Imagine for a moment that personal support workers were to walk off their jobs for one hour and stand with a placard saying, “I am a PSW, you may need me one day – now I NEED you.” Maybe the visual of just how many there are would finally humanize the issue at hand.
It is not news that unregulated healthcare professionals across the country make up a great portion of what we know as “frontline workers” and have borne a significant share of the burdens of the pandemic. The plight of this workforce, the current shortage, burnout among its ranks and lack of recognition and standardization have been covered to some degree.
What remains, for some unclear reason, is the inability of the federal government to regulate this profession and offer these folks and the public protection – lack of standardization results in unsafe practices.
Provincial governments have attempted to ease the burden with temporary pay raises, bonuses for new graduates and the introduction of new levels of workers.
These, however, are short-term strategies. What happens after the temporary pay raise timeframe closes? Are we saying to those workers, “Thanks for helping us through COVID, but yeah, we don’t value you as much anymore?”
Bonus for new graduates are well intended no doubt but they are insulting to those who have been fighting the battle all along.
As for new levels of workers: Sure, we need more people to help but further “watering down” the role of the PSW is not what is needed. In fact, the introduction of new levels makes this already convoluted profession even more murky.
The workforce is already unstable: an estimated annual attrition rate of 25 per cent of PSWs leaving their jobs and a 40-per-cent attrition rate from graduation to PSW practice.
And the current workforce is morally exhausted and demoralized. Working conditions remain an issue and it is difficult for PSWs to come forward with their concerns as they fear retribution from employers. How are we to fully understand the scope of what is truly happening on the front lines if our frontline workers are not in a position to speak freely?
What we need are permanent solutions to make the profession one of choice: making pay raises permanent and implementing standardization of the profession to attract a new generation of workers. Solid recruitment and retention initiatives need to be implemented with long-term effects not half-baked strategies that only put a band-aid on what is a gaping wound.
Canada must establish a national PSW Task Force where all levels of government – policymakers, PSWs, PSW employers and PSW educators – are at the table. Currently, a huge disconnect exists between what each province/territory is doing. Sure, there are a lot of voices, but the lack of collaboration is preventing genuine forward movement on issues related to PSWs. The more than 50 titles such as orderlies, care assistants, clinical care assistants, and personal care assistants used in this country to describe PSWs and their inherent responsibilities causes confusion and misunderstanding.
Having a dedicated group working on recruitment and retention strategies should be one of the group’s mandates. Recruiting individuals to the field will require making the profession appealing, one in which the pay is permanently higher than what it is now, where full-time jobs (with benefits) are the norm and where there is one title.
A simple name change may help PSWs gain respect from the public and other healthcare professionals. Years ago, Registered Nursing Assistants (RNAs) revised their title to Registered Practical Nurses (RPNs) to change how they are viewed by the public. Replacing “worker” in PSW with “provider” will bring more understanding to the role and its importance.
The task force should also look at ways to pay for PSW education as a recruitment tool in addition to collaborating with employers in all sectors to promote on-the-job training. It is difficult for educational institutions to secure clinical placements during the pandemic with personnel restrictions and yet the need for support is high, again highlighting the disconnect.
Perhaps the most important mandate should be regulation of PSWs. This would provide standardization of title, education, scope of practice and provide the public with safer care since professional regulation also is a form of consumer protection.
Regulation means the profession has a governing or regulatory body that is sanctioned by law and is guided by public interest. Nurses, doctors and lawyers are regulated. Personal Support Providers (PSPs – see how I am using the new “professional” title?) should be, too. Without regulation, PSPs are expected to perform nursing assessments and give medication. Without proper training and support, this is a recipe for unsafe healthcare.
Regulation and standardization also would be effective recruitment and retention strategies as PSP would become a profession of choice. In essence, achieving legitimacy as a true profession is congruent with being regulated. What must be emphasized when arguing for regulation is not that the profession deserves to be recognized but rather that the public needs protection. The fact that federal and provincial/territorial governments have not moved on this yet is immoral.
News from the pandemic has presented us with a dizzying array of numbers – number of cases, number of deaths, rates of infection and exponential growth – that we are in danger of losing the ability to see that real people have lost their lives and real people are struggling.
I certainly hope we have not become desensitized to the news, that we remember that we have the ability to make a difference. If your life has not been positively impacted by a PSW yet, chances are it will. Speak up, join the revolution and help to get this workforce regulated. Let’s work together to make that happen.
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I completely agree with Professor Bulmer. PSWs need our support as the work they do is highly important but, in my opinion, undervalued. This issue is about equity as well. The pandemic has highlighted the inequities that exist in our healthcare system for people working in precarious positions. Regulation will hold institutions accountable for the best training and protection of PSWs, a workforce largely populated by individuals who face multiple oppressions due to the intersectional aspects of their social identities. I see PSW work akin to the important work that Early Childhood Educators do; ECEs are currently regulated in Ontario and PSWs need to be as well.
The government should consider not telling families that the only way they can visit inside is to have two designated family members “provide care”. What?!?! Residents pay for their care and for that care to be delivered by trained professionals, not their family members who do not have the proper training and medical related knowledge. Where is that money going to? Certainly not enough is being done to retain the ones already working way beyond their capacities, therefore receiving no respect for all that they have been doing and continue to do.
We are the “servants” of the health care industry. Our patients certainly appreciate us because we keep them alive and help them to live their lives with dignity. But until the politicians in power have a personal or family experience of needing a PSW it’s hard for them to fully appreciate that we save lives everyday. We don’t perform surgery or any of the more glamorous/sensationalized aspects of health care that make it onto TV. We do the work you don’t see – the weeks of work to support recovery after the hours of surgery, the years of care after your parents can no longer look after themselves, the feeding, the cleaning and just as important the emotional contact and support.
I’ve seen this Balkanization of an industry before – in the financial industry. Canada is a country of 38 million people with 13 financial regulators – the US has 10 times our population and only 1 securities regulator. In Canada I believe it is regional politicians and regulators refusing to relinquish their provincial power to a national regulator that keeps that fragmented status intact. Without a current regulatory body for PSW’s we need to start the regulatory process right with 1 regulator only.
There is absolutely NO NEED for each province/territory to run their own regulations for PSWs – we need a national regulator to establish standards and best practices, create greater accountability for PSW’s and their employers, and create better working conditions for PSWs and patients such as limiting the number of patients per PSW to a reasonable number. Depending on the patient care needs that could be from 3-6 patients per PSW. Canadian citizens deserve the same quality of care across the country and that quality needs to be backed by a single national regulator.
Seniors living in long-term care have very complex medical needs. Some PSWs are making assessments, providing nursing care, and even administering medications. I certainly hope they have more than a minimum of medical/nursing education and background. Why are unlicensed, unregulated workers administering medications and assessing complex medical conditions? Registered Nurses or Licensed Practical Nurses should be responsible for that. PSWs are valuable for what they can offer, and have a place in the health care system, but they are not professional nurses. I don’t doubt their sincerity or character. They are simply not Registered Nurses or LPNs. You can’t just say that the number of cases of Covid-19 in long-term care centres was simply due to not enough PPE available. We’ve read the reports from the Canadian military when they were asked to intervene in the nursing homes. They found a lot lacking. The owners of the homes have a lot to answer for. I would ask this: what is the ratio of PSWs to LPNs or RNs in the long-term care centres? What is the education level of the PSWs? Do PSWs have a working understanding of disease transmission, signs and symptoms of acute illness, the principles of isolation, dehydration, respiratory function, vital signs, oximetry, etc? It takes a lot of knowledge to properly and efficiently care for someone with complex medical needs. Our seniors deserve to have the best possible care. EDUCATE, STANDARDIZE and REGULATE this industry.
My exposure to the PSW world has been small but I’m smart enough to know that in the future my life will be impacted by a PSW. What can I do now to help the process? Who do I email? who do I call to help move the changes along. One day when I need a PSW, I want to know that they are there for me.
Very well spoken. Made me stop and think for a moment about how many friends and relatives i have working in this profession or have at one time. We certainly need to step up and support more.
I have long thought that PSWs are an essential component of healthcare, both in institutional care and in the home. Having worked in the Home Care field before my retirement I know first hand that PSWs enabled many seniors to stay in their homes and continue to live as independently as possible.
I support any initiative that will bring more reward and recognition to PSWs.
As just an average tax payer, I fully support your efforts to get PSWs recognized, governed and paid for their service….Given the alternative is little personal help, which increases the likelihood of hospitalization (or worse) both from a humane and economic point of view we should support good PSWs.
We all should support these valuable workers and Governments should take action now to Regulate , Recognize and Respect this valuable workforce.
They are Indispensable to our society as a whole.
I will start by thanking you for the incredible work you’re doing on advocating for us. As a PSW student, it pains me to hear the stories of PSWs who are out there in the middle of a pandemic and any other day. Whether the weather permits (-35 degrees or 40 degrees) or not, they still have to show up to work and on time and care for the most vulnerable seniors. But they or not regulated, It’s sad. This will not change my mind to become one of the PSWs who are out there helping people who need us.
Amazing article Laura. Keep being so passionate until the changes you want to happen, indeed happen!!
-PSW student
Couldn’t agree more. Overall great article to review and read!
It is absolutely critical that changes need to be made. This article was insightful and it absolutely makes sense. PSWs need our support now and things need to be regulated as in some real cases PSW make the difference between life and death.
What a great article! Thank you much, I totally agree!
Couldn’t agree more. A very important field and not enough recognition. Very well written Professor!
I have never read something so true before. I feel this from the bottom of my heart.
The horror stories about long term care homes show the need now more then ever for regulation and for better pay and to ensure PSWs are treated with dignity and respect. This article perfectly highlights solutions to headline after headline of the situations in home where families wake up everyday worried about their loved ones and the care and PSWs go to work in fear of their safety and dealing with immense stress and burnout. Thanks for this great article Laura.
Anyone can see how important PSWs are and how much they need to be regulated and respected. If for nothing else it is in the interest of public safety.
Keep spreading the word Laura!!
I couldn’t agree more, changes are long overdue. The pandemic has brought the issues to the fore front and they can no longer be ignored. Keep spreading the word!
Great article!
Wholeheartedly agree with Professor Bulmer. We need to help the industry in the long term, not just Covid times
You really make so much sense. The government needs SME advisors, such as yourself, who can help orchestrate these much needed changes for PSW’s.
Wow! This piece is excellent! PSW frontline workers must have our support now! Thank you Ms. Bulmer for sharing your insights into this under represented, critically needed, but demeaningly misunderstood level of our healthcare.