Health-care workers face 'moral injury' from work stress, protests, says expert

Emergency room nurse Jaime Gallaher recalls the emotional toll of a verbal attack she recently faced from a woman at a grocery store after another gruelling workday.

"I was still red-eyed from crying from the past two hours and she just swore at me," Gallaher said following protests outside Royal Inland Hospital in Kamloops, B.C. "I just broke down in tears, put my carton of milk down and left the grocery store."

Experts are raising concern over "moral injury" among health-care workers suddenly targeted after several provinces brought in vaccine passports.

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Gallaher said she had spent two extra hours at work to avoid protesters on the same day last week when other hospitals in British Columbia and elsewhere in Canada were grappling with rallies.

"We were making some life-and-death decisions around bed allocations. On that specific day, of all days, we had two young patients in our department who were waiting for ICU beds for two days, but they couldn't get them because the ICU was full of unvaccinated COVID patients," she said.

"One of our patients actually passed away in emerge, behind a curtain with his family, which was gut-wrenching because that should never, ever happen. They had no privacy to mourn."

Gallaher said while protesters are entitled to their opinions, the demonstration could be heard in the ER and was a "slap in the face." They could have protested at a park or other public place, she added.

Staff at the hospital were already reeling from treating a seriously ill unvaccinated mother in her 30s with two young children before she was transferred to intensive care.

"She deteriorated quite rapidly in our department over the course of a couple of hours. And the fear in her eyes and the questions about 'What will happen to my kids?' The fear was like nothing I've ever seen," she said, adding that the woman expressed remorse about not getting vaccinated.

Gallaher said nurses who try and care for themselves by booking massage or physiotherapy appointments have been turned away because they have been in contact with COVID-19 patients. They have had to rely on support from each other as many are leaving the profession, she said.

Elizabeth Peter, a nursing professor at the University of Toronto, said nurses on the front lines of the pandemic are suffering from "moral injury," a term also used by the Ontario Hospital Association after several protests outside hospitals in the province.

The military term describes the plight of soldiers experiencing an extreme violation of their moral values, but Peter said it's fitting for exhausted health-care workers who are trying to save lives against the backdrop of protesters opposed to scientifically proven COVID-19 vaccines.

The anger of many health-care professionals has turned to moral outrage at this point in the pandemic, Peter said.

"Virtually everyone in health care would want to help other people," she said. "But when they get the protesters actually telling them they're harmful, horrible humans, that's deeply distressing."

Peter is writing two studies on the moral impact of the pandemic, one on registered nurses and the other on licensed practical nurses working in long-term care homes based on interviews that were finished last spring. A separate study is needed on later effects on the front-line workers to include the anti-vaccination protests and yet another wave of sickness, Peter added.

Earlier this week, the Alberta government withdrew a proposed three per cent salary cut for nurses in the province. The nurses union has said the province still wants concessions like ending lump-sum payments, which amount to a two per cent reduction in their take-home pay.

Finance Minister Travis Toews said the "new proposal acknowledges the hard work and dedication of Alberta's nurses while respecting the tough fiscal situation the province is in."

Dr. Rod Lim, a pediatric emergency room physician in London, Ont., said health-care workers around the country already feel "under siege" but Alberta's contract proposal and the negativity of the protest indicate health workers are unvalued 18 months into the pandemic.

"The protests are demoralizing," he said. "There's a lack of common decency, to protest in front of a hospital, to delay people who are trying to get the care that they deserve. They have nothing to do with the protests, nothing to do with government policy, and they're being adversely affected. This is absolutely maddening and brings out all kinds of emotions."

Lim, who chairs the wellness committee of the Canadian Association of Emergency Physicians, said a shortage of nurses and other staff in emergency departments has led to parts of some emergency rooms being closed when the number of COVID-19 patients is rising.

He said there needs to be a national mental health strategy for doctors dealing with the emotional fallout of the pandemic, in co-ordination with the provinces.

"Never before has the mental health of a workforce, especially among physicians, especially among emergency and ICU physicians across Canada, been really at the forefront that it is now."

This report by The Canadian Press was first published Sept. 10, 2021.