As I was getting ready to come to Vancouver to spend time with nurses at the frontline of the overdose epidemic, I did not know what to expect. I had never experienced an overdose epidemic before.
None of us nurses have.
I knew this epidemic was bad. Records showed more than 6,000 overdoses at Vancouver hospitals between January and November 26. At Insite, there were more than 100 the week before I arrived, and almost 30 in one day. There is not one nurse in Canada who is prepared to deal with that many overdoses. And this has nothing to do with training, competence, or skills. It has everything to do with being human.
Repeated exposure to life-or-death situations is not without consequences. We know this based on years of documenting the experiences of nurses at the frontline of wars, humanitarian crises, disaster relief, and pandemics. The overdose epidemic is no different. So why are we failing to treat it as such and take concrete actions to protect our frontline nurses?
During my stay, I talked to nurses in various settings and spent time with them. Independent of where they work, they all said the same thing. They are short-staffed. They are working longer hours and not taking breaks. They barely have time to eat. They do not have time to complete all their work and provide the care required by their complex patients. They are scared to leave their colleagues alone even for a few minutes. Too often, they have to leave patients unattended or waiting because urgent care is required.
They worry about missing things. They cannot plan their day and end up rushing from one overdose to another, providing care to patients in between each of them. On average, they have been managing anything between 10 to 20 overdoses per day, every day, for months. This has taken a toll on their professional lives and their personal lives. It has also taken a toll on both their mental and physical health.
It has taken over their lives.
As I talked to them, I recognized the compassion fatigue (i.e., emotional and physical exhaustion from repeated exposure to traumatic, stressful, and difficult situations) I experienced as an emergency and trauma nurse. But something was different about it. I worked in an acute-care department in a teaching hospital with access to specialists, equipment, and resources. When patients required ventilation, like the ventilation required for an overdose, respiratory therapists provided assistance. When I was busy providing urgent care, a colleague of mine could help with documentation. If we were short-staffed and overextended, there was always the option of calling an extra nurse.
For nurses at the frontline of the overdose epidemic, though, there has been no additional or backup staff, no resources, and no support for months now. They work in the same environments, with the same staff, with the same patients—except that their patients are overdosing and dying at alarming rates. They hear the sirens while coming into work and leaving work, every day.
When nurses found themselves in the middle of a SARS outbreak, everyone mobilized to support them. We did not have to convince governments, employers, unions, and professional associations to act. They did. Nurses had access to hotlines, debriefing, counseling, additional staff, funding, resources, and direct support if they contracted the virus. Nurses were in the media, telling their stories and generating a great deal of attention at all levels.
To this day, SARS still haunts nurses. Globally, it is estimated that 916 people died of SARS. This is close to the number of people who will die of an overdose this year in British Columbia alone. So why is it that months into a public health emergency, we have to make a case for supporting frontline nurses?
This overdose epidemic will haunt nurses for a long time, in large part because of the inaction of governments, employers, unions, and professional associations and its resulting (and long-lasting) effect on their careers, lives, and health.