By Laura Bulmer 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. Laura Bulmer is an OPSEU member, full-time professor at a Toronto community college, and Chair of The Canadian Association of Continuing Care Providers (CACCE). She has received the RNAO Best Practice Award for her work in palliative care and is a recipient of the Crystal Apple Teaching Award. She would love to hear your stories and is always looking for fellow PSW advocates to join her on this journey.
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