Almost ten years ago, the World Health Organization published the document A Universal Truth: No Health Without a Workforce (Campbell et al. 2013). At that time, the situation across the world was grim, with millions of people without healthcare and universal health goals a long way from attainment. Today, enabled by a global pandemic, the consequences of climate change and economic recession, that grimness has morphed into a worldwide health human resources and healthcare crisis of unparalleled magnitude.

Almost everyday I hear or read accounts from patients and families across the country who do not have access to a primary care provider or have waited countless hours only to be turned away from emergency departments. These individual stories are accompanied by startling population data from reliable health information sources. For example, in 2020, Statistics Canada reported that almost five million Canadians over the age of 12 did not have a regular primary care provider (Statistics Canada 2020). In addition, the number of people using the emergency department from 2021 to 2022 was almost 14 million compared to 11.7 million in the previous year (CIHI 2022). Given these stark realities, while it is positive that the number of nurse practitioners (NPs) grew by almost 11% between 2020 and 2021, it is difficult to comprehend why there continue to be differences in their scope of practice across Canada (CIHI 2020).

At the same time, I hear the weariness, sadness and, sometimes, anger and betrayal in the voices of front-line nurses and NPs who relay stories of how they were treated by patients, ranging from rudeness to harassment and, sometimes, even violence. This is in addition to the pressures to work more hours, mentor more junior staff or students and take on more responsibilities – it can be so overwhelming that for some leaving the profession they love may seem like the only option. Those of us in formal leadership positions have a moral imperative to give nurses a reason to stay in the profession and make recruitment of new people to the profession, attractive.

Recognizing the significance of the health human resources crisis, its essentiality to healthcare and the need for evidence to inform leadership in multiple domains, the Canadian Journal of Nursing Leadership launched a call for abstracts for a special issue that focused on retention. We were delighted with the response. There is clearly much work being done in this area and the journal will be producing three issues with a focus on this critically important topic.

In This Issue

To launch the series, we invited Gail Tomblin Murphy – vice president of Research, Innovation and Discovery and chief nurse in Nova Scotia Health – and her team to write a discussion paper about the innovative approaches being taken in Nova Scotia Health to enable the sustainability of the nursing workforce (Tomblin Murphy et al. 2023). Using the World Health Organization's working lifespan framework (WHO 2006), they provide an insightful analysis of how the pandemic has created a window of opportunity for the nursing workforce to innovate collaboratively by using strategies that invest in innovation, grow collaborations among stakeholders and partners and engage with local nurses and nursing leaders to identify challenges and co-design solutions. Their comprehensive and thoughtful description of innovations and related early impacts inspires hope and optimism.

The second paper in this issue (Velji 2023) is based on an invited keynote address given by Karima Velji, chief of Nursing and Professional Practice and assistant deputy minister for the province of Ontario, to the newest group of fellows who were inducted into the Canadian Nurses Association's Canadian Academy of Nursing in June, 2022. I had the good fortune to be in the audience to hear her talk and was completely spellbound by the message encapsulated in the keynote's title “Nurses – Architects of the Future of Healthcare!” While acknowledging that we are experiencing unprecedented workforce shortages, she challenges us to fast-forward bold ideas to create nursing-led solutions now because that is what the public needs from us.

The third paper in this issue comes from a group of nurses who are PhD students at Memorial University in Newfoundland (Curnew et al. 2023). Their discussion paper, “Hindsight Is 2020: A Graduate Student Perspective”, offers a critical reflection on a 2006 report from the Canadian Nurses Association titled Toward 2020: Visions for Nursing (Villeneuve and MacDonald 2006). While acknowledging the seriousness of the current healthcare system crisis, the authors offer fresh perspectives on bold solution-focused actions from a graduate students' perspective.

The fourth and final paper in this issue, entitled “Case Study: The Impact of Nursing Professional Practice during the COVID-19 Pandemic at a Large Community Hospital in Canada” (Yoon et al. 2023) describes the implementation and evaluation of three interventions led by professional practice leadership, in the intensive care unit of Humber River Hospital, a large community hospital located in Toronto, ON. The results of their work are quite remarkable and that has led the authors to conclude: “Nursing leaders should not underestimate their knowledge and influence on nursing practice. This intimate knowledge of clinical practice should be used to empower and support structures and processes to enable care providers to deliver safe and quality care.” (Yoon et al. 2023: 60). This is a powerful message.

Stay tuned for two more issues in 2023 through which the Canadian Journal of Nursing Leadership continues to explore the multifaceted challenges and opportunities to sustain and grow nurses and the nursing profession as we reshape the evolving Canadian healthcare system to meet the needs of all people. You can look forward to articles about the critical importance of leadership, collaboration across nursing organizations, Indigenous perspectives, supports for internationally educated nurses, nursing informatics supports and innovations such as “stay interviews.”

I hope you have all had a restorative holiday season and have returned with renewed strength and conviction to seize the opportunity for transformative change presented by this crisis.

Ruth Martin-Misener, NP, PhD, FAAN, FCAN, Director and Professor, School of Nursing, Assistant Dean, Research, Faculty of Health, Dalhousie University, Co-Director, Canadian Centre for Advanced Practice Nursing Research, Affiliate Scientist, Nova Scotia Health, Affiliate Scientist, Maritime SPOR Support Unit, Halifax, NS

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