Head of union: Nurses driven to their breaking point could stop smiling

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Anneli Kannus. Source: Priit Mürk/ERR

The patient deserves the best, while the best is not available in a situation where nurses and caregivers are overworked and exhausted.

Nurses are nearing their breaking point now, President of the Estonian Nurses Union Anneli Kannus admits.

She is attempting to negotiate with the hospitals and medical emergency associations for a new collective agreement one part of which would be a wage hike.

Give us hope that the coronavirus period will pass and things will become easier.

We are all waiting for properly warm weather, to be able to go out lightly dressed, feel free and meet with loved ones. As medical workers, we eagerly await and hope that the more people are vaccinated, the faster that time will come.

In your opinion, how has Estonia done in terms of vaccination?

Vaccination makes for a confusing topic because new information becomes available and last-minute changes are made every day. Perhaps we should not immediately share every new piece of information and instead analyze it first.

We do not ask our doctor or nurse what type of vaccine is being used when we go in for our annual flu shot. While we do now, during Covid. We no longer trust medical workers as far as we used to.

Do you trust all vaccines?

Yes, because they are based on and developed using scientific decisions and have shown excellent results.

Are you vaccinated?

I belong to a risk group and have been inoculated with pretty much every vaccine out there. (Laughs)

A family nurse acquaintance of mine told me that they never thought they would have to work as a salesperson – to have to call people and offer them vaccine instead of vacuum cleaners or supplements and sell them on its quality and credibility.

Vaccination efforts have now reached a point where we could make vaccines available to active people who want to be immunized. This would spare nurses from having to do the work of salespeople.

Nurses have to administer a million shots. The vaccine jab only takes a second, but the person wants to ask questions before and after – it all ends up taking much longer. A colleague of mine suggested that a person wants to be healthy and also want peace of mind in terms of whether the shot they are being given really helps.

We believe that vaccinating the older generation should be left to family doctors, while younger people could now be inoculated using mass vaccination drives.

We could now decide that every shot we administer helps us move closer to opening society.

Can you answer the question of why some people do not believe Covid is dangerous or that restrictions are necessary?

Every person is different. That is why. We all have our convictions, opinions and knowledge. They all depend on our past experience, education and the people around us. The more difficult the situation, the more likely people are to latch onto different beliefs.

These are often narrow echo chambers people confine themselves to, creating social groups of likeminded individuals.

Indeed. However, what I want to say is that we are paying too much attention to the non-believers. We cannot convert adults who have a personal opinion on something. They also number far fewer than the [media] picture today would suggest.

You believe we should ignore those who say that masks shouldn't be worn because they are useless, that vaccination is of the devil etc.?

They are people who do not need our help today. We must first see to those who do.

How are hospital and family nurses holding up in the coronavirus situation?

(Sighs) I spoke to a nurse in February who has been vaccinating people since January. Every night and every weekend. And they told me they cannot see how this could go on all the way to summer.

But it will?

Precisely – it will. It means that nurses and caregivers are overworked, exhausted and nearing their breaking point. If a nurse asks for a few days off because things are very difficult at work and because they just do not have the strength, only to be told that it is impossible…

What will happen?

They will eventually either go on "sick leave" or unpaid leave, or they will quit. Because one of those drops will be the last one.

A nurse who works in a Covid ward and sees people die every day, whereas not all of them will have led a long and beautiful life, needs time to recover. No such time is available today.

Intensive care units of hospitals have been working full time for four straight months now. Once [previously canceled] planned surgeries return, almost every patient coming out of surgery will first be taken to the ICU. The staff is overworked as it is, meaning we should make it possible for them to rest in the summer as we do not know whether we will get a new wave of the virus come fall. We should close half of our operating rooms and let people rest. But we cannot.

And it is not just a question of hospitals. School nurses who have to address students' mental health issues are also in trouble, while teachers have their own set of problems…

The "Teeme pai" campaign that started as a citizens' initiative has collected over €300,000 in donations for nurses and care workers in just a few weeks. The people care for you.

Yes, people care for us and can see how difficult the situation is for nurses and caregivers. But we need the state to really acknowledge as much.

It would mean ending this 21st century slave labor. A nurse and caregiver having to work two jobs just to make ends meet is not normal. It should be a person's free choice to work two jobs, not a constant guilt trip where if you do not step up, we will have no one to put on-call.

The average salary of nurses was €1,697 a year ago – more than the national average.

That was the average. Besides, when the data was made public in March 2020, it already included extra remuneration for the Covid situation. We should instead look at the minimum salary of nurses, which is €8 an hour or €1,344 before taxes in the case of normal monthly workload. If we add some night shifts and weekends, we are left with a monthly average of €1,422.

Many nurses work without night shifts and weekends, have no Covid bonuses and receive between €1,344 and €1,422 before taxes.

A nurse is responsible for performing the tasks they are given by the doctor precisely and on time. Can a nurse who is on call for 24 hours, sleeps for 12 hours and then heads back in for another 12-hour shift really get enough rest or put up with this kind of workload forever? A third of nursing employees have been regularly working overtime for a few decades. That is the reason people are leaving healthcare. They just cannot put up with the workload indefinitely.

Anneli Kannus. Source: Priit Mürk/ERR

Is this the reason why Estonia was short 500 nurses before the coronavirus crisis and is now short 700 nurses?

There are two major causes of the shortage of nurses. Firstly, the state has not created more study places for nurses. Secondly, some nurses and caregivers who have worked selflessly are leaving as they realize that better working conditions and salary will not come. We need to keep in mind that the education of Estonian nurses is so good that they can go anywhere.

And Finland is just across the gulf.

It is indeed. Now, the Finnish state has said that they will need 30,000 nurses and caregivers by 2030 and commissioned more trained nurses. We have, with great difficulty, managed to agree on hiking the number of admissions past 500 on a single occasion and have been talking about how many we would realistically need since 2019.

How many would we need?

Estonia would need to train 600-700 nurses every year or 100-150 more than we do today. We would need 700 new nurses every year to catch up to the OECD average.

I know just how few young people graduate from high school in Estonia, meaning that many of them would have to decide to become nurses. (Smiles) Luckily, many have enrolled for a second education so to speak. People who already have an education but who come and train as nurses. The average age of nursing students has grown to 24-25 years.

The Estonian Nurses Union wanted to launch collective agreement talks with the Estonian Hospital Association and the Union of Estonian Medical Emergency. How far have you come?

We started in June of 2020 when we made a proposal to employers. We have met once since then in September and exchanged a few letters. That is the sum of it.

I believe that a solution and compromise can be found in every difficult situation. However, this requires communication of which there has been none.

Will your next step take you to the public conciliator?

The nurses' union has not filed a labor dispute application with the public conciliator. We believe that our employers should be best aware of the true situation of nurses and care workers and that they should talk to us first.

People are very busy during the coronavirus crisis.

People are always very busy in healthcare. We cannot say the situation today is so much worse as to make negotiation impossible. Especially in a situation where head of the North Estonia Medical Center (PERH) Agris Peedu has said in several interviews that the shortage of nurses is the most acute problem. A caregiver can be trained in less time, while we cannot manufacture nurses overnight. It takes three and a half years of training before a person can really work as a nurse.

What will you do? Will you go on strike?

A strike is the last resort in any situation. We are definitely not talking about a strike in the coronavirus situation.

We still believe it is possible to sit down with the hospital association and medical emergency union. Estonia has a new economic forecast, the Health Insurance Fund will have a new budget – employers have all the information they need to make a concrete offer in terms of better working conditions and salary advance for nurses in 2021 and 2022.

You want the €8 hourly pay to be hiked to €9.4 for nurses and from €5 to €6 for caregivers.

Yes, that was our proposal in June 2020.

Your website reads that "Nurses, stop being nice!" is becoming the message of the European Federation of Nurses Associations. Would this mean not smiling to patients.

We cannot stop smiling for patients, but we can stop smiling when it comes to our employers.

What does that mean?

Nurses and caregivers are always placing the needs of patients above their own. They constantly make excuses for themselves, saying that while it is difficult for me, it is even more difficult for the patient lying there. The message today needs to be that it is just as difficult for nurses and caregivers as it is for patients. We must consider that the patient needs the best possible care. However, this is impossible in a situation where the nurse is constantly overworked and exhausted.

The message is that nurses should stop being nice so to speak, stop waiting for the state to notice the work they do and show it appreciates these efforts.

We are all waiting for Covid to pass, while what will follow could prove to be much more painful still. Our colleagues from the European Federation of Nurses Associations say that they are already seeing pensioners leaving healthcare. Estonia is short on nurses as it is, whereas around 15 percent of our nurses have reached the retirement age. Having 400 nurses quit because they are at the end of their rope would be nothing short of a disaster.

If nurses working today are given no hope, it is very difficult for me to convince them not to leave…

I read your social media post about people who get "pressure sores" from sitting in front of computer screens during the Covid period, with their backs bent, feet swollen, eyes red and necks stiff. You said that exercise is not just a necessity for them but rather a matter of life or death. What should they do?

A person needs to balance their professional and family life and downtime. Lying flat on the bed is not rest. A person rests when their body is working while their head is not. One needs to find their favorite physical activity – some like to dance, others to run or go to the gym… And you can dance at home, walk and run outside.

Children are glad to join their parents in whichever activity. If you are home with the kids but need time for yourself, have the mother go running in the morning and the father in the evening. If your kids are big enough to run with you, take them too.

The weather is getting nice. Go out and play ball, just throw it around if nothing else.

Another recommendation is to avoid watching the news every day. You do not really need to know what they are writing about vaccination, the case rate etc. Take some time to concentrate on yourself and your family.

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Editor: Marcus Turovski

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