Working on the front line can be a setback for staff working at long-term care facilities.
There are not enough people on duty, physically taxing responsibilities, and very sick residents to feed, change and bathe during a shift. That can take its toll on employees, says a woman who works with residents on a daily basis.
Add to that, she says, cutbacks by the government in health care and sick leave policies have staff struggling to provide basic care to people who can't care for themselves.
"There are not enough staff on a unit to follow the guidelines for each person to be done by no less then two staff. This is where injuries come from. Some residents require more than two staff for care," said the 34-year-old who asked that her name not be published as she still works for Eastern Health.
"Each staff member had to take part in special training before and after being hired on how two staff members are to work together caring for residents and the techniques to use. According to policy residents should be lifted, turned, changed by two staff. This is near impossible with the number of residents to staff and the time allowed to have their work for the morning or any time during the day completed," she told The Telegram.
Having worked with Eastern Health for about two years, she began her career at the Hoyles- Escasoni Complex where she said she stayed for six months before deciding to move on to a smaller long-term care facility.
The Hoyles-Escasoni Complex, which has 357 long- term care beds, has been at the centre of controversy for about two weeks with residents and family members expressing publicly their concerns about care, medication, staffing levels and the quality of food being served there.
Led by Ken Kavanagh's frustration about the level of care he says his mother has been receiving as a resident - including being fed spaghettios as a meal - he has stirred a debate about long-term care between unions, Eastern Health and the public.
The unions say hire more staff. Eastern Health says the facility has all permanent positions filled and has full-time relief staff in place to replace extended leaves. Families just want their loved ones cared for no matter what it takes.
"In my opinion there is a need for more PCAs (personal care attendants)," she said. "We are the ones who have the biggest workload. LPNs (licensed practical nurses) have two to three residents to care for and their medications. If there were more PCAs there would be less injury and there would be time to care for each resident properly."
According to Eastern Health, Hoyles-Escasoni has about 300 permanent full-time and part-time nursing staff and about 120 nursing staff on shift daily. Of the 120, it says there is an average of eight to 10 daily calls for short-term sick leave.
"We have significant temporary call-in staff, however, due to high levels of absenteeism, we don't have enough. The sick leave rate is higher in long-term care than anywhere else in our system and we have the highest sick leave nationally," Eastern Health has previously stated.
Regarding sick calls, the front-line worker told The Telegram there is a policy in place whereby the first person who calls in doesn't get replaced.
"Is it to save money or to punish those who are there ready to work because a co-worker is sick? While I was employed at Hoyles (administration) actually came onto the units during the cutbacks and informed us that the first sick call would not be replaced," she said.
"This was a tactic to try and stop staff from calling in sick in order to get a day off. The ones that suffer are the residents. Each staff on a unit has a list of five-six residents that they have to have fed, washed, dressed, up in their chairs if they are medically able. The person who calls in sick, their list is then divided between the other staff making their list six-eight residents each," she said.
Alice Kennedy, vice-president of long-term care for Eastern Health, has told The Telegram it is not a policy as such.
The Hoyles-Escasoni Complex consists of two main buildings - the Hoyles Building and the Escasoni Building - both of which has three wings. Eastern Health has said each wing is staffed by one registered nurse at night for a total of six registered nurses.
"Over the last six months, there have been only nine night shifts when the Hoyles Building has been reduced to two registered nurses from three, due to unavailability. During times when the Hoyles Building has been reduced to two registered nurses, two additional nursing staff, either licensed practical nurses or personal care attendants have been brought in as support staff. The Escasoni Building has never been below its full registered nurse complement at night," says a statement by Eastern Health.
The Newfoundland and Labrador Nurses Union has said the fact remains that when an RN is not replaced, the remaining RNs are working shorthanded.
"In this case, two RNs have to cover three wings. While the RN may be replaced with two LPNs or PCAs, neither of these workers can fulfil an RN's scope of practice nor complete the RN's full range of duties.
The only substitute for an RN is another RN," union president Debbie Forward stated in a previous email to The Telegram.