A photo of a neon blue heart.
A neon blue heart. Credit: Cathy Crowe Credit: Cathy Crowe

It’s like the time loop in the movie Groundhog Day. Waking up and experiencing repeated harms over and over – except it’s not a fantasy. In 2003 I gave a speech at the Canadian Federation of Nurses Unions. I called it ‘The New Reality: Nursing in Crisis. The Necessary Reality: Fight Back.’

“Whether you work in a hospital, a chronic care facility, or on the street, as a nurse today in Canada you are working in a war zone. There has been a targeted and strategic war on nursing in every province right across this country. You know the consequences of this war: layoffs, part-time and contract work, privatization, contracting out, reduction in benefits, marginalization, to name just a few.

I use the war metaphor carefully. I have written about war, about nurses’ involvement in war and peace movements. I know that part of our history derives from the militarization of nursing. But I do believe that we are working in a war zone because the same government policies that have diminished the possibilities of caring, that have made it impossible for nurses to do their job, these are the same government policies that reduce or eliminate social programs such as affordable housing, employment insurance, welfare, and disability programs.

These are the same purposeful policies that support privatization, profits over people, a two-tiered health system and user fees. They are the same policies that have led to the Walkerton water tragedy and have left us without the resources to deal with emerging health emergencies such as tuberculosis and SARS. They are the policies that continue to cause great pain, suffering, homelessness, malnutrition, and death.”

At the time, I was running a nursing outreach program for unhoused people at a community health centre. I witnessed the consequences of cutbacks to social spending made even more apparent by the SARS outbreak in Toronto. I went to a lot of funerals.

Bottom line, the term “street nurse,” which I have always used as a political term, exists because the health care system was unable to respond to the needs of unhoused people and governments had allowed the homelessness disaster to escalate.

Waking up, year after year the horrors continue, except unlike in the film Groundhog Day this is not a comedy.

Health care workers, their unions and health coalitions have steadfastly spoken out, documented staffing shortfalls, warned about privatization, contracting out and deskilling yet here we are. The concept of ‘fight back’ has mostly been limited to studies, lawn signs and meetings.

Today, a global pandemic still ravages our health care system.

Attacks on nurses on the rise

The 7 p.m. banging on pots and pans in support of health care workers is long finished. A few lonely neon hearts for healthcare workers still glow in windows – a reminder of those rallying times.

Meanwhile emergency room closures hopscotch across the country, mostly due to nursing shortages. Nurses are getting sick, or their families get sick as governments reduce public health COVID precautions. Most worrisome is the number of nurses who are experiencing trauma and violence. Many are leaving the profession. Wage caps and wage suppression, most notoriously enforced by Bill 124 in Ontario fuel the lived experience that nurses are not valued.

I have long argued that nurses are only valued at times of war or physician shortage. Canadian nurses recruited for military duty during WWI led to a nursing shortage at home. This resulted in improved working conditions to be competitive in the job market and a substantive expansion of nursing schools.

The WWII recruitment of nurses played on nurses’ steadfastness, courage, and devotion, not unlike today’s ‘appreciation’ in the pandemic. Economic incentives were established for married women to enter nursing and childcare was provided – incentives that were eliminated after the war. So much for appreciation.

A few positive outcomes for the profession lingered after the war such as the establishment of nursing specialties such as treatment of burns, and full officer status for some nurses who stayed in the military. I personally benefited from free nursing education including room and board.

Physician shortages and medical dominance in the health care system colliding with nursing’s desire to expand its scope resulted in a nurse practitioner movement that had its ups and downs.

When I worked as a nurse practitioner, what I was allowed to do often depended on who the doctors were. It was a rare physician comfortable with nursing’s scope of practice.

In the early 2000s I spoke at a Queen’s Park rally in Toronto that was co-sponsored by the Registered Nurses Association of Ontario (RNAO) and a provincial doctors’ group. Prior to the rally, I was sent written directions by the RNAO to not mention nurse practitioners in my speech. Today, there are some wins on the nurse practitioner front however primarily in areas of physician shortage or disinterest.

People who care about health care and working people recently lost a champion in Barbara Ehrenreich, an important thinker and writer on nursing and women in the workforce. With Deirdre English in Witches, Midwives & Nurses she wrote:

“
the drive to professionalize nursing, is, at best, a flight from the reality of sexism in the health system. At worst, it is sexist itself, deepening the division among women health workers and bolstering the hierarchy controlled by men.”

The drive to professionalize nursing included the move to a four-year baccalaureate degree as entry to practice for registered nurses, thus diminishing the community college nursing programs that were both accessible and affordable to many.

Professionalization included a push for men to enter nursing to improve the image of nursing.

Professionalization included a new emphasis on something called nursing diagnoses and nursing theory and courses such as ‘Integrate Nursing Science Theory. Research and Inquiry’ and ‘Critical Reflexivity: Theory as Practice.’

Hierarchies of nursing were created. Today, nursing care is provided by the degree nurses (RN), by registered practical nurses (RPN), by lay practical nurses (LPN), by the newly created personal support worker (PSW) and home support worker (HSW) category and a list too long to go into here. Not yet available, but coming soon is a new PSW course that includes six-week online training and four-month paid placement funded by the federal government – this development due to PSW shortage.

Professionalization deadened organized nursing’s attention to social justice both within and outside of nursing.

There is an expression my very wise nurse mother used to repeat: ‘Nursing eats their young.’  I will go one step further. We, as a society, are cannibalizing nursing.

Both young and old, degree or no degree, nursing lives are being decimated and nurses are left to witness obscene conditions and patient suffering.

Governments are not treating this as a health care and long-term care crisis.

As Naomi Klein wrote in This Changes Everything, “Clearly what gets declared a crisis is an expression of power and priorities as much as hard facts. But we need not be spectators in all this: politicians aren’t the only ones with the power to declare a crisis. Mass movements of regular people can declare one too.”

Yes, we can.

As writer and activist Rebecca Solnit wrote: “Making an injury visible and public is usually the first step in remedying it, and political change often follows culture, as what was long tolerated is seen to be intolerable, or what was overlooked becomes obvious.”

Nurses like Birgit Uwaila Umaigba, and the ‘Gritty Nurse’ podcasters Amie Archibald-Varley and Sara Fung have been part of making the injuries and intolerable conditions visible.

We need new and refreshed solidarity movements now. Think of Ontario’s Days of Action in the 1990s. Think of the struggle for women to get the vote. Think of the fight for other human rights worldwide.

We need, what I called in a Winnipeg speech, ‘The Wind that Shakes the Barley’, a labour and popular movement that will stir a wind for social change, that will stir people, energize and warm people, compel people to gather and protest and fight to win.

Cathy Crowe

Cathy Crowe

Cathy Crowe is a street nurse (non-practising), author and filmmaker who works nationally and locally on health and social justice issues. Her work has included taking the pulse of health issues affecting...