‘You just go to the bathroom and cry it out’: Paula, licensed practical nurse, Red Deer

Despite having worked as a licensed practical nurse in emergency departments for the past 20 years, Paula (a pseudonym) says the job has never been this gruelling. “I’m so frustrated,” she says. “It feels like all the energy and empathy I had when I was younger is slipping away from me.”

Paula says dedicated LPNs are being pushed to their limits by overburdened hospitals and short staffing. Some nights, she says, patients wait as long as 13 hours to be seen – and it’s making the abuse that LPNs experience even worse.

“We get yelled at and called names a lot. We’re always getting blamed for things that are completely out of our control,” she says. “My co-workers will come off their breaks in tears. They don’t want to go back on the floor because they’ve got really tough patients to deal with.”

Though Paula has been struck by a patient before, she says her hospital’s security team usually is able to de-escalate the situation before abuse turns physical. A welcomed change, she says, after years spent working in a remote rural Alberta hospital. “There’s a lot more physical abuse in rural communities than here. There is no security there. You’d have to call either the maintenance men or the RCMP and it takes a while for them to get in.”

Paula does her best to cope with work related stress but says “you can only take so much abuse before you start internalizing it and it starts affecting your work.”

But abuse is only one factor contributing to Paula’s overwhelm. There’s been a steady creep in demands on the job that have become unmanageable, she says. Over the past few years, Paula’s employer began strongly recommending LPNs receive extra training through the College for Licensed Practical Nurses of Alberta. Now, LPNs perform transfusions by themselves when they were previously only allowed to hang blood. They can administer a much larger scope of medications, monitor cardiac rhythms and give cardiac medications. Despite the increase in responsibilities, LPNs haven’t been paid more after upgrading their skills. “I believe that the employer wanted us to do this so we could do more for less.”

While the difference (in the scope of Registered Nurses, who generally complete a four-year university degree in nursing, and LPNs, who complete a two-year diploma) at this point “is minute,” says Paula, the difference in pay between the two is substantial. Paula’s salary capped out a decade ago after 11 years in the field. She earns $36 an hour. By comparison, an RN who has just graduated from school will make the exact same amount. An RN with Paula’s equivalent years of experience would make almost double Paula’s wage, at $60 an hour.

Bonnie Gostola, a vice president at the Alberta Union of Public Employees (AUPE), says employees are making the calculation that, “we won’t have an RN do this and pay them that high price, we’ll have an LPN will do it for $20 an hour less.”

In long-term care, she says that it’s common for half of the beds to be assigned to an LPN and the other to an RN. “They are literally performing the same tasks.”

Asking LPNs (called Registered Practical Nurses in Ontario and some other provinces) to do more specialized tasks, without a pay increase, happens across the country.

“It equates to exploitation, because you’re trying to make [LPNs/RPNs] do the same job as a worker of a different classification but not pay them the same,” explains Erin Ariss, president of the Ontario Nurses Association.

These days, Paula can make ends meet but says that when she was younger and raising her children as a single mother, she was strapped for both money and time. “We lived off Ichiban noodles and macaroni and cheese. There were a lot of sacrifices, but you do what you have to do for your children.”

Her mother often babysat while Paula was working, and she’d do her best to trade her evening shifts so that she could still spend time with her kids.

“I feel that I did my children a disservice by being a health-care worker.”

“I feel that I did my children a disservice by being a health-care worker,” she says. “I didn’t get to spend as much time as I wanted to with them.” Despite these sacrifices, Paula says she has persevered because she loves caring for people in their time of need.

But LPNs are being asked to sacrifice more and more of their mental, physical and emotional health, as well as their family time. Although LPNs’ contracts stipulate they are allowed to work more than 16 hours per shift only in cases of emergency, Paula says it’s not uncommon for staff to be asked to work 24-hour shifts. “People are afraid to go to work because they know they’re going to be abused and then berated into staying late and not taking their breaks.”

Paula says she’s typically on her feet for 12 hours straight. She suffers from chronic back, neck and foot pain from the tasks she performs at work and, although the hospital has done “great work” in bringing in ergonomic machinery to help with lifting heavy patients, she says LPNs ultimately need better benefits.

“We need physiotherapy, chiropractor work and massage (to manage work-related pain).” she says, noting their benefits cover less than 20 per cent of the cost of these services.

The low pay and gruelling work conditions are burning out new LPNs rapidly, Paula says. “If I take a week off of work, I come back and there’s brand new faces.” And the new LPNs can struggle to keep up with the demands of the job.

“We’re seeing a lot of new grads. They come out of school with the knowledge, but they don’t have that real world experience yet,” Paula says that the rapid-fire pace in emergency in particular is difficult for recent grads to keep up with.

“A lot of them are burning out really, really fast, they go on sick leave or take positions elsewhere, then we just have to hire more people who have even less experience.”

Paula says the real-world experience LPNs would gain from staying in the field longer is a valuable asset. Without it, there’s a real impact on patient care. She remembers one colleague who had attended nursing school during the early years of the pandemic. “She hadn’t done a real foley catheter [urinary catheter] insertion until she got on the floor. She just used a rolled up towel at home to practice,” Paula says. “She’s a good nurse, but it’s not fair because she’s getting thrown to the wolves and these patients need proper care.”

In the meantime, Paula says patients are paying the price.

“They’re not getting the proper care because we don’t have the staff … There’s a lot of PTSD out there. Even being a seasoned nurse, some things get to me. You just go to the bathroom and cry it out, wipe the tears away, and get back on the floor and do it all over again.”