Retaining nurses top priority, says report
Canada needs a multipleintervention strategy to stem the departures of nurses from the profession, says a report authored by two University of Ottawa researchers.
“The crisis is unprecedented. We need bold action and we need it fast,” said Ivy Bourgeault, the university’s research chair in gender, diversity and the professions and the co-author of Sustaining Nursing In Canada, released Thursday.
“We need a number of people whose full-time job it is to fix this,” said Bourgeault. “This is a problem that is spiralling out of control quickly. People are leaving because the environment is toxic. Or they are retreating by working parttime. It’s a huge exodus.”
According to Statistics Canada, the number of job vacancies in the health care and social assistance sector reached a new record high of 136,800 in the first quarter of 2022, up by five per cent from the peak of the fourth quarter of 2021. That included 22,9000 vacancies for registered nurses and registered psychiatric nurses, while vacancies for licensed practical nurses reached 11,300.
For nurses, the intersecting issues include inadequate staffing, excessive workloads, mandatory overtime, toxic workplaces and violence, the researchers note. The pandemic compounded these problems and introduced new issues such as overcapacity challenges.
It is a complex, multi-layered problem. But Bourgeault and co-author Houssem Eddine Ben Ahmed also see it as a vicious cycle that can be interrupted, starting with retaining nurses already in the workforce, fostering the return of those who have left and recruitment — in that order of priority.
“There is stuff we know we can act on now. We need to stop the bleeding with retention, we need to create pathways to get nurses back,” said Bourgeault.
Among dozens of other measures, the report calls for national nurse-patient ratios; mental health days to prevent stress and burnout; more time for professional development to improve job satisfaction; funding flexible programs for nurses who have left the field to allow them to return; and a national public awareness campaign about workplace violence against health-care workers. One of the most promising measures is to reduce workload, says the report, which also advises streamlining the immigration and registration process, and helping to smooth the employment process for internationally-trained nurses.
“The crisis is global,” said Ben Ahmed, a part-time professor in the faculty of social sciences who has a PhD in nursing. “We have nurses in Canada who are still struggling with the immigration process, the registration process and the employment process.”
The researchers considered programs and polices that have been successful in other jurisdictions, as well as academic studies. For example, a program in B.C. allows student nurses to enter a paid practicum program of to up to 300 hours before they graduate, helping them gain skills and experience while earning wages.
The suggested solutions should be considered as an integrated set for coordinated action, said Ahmed.
“If we just take one of two solutions, it would not solve the problem,” he said. “We have report after report that suggests the same thing. if you want to sustain the nursing workforce, you have to take all of the solutions together.”
Canada doesn’t have a national health workforce strategy — and that’s a major problem, said Bourgeault. Health spending constitutes nearly half of provincial and territorial budgets and over eight per cent of Canada’s GDP, making the lack of workforce planning even more egregious, she said.
The federal government has announced a number of recent initiatives to address health workforce challenges, including $26.2 million in the last budget to increase the forgivable amount of student loans for doctors and nurses who work in rural and remote areas.