurses.

According to the Ontario Nurses Association (ONA), Ontario has one of the lowest nurse-to-patient ratio in Canada. Further worsening the situation, the Ford government passed Bill 124 in 2019. This bill contained legislation that suppressed the wages of Registered Nurses, Nurse Practitioners, and healthcare professionals. Even though wages were increased by 1 percent, this is spread out over three years. The ONA also believes that Bill 124 negatively impacts nurses’ rights to bargain and has launched legal action against this bill, with the hopes of seeing it eventually repealed.

The Covid-19 pandemic would rear its deadly head in 2020, further exacerbating the tension created by Bill 124, as well as aggravating existing issues of healthcare staff shortages.

Mazmanian referenced a study, published in 2021 by the International Journal of Nursing Studies, titled The “nurse as hero” discourse in the Covid-19 Pandemic, as particularly enlightening regarding the specific language used by the government and hospitals to describe healthcare workers. In this study, main author Shan Mohammed and his team examined media coverage of nurses in 2020 across Canada, the United Kingdom and the United States. The study found that the “hero” label used to describe nurses wasn’t simply an expression of appreciation, but also a “tool employed to accomplish…the normalization of nurses’ exposure to risk, the enforcement of model citizenship, and the preservation of existing power relationships…. Politicians have been able to hold nurses up as an example for the public…. But this kind of moralism obscures the real issues at stake within nursing.”

Mazmanian pointed out the irony of the Ford government publicly praising nurses and frontline healthcare workers as “heroes,” yet not providing enough funding for healthcare staff to have proper personal protective equipment (PPE).

Another piece of legislation, Bill 195, which was passed at the beginning of the pandemic, also contributed to an even more stressful working environments for nurses and healthcare workers, said Mazmanian. This bill allowed employers to re-deploy employees to different units depending on need (for example, to help with understaffing). However, according to Mazmanian, employees would be pulled from existing units that were already greatly understaffed.

“The Ford government gave employers free rein to do whatever they want. Before Covid, there was already a system-wide nursing shortage. Covid is being used as an excuse, sort of like an umbrella, to move staff from already understaffed units to other understaffed units to help with the staffing issue. They really need to fix the underlying issue of staffing.”

Covid is being used as an excuse, sort of like an umbrella, to move staff from already understaffed units to other understaffed units to help with the staffing issue

She went on to explain that this redeployment created stressful conditions in which employees were placed in unpredictable situations, unfamiliar units, and healthcare departments they were not specifically trained for, often with minimal orientation. More experienced staff were forced to split their already heavy duties between caring for existing patients, and essentially “training” new staff who had been added to the team to support them.

For staff, this would often lead to extreme work-related anxiety, depression, depersonalization, and burnout. The short staffing also led to situations in which nurses felt pressured to not call in sick, or they were simply unable to take time off from work.

For Mazmanian, it was through the support of various figures in her union and the healthcare system who told her that her feelings of anxiety, depression and PTSD were valid and real, as well as friends who noticed that she was no longer herself. After much soul searching, and despite guilt about temporarily leaving the profession and her patients, she deemed that it was necessary to take time off to take care of her own mental health. According to Mazmanian, it was also her many years of experience as a nurse that allowed her to put words to what she was feeling, and to stand up for herself and take some necessary time off to rest, heal, undergo professional counselling, and work on her master’s degress in psychology.

She went on to explain that it is important not only to advocate for yourself, but also for others, particularly new nurses who don’t have the experience or the confidence to speak up for themselves, due to the pressures of starting a new job just after graduating.

“As nurses, we try so hard to smile and be positive, but really at the end of a 12-hour shift, we are defeated and exhausted. Working conditions during Covid meant that none of us knew what we would face, every day. We felt like puppets.”

Mazmanian said that there was an exodus of nurses during each successive wave of Covid, as the burnout and depression increased amongst staff, and that this burnout went largely unnoticed by the general public.

“We need people to listen to us, particularly politicians. We are the ones at the bedside, 24 hours a day, so we know what we are talking about. We need to have more staff, more active leadership, and we need the government to get to the root of the problem in the healthcare system, not slap a band-aid on it. It’s like surgery, that has to begin from the inside.”

Mazmanian hopes to return to nursing soon, and once she finishes her master’s degree, and wishes to help other nurses to advocate for themselves in an often female-dominated profession. She has created the Facebook group Niagara Nurses Helping Nurses to create a community of support for nurses who have faced trauma and experienced anxiety related to their job. She also expressed a desire for the general public to become more aware of the issues that nurses face, and to speak up against Bill 124 and 195.

“There’s lots of [nurses] still out there who are still struggling. Be gentle with us, be kind to us. We understand that you are struggling too because you are isolated due to Covid and can’t see your family. Nurses need a break too. They don’t get into the profession for the glamour of it—they know what they are getting into. We are at the forefront. We need the government and our employers to be clear and transparent with the public, and to follow through with the extra help and support that they promised to us.”

“When you actually think about it,” said Mazmanian, “heroes in stories are never like the King or Queen who don’t fight on the battlefield. Heroes are like soldiers, sent into a battlefield from the bottom of the barrel. And I have never felt more like a bottom of the barrel person in the past year and a half. It’s really disheartening. I don’t want to just be called a hero, I want real change to happen.”