Beside the Bedside

Krystyna Dyl still remembers the eight-hour journey she embarked on twenty-five years ago. With only one suitcase, she left Poland and moved to Canada to fulfill her dream of being a nurse.

She spoke very little English and did not know the obstacles she would face when she got here. She did not have the educational requirements to become a nurse in Canada.

“I didn’t speak English at all so it was tough,” says Krystyna. “I would work in the morning and then attend school in the evening four times a week to upgrade my education and learn the language. I was trying to balance everything because I knew my main goal was to become a nurse.”

Krystyna worked hard to complete her studies and became a registered nurse in Canada. She’s been working for the last 19 years as an RN at the United Mennonite Home in Vineland, Ontario, and is a Local 302 member and steward. But her dream of spending her time caring for and helping people has been eroded by the amount of documentation she is required to fill out for each shift she works.

She’s not alone. The role of registered nurses in Ontario’s long term care sector has changed drastically over the past 10 years due to regulations. Today, many RNs spend more time behind a computer than beside the bedside of the residents they care for.

Michele Taylor's day begins at six a.m. when she checks in with the personal support workers (PSWs) on her shift and discusses any high-risk patients for the day. She then begins her morning medication pass, supervises breakfast, and tries to fit in documentation, care planning, and assessments before lunch. After lunch, she attends occasional meetings and then completes her documentations for the day.

Like Krystyna, a large portion of Michele’s day is not spent at residents’ sides but at a desk completing paperwork. Michele is a registered nurse and Local 304 member employed by Owen Hill Care Community in Barrie, Ontario. Because Owen Hill is a smaller home, she gets to interact more with her residents than most nurses in other homes get to do, but she says her role is still busier now than it was even a couple of years ago.

“I feel very rushed at times,” says Michele. “There are a lot of things that I would like to be able to do but don’t have time for. I would love to spend more time with each resident.

“I think the role of a registered nurse is definitely an evolving role. As the role of RPNs has changed, so has ours. It’s really great that I get to be involved in the medications and the hands-on nursing care. However, I am still responsible to do a lot of paper assessments as well as the minimum data sets [MDS] that have now been added.”

Cindy Reuber's workload has also increased greatly over the last decade. Cindy is an RN and Local 304 member and steward employed by Caressant Care in Harriston, Ontario.

“Our residents now require a lot more time and effort,” she says. “We’re seeing more acutely ill and chronically ill residents and a very increased population with mental health issues, and we don’t have added staff for that. We’re still working with the same number of staff that we would have a couple of years ago—except now our jobs are more complex with the extra workload.”

To take care of all her residents along with the increase in the number of daily tasks she needs to complete, Cindy has to prioritize care.

“You may not worry about a bandage on an arm one day; that might have to wait if you’re dealing with a crisis and someone is going into heart failure, or someone is having trouble with their diabetes, or someone has fallen. It gets difficult sometimes.”

After 15 years as a nurse, Cindy has seen it all. She’s seen all the technological advancements, the changes in the Ontario healthcare and long term care systems, and her changing role as a nurse. But the worst part is the monotony of paperwork that has been introduced.

“If someone has an emergency and falls, your first concern is making sure they are alright,” she says. “And once they are, and everyone has calmed down, you realize that now that one incident is going to take you 30 minutes to chart and document. Instead of having the time to go back and say, ‘How are you doing?’ or ‘How are you feeling?’ and giving them the emotional support that they need, you’re busy charting the incident.”

Nothing demonstrates the stark change in the role of RNs better than Krystyna’s workload.

“Fifteen years ago, I used to take care of 50 residents, and I still had time after my daily tasks to sit with the residents and listen to their stories,” she says. “Today, I only take care of 32, and I don’t have time for anything else other than my daily tasks and the documentation. It’s really frustrating. I don’t even have five minutes to sit down with them and listen.”

The changing role of RNs from hands-on caregiving to documentation is leaving Krystyna and her fellow members growing increasingly frustrated and stressed.

“I didn’t go through the process of becoming a nurse to fill out paperwork and code my residents’ care level needs for funding,” says Cindy. “That’s not actively taking care of them. Someone who has a real interest in working with logistics and numbers should be doing that. I want to be caring, talking, and spending time with the residents. I think having a personal relationship with them is extremely important, but instead of creating that, I spend a lot of my time sitting at the computer now.”

When she’s on the night shift, Cindy spends at least four hours completing assessments and documentations on her computer. She used to have time not only to talk to the residents, but also to take her breaks when she first started working. But now, between the documentation and the additional responsibilities that come from having residents with greater care needs when they arrive, she doesn’t have time to talk or rest on her break.

“It’s overwhelming because every shift, we have to deal with something urgent,” she says. “It could just be a chronic condition that’s flaring up, but we know then that we have to watch that patient extra carefully.”

And every incident needs to be tracked.

“Tracking takes almost an hour and the assessment we are required to fill out takes three to four hours,” says Krystyna. “A lot of time in my shift is spent doing this. I understand it needs to be done because that’s how we get funding, but we have to fill out forms for every incident. It’s overwhelming for everybody involved.

“On top of the documentation, nurses still have to deal with the everyday tragedies as well so it all adds up. Some people think that we get used to seeing residents pass away. But that’s not true. It’s always very hard. What helps is when we keep in mind that we are not here to save lives. We are here to make the last days of the resident’s life comfortable. We are trying to maintain their good health for as long as possible.”

CLAC has actively worked with its members in long term care to put forward solutions to the Ontario government that would give RNs, RPNs, and PSWs more time for patient care, and still provide the accountability required. Krystyna served on the documentation committee for CLAC’s Patients First submission to the government, which outlines these recommendations and requests additional annual funding over several years to increase staffing on the floor. She and her fellow members on the committee wrote a report describing what changes were needed to the current documentation system to make it more accurate and less time-consuming.

“The committee made the government aware of how much time we spend on filling out documentation forms,” says Krystyna. “The system that they introduced is very time consuming—time we could be spending on direct care. Instead, our time gets taken up filling out forms.

“We’ve met with [the Honourable] Eric Hoskins [Ontario’s minister of health and long term care] and presented our report on how nursing homes in Ontario are standing with the care in comparison to other areas in Canada. The report discusses wage comparisons as well. We are pushing to get money put into the long term care budget because the population is aging, and within the next 10 years, Ontario will be in real trouble if it continues this way.”

For many RNS, working in term care is both highly stressful and very rewarding. Krystyna, who currently works a 32-hour week, says she’s more stressed than ever. On several occasions, she’s become very upset at work because she wasn’t able to care for a patient the way she would have liked to due to the lack of time, given the documentation burden.

But despite the stress of not having enough time to care, Krystyna still says being an RN is well worth it. She enjoys her job and looks forward to her shifts.

“When residents tell you they appreciate you, it is the best feeling in the world,” she says. “They know how hard we work, and when they acknowledge that, it really makes it rewarding.”

Michele, too, loves her job and enjoys every aspect that is involved with actual caregiving. Like all nurses, being able to take care of others is what she used to dream of doing. And now she gets to experience the joy that comes from it on a regular basis.

“I definitely have a job where I can go home every day knowing I brightened up someone’s day,” she says. “I remember admitting a resident who was a younger woman, quadriplegic with MS. During her admission, when I was asking her how we could help meet her needs, she told us she would like for us to shave her legs and put lipstick on her. I remember thinking these are such basic needs that as a young woman we take for granted.

“It was important to her to look nice and maintain her dignity, and she was trusting me with this responsibility. So we added this to her care plan and regularly shaved her legs and assisted her with her makeup. It was such a simple thing, but it made a big difference for her.

“I looked after her for a number of years, and got to know her really well. She had a young son not much older than my oldest, and we would exchange stories just like I would do with the moms in the schoolyard. Little things like this make my job so rewarding.”

But for many caregivers, being able to provide that level of personal care today is a rare thing. There simply isn’t time. Their main concern every shift is making sure they provide the best care possible to all of the residents—despite the amount of paperwork they are required to fill out.

“I still wake up happy every day knowing that I will have a chance to make a huge difference in someone’s quality of life,” says Cindy. “I just hope by the time I grow old, the system has changed for the better.”

Dental Hygienist or Nurse?

For Cindy Reuber, the process of being sure that she made the right career choice was a slow one.

“My dad gave me a choice between being a dental hygienist or a nurse,” she says. “I ended up doing my co-op at the hospital, and I initially found the nursing field to be stressful and overwhelming. But over the years, I have learned how to deal with it. I am happy that I chose nursing.”

Out of Africa

Michele Taylor first realized nursing was her true calling when she went to Africa to volunteer in medical camps.

“We were treating a lot of malaria, promoting sexual health, delivering babies, and everything else in between,” she says. “It really gives you an appreciation for life and the things that we take for granted. I knew I had chosen the right path for me because I felt extremely rewarded and empowered, and most importantly, I knew I was making a difference.”

In Kenya, Michele met a young girl named Margaret. She was six years old when Michele went to her school and taught the students about hygiene. They quickly became friends and Michele kept going back to visit her.

“I could tell she didn’t have a lot after meeting her mother and her principal,” she says. “I decided I wanted to make a difference in her life and I sponsored her education.”

After returning from Africa, Michele knew that she wanted to spend the rest of her life helping those in need.

The Trauma of Death

The most traumatic moment that Krystyna Dyl ever experienced working as a nurse happened recently. A resident had fallen and was found dead.

“It was hard for me because I had never seen something like this before,” she says. “I’ve seen people dying before, but this was different. I have good coping strategies, and I understand why things happen, but sometimes you just feel overwhelmed. This was one of those times.”

Blame It on War and Fashion

Hate shaving your legs? Or maybe you love that smooth-skin feel. In 1915, Gillette created the first razor for women, and in 1940, Remington introduced the first electric razor for women. During the Second World War, the shortage of nylon forced women to go bare-legged more often. Meanwhile, hemlines continued to recede, and fashion ads featured women without body hair and encouraged women to shave their legs. It’s not surprising that more and more women began to shave their legs in the 1950s and 1960s.

Today, it’s not only women who shave their legs. Some men also shave their legs, particularly athletes where it provides a competitive advantage. While leg shaving is still the norm for North American women, a growing number are choosing to go au naturel.

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