As fall winds by I find this time of year conducive to reflection. Whether personal goals, professional status, and the world. Perhaps it’s my method of organizing life events, as the blogs the past few months have explored the concept of complexity.
The pandemic with mandates, closures, and daily uncertainty has receded; the virus COVID-19 continues to affect hundreds indeed thousands every day. We really don’t know, as in the jurisdiction I live in testing is sparse, some agencies perform rapid tests, some municipalities test waste water and the tried and true the reading of my tea leaves; the provincial government seems to be hopeful the worst of the pandemic is behind us.
An analysis of what our communities experienced is overdue, here’s what is known:
— The health care system had displayed staffing vulnerabilities before the pandemic, winter occupancy above 100%, hallway and/or non-traditional care spaces utilized for patient care. One of the largest cohorts for Registered Nurses and Physicians was 55 years and over (another significant one was 64+ old). According to RNAO (2021) 1/3 of nurses 50+ years are considering retirement within 2-5 years. The physicians have a significant pattern of retiring, leaving practices, and not entering family medicine.
— by 2030 Canada will need >117,000 nurses (Scheffler & Arnold, 2018).
— From surveys (i.e., RNAO 2021) workload, dissatisfaction of wage levels (especially Bill 124), and burnout from the pandemic period were some of the themes identified. A key difference was burnout symptoms were present not only critical care and emergency staff but across the continuum of specialities. The stress of workload, moral distress, and working conditions translated into a vulnerable health care sector; nurses in significant numbers changing their practice from acute and long term care to remote work, public health, and leaving the profession.
— Those citizens with mental health challenges throughout our communities are vulnerable, for nurses 70% of them reported their mental health had worsened during the pandemic (CFNU, 2022); over 1/3 indicated their mental health was poor.
— Strategies such as mandatory overtime, delay of vacations, and increasing part time positions to temporary full time (no benefits) were stop gaps but did not address the fundamental issues.
What do Nurses Need To Have Changed?
Health Care Agencies need to increase their focus on retention strategies, an example would be to advocate for a portion of the provincial surplus of monies be prioritized for health human resource management. Recruitment strategies are needed, but negative outcomes could result if ++resources spent on sign on bonuses, the pandemic survivors need viable options to take respite = time off. The mid to late career nurses are intrinsic linchpins to mentor the new grads and the now increased number of internationally educated nurses (IENs) entering the work force.
Speaking of IENs an anecdote I heard about was a RN who applied to a provincial college of nurses, to wait 3.5 years; with a pandemic in the midst of the time period, to be told her experience was not eligible. Her school of nursing was within a leading university in the world, English is her primary language, she lives in an under resourced community and wants to work in long term care. W. T. F. I see the reality nurses work in and where the college is operating from as a chasm compounding the shortage and creates unnecessary barriers.
Utilize evidence-based scheduling practices to ensure patient centred principles are resourced, there is an appropriate skill mix ratio of RNs, RPNs, PSWs, and allied health as well as support staff are funded as an investment not wholly as an expense.
Sadly the nurses’ work conditions are characterized by violence on a regular basis, McGillis-Hall (2020) described 81% of nurses reported a physically violent episode once/year, 25% reported the incidence as weekly and daily. Bullying is a sad characteristic a number of nurses experience, and evidence shows resiliency as a characteristic is supported by having a social network support. Zero tolerance needs to be the aim, a safe work environment is imperative.
RNs are key to health care teams, they’re sentinels, leaders, team members, and patient centred, they need the resources to provide knowledge, skills, and apply clinical judgement. “Developing and sustaining such practices can improve nurses’ wellbeing and retention, improve the quality of patient care, and yield financial benefits for organizations”. RNAO’s BPG Developing and Sustaining Safe, Effective Staffing and Workload Practices (2017). Namaste.
Four main contributors to the nursing shortage summary:
- Retiring nurses or those choosing to leave the profession.
- The aging population necessitates increasing the level of care patients require.
- A nursing faculty shortage capping pre-licensure admission capacity.
- Nursing burnout.
McGillis Hall, L. (2020). Outlook on Nursing: A snapshot from Canadian nurses on work environments pre-COVID-19. Canadian Federation of Nurses Unions. Retrieved October 18, 2021, from https://nursesunions.ca/research/outlook-on-nursing/.
Registered Nurses’ Association of Ontario. (2021, March 31). Work and wellbeing survey results (p.16). Retrieved from https://rnao.ca/sites/rnao-ca/files/Nurses_Wellbeing_Survey_Results_-_March_31.pdf.
Scheffler, R. M., & Arnold, D. R. (2018). Projecting shortages and surpluses of doctors and nurses in the OECD: What looms ahead. Health Economics, Policy and Law, 14(2), 274–290. https://doi.org/10.1017/s174413311700055x
Registered Nurse Storyteller, Healer, Scribe, Transformational Leader
Unfortunately this is Healthcare today. I pray that at sometime the government will have a lightbulb moment and see the situation for what it is a system that is close to collapsing. Private healthcare is not the answer. Thank you for your insightful thoughts on the situation. Somehow we need a Nursing Revival!!