A senior nurse hopes her resignation last month from the Labrador Health Centre in Happy Valley-Goose Bay, N.L., because of stressful shortstaffing and other situations sends a strong message to her former employer.

Doreen Hawco-Mahoney worked for Labrador-Grenfell Health as a registered nurse for 23 years. She said she made the difficult decision to resign, with plans to continue her nursing work in Nova Scotia, after she woke up one day and felt as if she were "dying inside" and couldn't see herself maintaining a good work-life balance at the health centre for the remainder of her career.

"It has affected me personally, professionally, and affected my health and well-being," she said in a CBC Labrador Morning interview.

"I'm struggling to be an effective parent to my girls and a wife to my husband," she said.

Hawco-Mahoney, who served in various local and provincial roles with the Registered Nurses' Union of Newfoundland and Labrador, said filling vacant positions with locum or agency nurses — or sometimes not filled at all — means nurses are short-staffed.

Budget cuts and restructuring at the health centre mean staff are forced to do more with less, she said. Hawco-Mahoney also said the facility is "unstable" when it comes to the recruitment and retention of nurses, due to Labrador's geography and the social determinants of health.

She said there are more staff leaving the facility than there are coming, and worries about the quality of work life for those left behind.

"Feelings of uncertainty, vacant positions, never knowing if you can get your time off, mandated overtime, working short-staffed, and it's almost like you're kind of meant to feel like you're a robot going through the motions," she said.

Hawco-Mahoney said nurses are in "a constant state of turmoil."

Wake-up call

"It's a real wake-up call for me when I just thought, 'If I don't make some positive changes, I'm not going to see my six-year-old grow up,'" she said.

Hawco-Mahoney said the outmigration of nurses should tell Labrador-Grenfell Health there's a problem at the health centre.

She worries patients are overhearing staff discontentment, or that families are not receiving the information or the care they deserve.

My resignation represents the toxic lack of work life balance. - Doreen Hawco-Mahoney in email to premier

She said the stress nurses face contributes to a "survival of the fittest" mentality as means of self preservation.

The Registered Nurses' Union of Newfoundland and Labrador says the situation at the health-care centre has reached a crisis.

In November, nurses' union president Debbie Forward said the staffing situation in Happy Valley-Goose Bay has reached a breaking point. (CBC)

In October, the union carried out a survey among registered nurses at the Labrador Health Centre to get an idea of their perceptions of their workload and job satisfaction.

The survey said RNs identified these concerns:

Chronic understaffing, leading to unsafe conditions for patients and staff.

A perceived lack of support from management.

New graduates and locum nurses expected to provide care above their experience or skill level.

It also found 92 per cent of nurses who took the survey "sometimes feel challenged to meet the minimum standards of nursing practice due to working short-staffed and fatigued from working overtime each week."

Since her resignation Jan. 4, Hawco-Mahoney has met with Wally Andersen, the mayor of Happy Valley-Goose Bay, as well as the MHA for the Upper Lake Melville area to express her concerns.

She sent a letter to provincial Health Minister John Haggie, Premier Dwight Ball and other officials to explain why she resigned as a caregiver and is relocating to Nova Scotia to maintain her passion for nursing.

She said there's a negative organizational culture at the Labrador Health Centre.

"With a further 10 years left in my career, I have chosen to leave my home for the last 43 years, and relocate to Nova Scotia. My resignation represents the toxic lack of work life balance and disrespect for the staff of LGH," she wrote in an email.

To date, she hasn't received a reply from the health minister or the premier.

Lack of mentorship

Hawco-Mahoney believes nurses are doing their best to provide the standard of care, but she questions whether junior staff and new graduates are getting the mentoring they need to carry out their duties.

Since airing Hawco-Mahoney's story, families of patients and nurses who worked in Happy Valley-Goose Bay have contacted Labrador Morning to share their own experiences in the Labrador-Grenfell health-care system.​

A nurse — who CBC is not naming as she worries it could affect her future employment — said the Labrador Health Centre is a dangerous place to work.

She did contract work for Labrador-Grenfell Health on several occasions, and said understaffing as well as poor training/education for staff makes the facility an unsafe workplace.

"Many nurses are new grads and thrown to the wolves, nurses working outside their knowledge base and no critical care training for those who are caring for critical patients. It's a lawsuit waiting to happen," she wrote in an email to Labrador Morning.

"The regular staff cannot get much needed time off.… How can you provide safe care for vulnerable patients when you are so exhausted and burnt out you can barely care for yourself? I feel for the nurses there. They cannot keep them for a reason."

Labrador health board needed

Happy Valley-Goose Bay's mayor believes Labrador needs its own health board to work toward improved health care in the region.

Andersen said a shortage of nurses and doctors is discussed at regular meetings with health officials like Health Minister Haggie and Labrador-Grenfell Health, and he brings concerns of residents forward.

"The shortage of nurses, nurses overworked, and other professions within the hospital, that's a big concern to us," he said.

He thinks incentives to bring health professionals to Labrador is part of the answer.

(Labrador-Grenfell Health)

Labrador-Grenfell Health CEO Heather Brown wouldn't comment on a Labrador health board.

But Brown said recruitment and retention of nurses was a key issue when she began her role as CEO in the middle of 2018.

The CEO, who lives in Happy Valley-Goose Bay, said she and other Labrador-Grenfell Health officials have been meeting with staff since early fall and describes the situation as "stable," with 42 nursing positions at the Labrador Health Centre and recruitment being done for other positions.

She does admit staffing is of concern to Labrador-Grenfell Health officials, as well as the registered nurses' union and staff members, because it relates to patient care and an ability for staff to maintain a work-life balance.

"We're concerned about staff. We're concerned about our ability together to provide a healthy workplace and to ensure this is a great place to work, " she said.

Brown also said she believes Labrador-Grenfell Health is able to manage the situation, and they're working on solutions for a problem that isn't unique to Labrador.

A committee formed to address the staffing issues at the Labrador Health Centre — with members from the provincial health department, the health authority and the nurses' union — met for the first time in November.

Brown said the results of the survey of nurses are being looked at and staff are being asked for ideas.

"Some of the things that we're looking at are things that may improve work life, so we're considering and looking for solutions from staff regarding schedules for their work," she said.

She noted that highly specialized locum and agency nurses also bring ideas and support permanent staff for safe and quality patient care.

Conversations about care

​Hawco-Mahoney said she hopes her resignation opens a conversation about what can be done for staff who are struggling, and encourages everyone at the Labrador Health Centre to show compassion and kindness to one another at the facility.

Hawco-Mahoney hopes her resignation opens a conversation about caregivers struggling for a work-life balance. (Bailey White/CBC )

"My hope is that nobody else finds themselves in the place that I'm here today. That nobody else is thinking and feeling like this is what they have to do as a means for self-preservation," she said.

Dozens of comments on social media thank Hawco-Mahoney for her service as a nurse in Happy Valley-Goose Bay.

She begins her nursing position in Nova Scotia next month.

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