Nurse Retention: Multiple Strategies to Change Course in a Sea of Challenges
Like the Canadian season of spring, this issue brings fresh ideas and insights about the layers of complexity and potential solutions to the significant challenges associated with the retention of the nursing workforce. As these challenges intensify, nursing leaders – formal and informal – are rallying to redefine the boundaries of what can be done. We are innovators who are transforming this crisis into an opportunity to shift our thinking and do things differently. We are optimizing our roles and expanding our deployment to areas of the system that have previously underutilized nurses and nurse practitioners. The value we bring to the health system is indisputable.
Yet, many of our colleagues do not feel valued. Our mission as leaders is to reimagine workplaces so that nurses and nurse practitioners feel respected and are nurtured and supported to apply their leadership capabilities and realize their career goals. Workplaces have to become so good that they are hard to leave. The articles in this issue of the Canadian Journal of Nursing Leadership – the second in the series with a focus on retention – sheds new light on the diverse strategies being implemented to address this urgent challenge.
In this Issue
LaForest and Jadunandan (2023) start this issue off with an article describing the Black Nurses Leadership Institute and their exciting new leadership training program designed specifically for nurses who identify as Black and/or of African descent. The Institute was formed to challenge the “black ceiling” (Laforest and Jadunandan 2023: 8) in formal nursing leadership roles that has discouraged Black nurses from attaining these roles. The inaugural cohort of learners completed the program in 2022 with participants from British Columbia, Ontario and Nova Scotia. The article describes the historical background of this innovative program, its context and structure and plans for its evaluation and sustainability.
The second article, authored by Ben-Ahmed and Bourgeault (2023), reports on the results of a comprehensive and rapid review of evidence-based solutions from multiple data sources, including peer-reviewed literature, an environmental scan, individual and group interviews with key nursing stakeholders and a survey of Canadian Federation of Nurses Unions' member chief negotiators. The focus of this paper lies in specific retention, return, integration and recruitment initiatives. The authors identify what they refer to as crisis reactive solutions, along with complementary approaches that improve workforce planning strategies and foster resiliency among nurses. Their research found that the number one retention strategy identified by their data sources was reducing nursing workloads.
In their reflective article, Lawrence et al. (2023) use surveys and focus groups to evaluate the experiences of internationally educated nurses (IENs), their preceptors and nurse leaders in a supportive initiative for IENs known as the Supervised Practice Experience Partnership. It is an initiative in which IENs are supported by a preceptor and a mentor for a minimum of 140 practice hours. Lawrence and colleagues' (2023) evaluation provides valuable information about which factors retain and sustain IENs. Their article also addresses the factors that impede the integration of IENs, such as their experience of micro-aggressions from colleagues and patients. Creating supportive work environments that welcome IENs is an important role for nurse leaders.
Strudwick et al. (2023) describe the development of a nursing informatics engagement strategy that aimed to sustain and retain the nursing workforce. The strategy was informed by a needs assessment, benchmark survey and literature review. Components of the strategy included improving the engagement and leadership of nurses in decisions related to informatics and nurses' experiences of using electronic health records. The strategy highlighted how nurses were using electronic health record systems and subsequently found ways to simplify their documentation, as well as improve training about informatics.
The article by Watts et al. (2023) describes community-engaged research that uses Indigenous research methodologies to identify barriers to care and explore how to improve healthcare delivery. The authors identify the importance of the “voice of the community in research” describing it as “a powerful force for advocacy” (Watts et al. 2023: 56). The authors discuss the importance of how nurses are “supported in relationships with communities and in designing programs that fit the community's vision for health and wellness” (Watts et al. 2023: 56). The importance of nurse leaders in the development of policy processes for program redesign for health and social justice impacts are discussed along with implications for nursing leadership. The article identifies eight nursing policy directions and calls to action for nursing leaders and eight nursing policy directions for nursing education and mentorship.
Monkman and Limoges (2023) complete this issue with their synthesis article that applies the Truth and Reconciliation Commission of Canada's Call to Action #92 and the United Nations Declaration on the Rights of Indigenous Peoples to create workplaces that address racism, social exclusion and barriers to self-determination. Such workplaces can recruit and retain Indigenous nurses and create an environment where they can thrive. They propose four intersecting and compounding strategies for the recruitment and retention of Indigenous nurses: (1) identifying and challenging deficit-based discourse; (2) new approaches to collaboration and engagement; (3) incorporating Indigenous worldviews into policies, education and leadership; and (4) education to support cultural safety (Monkman and Limoges 2023: 72).
To summarize, this issue identifies strategies to address retention in a variety of settings and with various patient populations. The strategies themselves range from being very specific to broad and are based on evidence, theory and/or experience. Their diversity is fitting for the complexity of the challenge before us.
Our next issue will be the third and last issue in this retention-focused triad. In the meantime, I want to take the opportunity to wish all of you a very happy and rewarding Nurses Week.
About the Author(s)
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
Ben-Ahmed, H.E. and I.L. Bourgeault. 2023. Sustaining the Canadian Nursing Workforce: Targeted Evidence-Based Reactive Solutions in Response to the Ongoing Crisis. Canadian Journal of Nursing Leadership 35(4): 14–29. doi:10.12927/cjnl.2023.27076.
LaForest, S.P. and S. Jadunandan. 2023. Smashing the “Black Ceiling”: The Black Nurses Leadership Institute. Canadian Journal of Nursing Leadership 35(4): 8–13. doi:10.12927/cjnl.2023.27077.
Lawrence, K., K. Boyd, L. Rashleigh and T. DasGupta. 2023. From Recruitment to Retention: Evaluating the Experiences of Internationally Educated Nurses in the Supervised Practice Experience Partnership. Canadian Journal of Nursing Leadership 35(4): 30–41. doi:10.12927/cjnl.2023.27075.
Monkman, M. and J. Limoges. 2023. Pathways for Healthcare Organizations to Strengthen Indigenous Nurse Retention. Canadian Journal of Nursing Leadership 35(4): 68–84. doi:10.12927/cjnl.2023.27072.
Strudwick, G., T. Tajirian, J. Kemp, N. Coombe, U. Haider, S. Kaur et al. 2023. Utilizing an Informatics Engagement Strategy as an Approach to Sustain and Retain the Nursing Workforce. Canadian Journal of Nursing Leadership 35(4): 42–54. doi:10.12927/cjnl.2023.27074.
Watts, J., L. Bourque Bearskin, D. Blackstone, S. Christiansen, K. Young, J. Charleson et al. 2023. Nursing the Nuu-chah-nulth Way: Communities Driving Nursing Policy Priorities. Canadian Journal of Nursing Leadership 35(4): 55–67. doi:10.12927/cjnl.2023.27073.
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