In North America, the perfect storm is the lived experience for nurses in the health care system, as the anticipated shortages of educated and experienced health care providers have created a crisis.

Concurrent to the health human resources are the elements of delivering a healthy work environment, and evidence-based practice. The design of patient care include the fundamental concepts of nursing i.e. holism (individuals are more than the sum of their parts), caring (individuals receive consistent and needed compassion and empathy), adaptation (individuals strive for optimal health by responding to internal and external environments–coping using intrinsic and extrinsic strategies), and self care (various activities that individuals perform to maintain their own health and well-being).

The framework of nursing contains phenomena: specific aspects of interest or observable occurrences that are the focal points of theoretical inquiry and study. Theorists seek to understand these phenomena by identifying, describing, explaining, and predicting within the context of nursing practice. The theories tend to be complex, multi-faceted, and encompass the various dimensions of patients’ health and nursing care.

Examples of Phenomena

Pain

Chronic illness coping

Nurse Patient interactions

Health Promotion

Cultural Competence

The nursing philosophy includes ways to explain existence, values, and the human experience through critical inquiry and reflection. These elements act as a compass for nurses as they build their practice, including the nature of nursing, patient care, ethical considerations and the nurses’ role in the health care system. In the toolkit of a clinical nurse are foundational beliefs, proven theories, and evidence-based practices that lead to more comprehensive, patient-centred care.

The world of nursing is quite complex; it has evolved from a task-oriented apprentice model to a knowledge-acquired, philosophical practitioner. The competencies outline the entry requirements for an individual to acquire the title Registered Nurse. Nurses are self-regulated with an understanding and application of a code of conduct, autonomous functions (health promotion, assessment, and diagnosis), and carry out controlled acts under orders or specific conditions (injections, specific procedures). The broad scope is outlined by the College of Nurses and includes practice domains of direct care, education, leadership, and advocacy. The key difference between RNs and RPNs is the handling of more complex tasks and responsibilities.

The academic requirements are complex, and the degrees of critical thinking and clinical judgment are essential. The dynamic acquisition of these necessary skills occurs through clinical practice and reflection on outcomes or, as may be the case, the degree of moral distress one experiences.

Crisis is a significant word, as it flags the danger one can be in, and, in Chinese, it also means opportunity. The prescription to address the challenges of the nursing crisis is to examine minutely and in a timely fashion the deliverables of a robust education program to prepare and continuously enhance nursing knowledge and skills. It means the direct care providers have to be included in the solutions, and middle management needs to be well-versed in nursing practice and the abc’s of staffing and scheduling related to efficiency and effectiveness. Executive leadership need to plan on the realities of today’s patients who tend to be sicker, have more complex conditions, diverse in income, culture, and knowledge, to name a few identifying markers. The need for an equitable, appropriate skill mix, adequate resources to meet organizational key performance indicators, and staff engagement, treating them as more than FTEs and valuing their ongoing efforts.

We have to get on board to resolve this crisis; the exit numbers from nursing ranks are shocking, especially among those under 30. In 2022, for every 100 young nurses entering the profession in Ontario, roughly 35 left. The pandemic did not help the exodus; this situation was identified pre-COVID, but yesterday was the time to resolve this crisis. Namaste.

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Paula M

Retired Registered Nurse (Non-practicing) Storyteller, Healer, Scribe, Transformational Leader