The first time I heard about Island Health’s fatigue management policy, I was sitting across from a nurse with dark circles under her eyes that no amount of concealer could hide. We met at a quiet café in Victoria, far enough from the hospital where she works that she felt comfortable speaking openly. She stirred her coffee absently, explaining how she’d worked three 12-hour shifts in a row before being called in on what should have been her day off.
“I almost fell asleep driving home,” she told me, her voice dropping to a whisper. “I kept slapping myself to stay awake. And then my phone rang—it was my manager asking if I could come in tomorrow because they were short-staffed again.”
This nurse, who asked to remain anonymous for fear of workplace repercussions, represents hundreds of healthcare workers across Vancouver Island who are struggling under what many describe as a fundamentally broken system. At the heart of this crisis sits Island Health’s fatigue management policy—a framework that, despite its name, appears to be fueling burnout rather than preventing it.
The policy, implemented in 2018 and revised several times since, was designed to address staff shortages while maintaining patient care standards. In practice, however, healthcare workers report being routinely scheduled for excessive consecutive shifts, sometimes working up to 70 hours in a single week, with minimal recovery time between rotations.
Dr. Alika Lafontaine, president of the Canadian Medical Association, has described healthcare worker burnout as a national emergency. “What we’re seeing isn’t sustainable,” he explained during a recent health policy conference in Vancouver. “When healthcare providers are exhausted, patient care inevitably suffers. It’s not just about individual resilience anymore—it’s a systemic failure.”
The numbers paint a troubling picture. According to data from the BC Nurses’ Union, sick calls across Island Health facilities increased by 32% between 2019 and 2023. Internal surveys obtained through freedom of information requests show that 78% of responding staff reported symptoms of burnout, with nearly half considering leaving their positions within the next two years.
For Marilyn Richardson, a respiratory therapist with 17 years of experience at a mid-Island hospital, the breaking point came during the third wave of the pandemic. “I worked 16 days straight because there was literally no one else available,” she told me as we walked along a rainswept beach near Nanaimo. “The policy says we’re supposed to have adequate rest periods, but when your manager calls crying because patients need care and there’s no one else—what are you supposed to do?”
Richardson ultimately reduced her hours to part-time, a decision that came with financial consequences but that she describes as “necessary for survival.”
The fatigue policy’s inadequacies become especially apparent in rural and remote facilities across Vancouver Island, where staffing shortages hit hardest. In Port Hardy, a community of about 4,000 people at the northern tip of the island, the local hospital has operated at reduced capacity for months due to insufficient staffing.
“We’re constantly running on fumes,” explained Dr. Jordan Cook, who practices in the region. “The fatigue policy looks good on paper, but it doesn’t account for the reality that in small communities, there’s often no backup. So people work when they’re exhausted because the alternative is no care at all.”
Island Health acknowledges these challenges. In a written statement, the health authority emphasized that “ensuring safe, quality care remains our highest priority” and noted that “efforts to recruit additional healthcare professionals are ongoing.” The statement acknowledged that “extraordinary circumstances sometimes require flexibility,” but maintained that the fatigue management policy includes safeguards to protect both staff and patients.
Healthcare unions and advocates argue these safeguards aren’t working. The Hospital Employees’ Union (HEU) filed a grievance earlier this year, citing specific concerns about the implementation of the fatigue policy. The union documented cases of members working dangerously long hours, including instances where staff worked 24-hour shifts due to last-minute callouts and an inability to secure replacements.
“What we’re witnessing is a slow-motion healthcare disaster,” said Jennifer Whiteside, Secretary-Business Manager of the HEU. “Our members are deeply committed to patient care, but they’re being pushed beyond human limits.”
The consequences extend far beyond staff well-being. A 2022 study published in the Canadian Medical Association Journal found that medical errors increase significantly when healthcare providers work excessive hours. Researchers demonstrated a 12% increase in adverse events when staff worked more than 12 consecutive hours—a schedule that has become increasingly common under Island Health’s current implementation of its fatigue policy.
Island Health isn’t alone in this struggle. Healthcare systems across Canada face similar pressures, but advocates argue that Vancouver Island’s geographical isolation and aging population create unique challenges that require tailored solutions.
Dr. Kevin Liang, a sleep medicine specialist who consults with healthcare organizations on fatigue management, believes the current approach misses fundamental realities about human physiology.
“The science on this is clear,” he explained during our conversation at his University of Victoria research lab. “The cognitive impairment that occurs after 16 hours without sleep is equivalent to having a blood alcohol level of 0.05%. After 24 hours, it’s comparable to 0.10%—legally drunk in most jurisdictions. We would never accept an intoxicated healthcare provider, yet we routinely accept an exhausted one.”
When I visited the emergency department at a major Island Health facility last month, the impact of these policies was immediately visible. The waiting room overflowed with patients, some who had been there for over eight hours. A charge nurse who had been on shift for 14 hours moved methodically between patients, her face a mask of professional composure that occasionally slipped to reveal bone-deep exhaustion.
“We’re not machines,” she told me during a rare quiet moment. “But the system treats us like we are.”
Solutions exist, though they require significant investment and political will. Healthcare policy experts recommend increased base staffing levels, mandatory recovery periods between shifts, and financial incentives for rural placements. Some facilities in other provinces have implemented strict caps on overtime and created dedicated float pools of staff who can respond to shortages without overburdening regular teams.
For the anonymous nurse I met in Victoria, these changes can’t come soon enough. Since our conversation, she’s reduced her hours and begun looking for work outside the healthcare system entirely—joining the concerning exodus of experienced professionals leaving a field they once loved.
“I became a nurse because I wanted to help people,” she said. “But I can’t help anyone if I’m too exhausted to function. And I worry about who will be left to care for patients if things don’t change soon.”
As Vancouver Island’s communities continue to grow and age, the human cost of an unsustainable fatigue policy threatens to undermine the very healthcare system it was designed to protect.
