How Canada can retain nurses amid a struggling health-care system: report

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With Canada’s health-care system struggling to keep its head above the water amid a flu epidemic, the continuing pandemic, staff shortages and worker burnout, the role of nurses is more important than ever — but more needs to be done, a group of unions says, to retain and support nurses.

A new report released Thursday by the Canadian Federation of Nurses Unions (CFNU), called Sustaining Nursing in Canada, laid out a list of solutions that could help to address the shortage of nurses during this dire situation for Canada’s health care system.

“From emergency room closures to children’s hospitals overrun with sick kids, health care is at a breaking point in every corner of the country,” Linda Silas, president of CFNU, said in a press release.

“At the heart of this crisis is a dire shortage of nurses. Between years of persistent underfunding and the constant pressure of COVID-19, nurses are in desperate need of real change and support.”

Among the issues facing nurses in Canada’s health-care system today are chronic shortages, ongoing burnout, consistent overtime, poor mental health and poor working conditions, according to the report.

In order to address the issue and keep more nurses in the field, the report laid out a “multi-layered” strategy with three steps: retain and support, return and integrate, and recruit and mentor.

Solutions from the report were among the suggestions presented during the discussions between federal, provincial and territorial health ministers at a two-day meeting in Vancouver last week.

But health ministers left the meeting without assurances of new federal funding. A statement from Canada’s premiers outlined that there had been “no progress” regarding the continued call to increase the federal share of provincial and territorial health-care costs from 22 per cent to 35 per cent. Federal Health Minister Jean-Yves Duclos claimed at a separate news conference afterwards that it was premiers who halted talks by not allowing health ministers to accept any conditions from the federal government in discussions.

CFNU expressed disappointment in its press release Thursday that there were no new agreements on how jurisdictions could provide relief and support for nurses.

“There is no time for political games – the health and, in some cases, the lives of Canadians hang in the balance,” Dr. Ivy Lynn Bourgeault, one of the University of Ottawa researchers who authored the CFNU report, said in the release.

RECOMMENDATIONS FOR HELPING NURSES

CFNU’s report stated that the first step in addressing the nursing shortages and issues in Canada should be to focus on strategies that will retain the current workforce and support it in the workplace.

Solutions for this could be reducing workloads, fostering safe and healthy work environments, supporting mental health of nurses, and using retention strategies targeted at specific populations within nurses, the report suggested.

Although nurse practitioners are one of the fastest growing groups among health-care professionals, according to a Thursday report from the Canadian Institute for Health Information (CIHI), many nurses are leaving public health while numbers increase in the private care sector.

Between the first and second years of the pandemic, more than 600 registered and licensed practical nurses left long-term care or community health agencies, the CIHI report revealed.

This was decline of 2.2. per cent overall in nurses within long-term care alone.

The same report found that nursing inpatient services made up more than 9,770,000 overtime hours for staff in 2020-21, and that 27 per cent of nurses were consistently logging overtime.

Nurses have also reported some of the highest mental health effects due to the pandemic.

A Statistics Canada report looking into the pandemic’s impact on workers found that 92 per cent of nurses reported feeling more stressed at work — a higher percentage than any other health-care profession, with the next highest group being physicians at 87 per cent.

More than 45 per cent of health-care workers surveyed by StatCan said their mental health was worse in 2021 than it was before the pandemic.

CFNU also stated in their report that they had surveyed more than 4,400 practicing nurses in their 2022 national survey, and found that 45 per cent of nurses report experiencing severe burnout, up from 29 per cent pre-pandemic.

“Calling nurses resilient is patching up the problem,” Claire Marshall-Catlin, an emergency department nurse in Vancouver, said in the CIHI report. “If nurses are resilient, they can manage working short, they can return to work after a death in the waiting room, they can stay longer than 12 hours when there is no replacement coming.

“We don’t want to be resilient. We want safe staffing levels, safe patient care and safe work environments. The environment in the ER has taken away our ability to care for patients and families the way we want to, and the way they deserve to be cared for.”

When StatCan surveyed health-care workers who weren’t planning on retiring about whether they intended to leave their current job within the next three years, almost one in four nurses said they were considering leaving their current job or having a career change, the highest proportion of all professions surveyed.

In CFNU’s survey, that number was even higher — more than half of the nurses surveyed said they were considering leaving their current job within the next year, with 19 per cent stating they were considering leaving the profession completely.

Citing StatCan data, CFNU said that nurse vacancies had increase by 133 per cent between 2019 and 2021

CFNU laid out specific recommendations to try and address issues driving nurses from the workforce.

It suggested a legislated minimum nurse-to-patient ratio in order to cut down on unmanageable workloads, a “promising initative” which has been implemented in some health-care settings in Quebec and is a “leading international practice … in reducing nursing workloads especially in acute care settings.”

Creating more capacity for float teams — health-care workers who could flexibly work across several teams to support them — could also take pressure off of nurses, CFNU said.

Staff should also have dedicated mental health days and peer-support programs, the report suggested. In terms of strategies targeted towards retaining specific populations within the nursing workforce, the report identified recent graduates of registered nursing programs as needing additional support in the transition to clinical settings, and also suggested nurses who have been in the workforce for a long time could be reinvigorated if there was more access to continuing education and salaried research opportunities.

The second major step the CFNU report recommends is one that is often overlooked when this topic comes up, according to the report: incentivizing nurses who have left to return to this career, and investing in those who may have been educated internationally but haven’t been able to get licensed within Canada yet.

Part of this issue is nurses who have left for the private care sector.

Between 2020 and 2021, while 612 nurses were leaving public long-term care work, the CIHI report found that there was an increase of 1,251 registered nurses and 667 licensed practical nurses in direct patient care jobs at private nursing agencies and health centres, as well as those working independently.

“Intricately connected to the poor work conditions within many public health care organizations, nurses are quitting to work in private agencies where they may receive higher wages and greater control over their working hours,” the CFNU report stated.

In Ontario, nurses have had their wage growth curtailed by Bill 124, which limits wage increases to one per cent a year for public-sector contracts, including nurses. It was introduced in 2019, but during the pandemic, nursing organizations have called for it be repealed numerous times, to no avail.

For nurses who have retired from the career altogether but may be considering returning, CFNU suggested incentives could include offering a flexible return to work and providing mentorship options.

But it is internationally trained nurses that represent the largest untapped resource in this section, with CFNU stating that there are potentially thousands of educated nurses who simply aren’t able to practice in Canada.

The registration process to transfer those skills and be licensed in Canada can be “complex, costly and time-consuming,” the report stated.

It called on governments to expand programs that fast-track the immigration process for skilled workers in order to process more nurses, and to eliminate some of the confusing steps in the registration process, which can sometimes include resubmitting similar documents to numerous regulatory bodies.

“One example to expedite the process is the Manitoba government’s funding to support (internationally educated nurses) by covering costs associated with certification and ordering the College of Registered Nurses of Manitoba to allow IENs already licensed in other jurisdictions to work in Manitoba,” the report stated.

The final step CFNU outlined was investing more in recruiting.

Some solutions to this include increasing the number of nursing faculty in order train an increased number of students, forging better partnerships with Indigenous and Black nursing organizations, expanding French-delivered nursing programs, offer more student-loan forgiveness to nurses who agree to work in remote locations, and providing free nursing education in exchange for them agreeing to work within certain regions once they’ve graduated.

The CFNU report also called for more comprehensive data on nursing across the country to be collected so that more barriers to nursing can be identified and then strategies can be created to tackle them.

“Nurses are at the heart of solutions,” Dr. Ben Ahmed, a University of Ottawa researcher and co-author of the CFNU report, said in the press release. “Retaining and supporting nurses still working, returning and integrating nurses who have left the public health system, and recruiting and mentoring new nurses into a healthier environment – it is through these evidence-based best practices that we can bring Canadian health care back from the brink.”

NURSES HELPING PRIMARY CARE GAPS

One of the big reasons nursing is such a pressing issue is that there are currently huge gaps in primary care, gaps which nurses could help to fill, those in the industry say.

"Over one million Ontarians are without a primary care provider, and as a result, over 30 per cent of residents are turning to hospital emergency rooms, causing unbearable wait times for care that a primary healthcare provider offers," Dana Cooper, executive director of the Nurse Practitioners’ Association of Ontario, said in a Nov. 14 press release. "Primary care is becoming virtually impossible to obtain in Ontario, and the government has the opportunity to involve Nurse Practitioners in primary care settings to alleviate the barriers Ontarians face in receiving health care."

The term “nurses” encompasses a range of more specific professions with different skill sets — nurse practitioners (NPs) are registered nurses who have received additional training and education that allows them to diagnose and treat illness, prescribe medication and do other more advanced tasks that registered nurses can’t. NPs are present in all health-care settings, including hospitals, primary care clinics, long-term care and rehabilitation.

These skills could be leveraged to help address the gap in Canada’s supply of family doctors, NPAO suggested, as nurse practitioners are able to handle many of the issues a family doctor might see on a regular basis.

“Nurse practitioner-led clinics are a great answer to reduce hallway medicine,” Julia Jacobs, operation manager of a nurse-practitioner led clinic in Windsor-Essex, told CTV News Windsor in August. “It prevents patients from going to walk-in clinics and emergencies for care.”

According to NPAO, their skillset could be leveraged to help fill the gap in Canada’s primary care system, particularly in more remote locations.

Within Ontario, there are 25 nurse practitioner-led clinics, NPAO stated. It is urging the provincial government to increase funding for these clinics in the province so that more Ontarians can access this care.

In some other regions of Canada, nurse practitioner led clinics are fewer and far between — in B.C., for instance, only opened its third nurse-practitioner-led clinic in 2020.