Leigh Chapman was appointed as Canada's chief nursing officer in August 2022. One of her main priorities was to engage with nurses from across Canada. She heard from nurses about the complexity and the multi-faceted nature of health workforce challenges requiring innovative, comprehensive mitigation strategies. Information garnered from her engagement prompted the development of the “Nursing Retention Toolkit: Improving the Working Lives of Nurses in Canada” (Government of Canada 2024), which provides a framework that can be utilized by employers and organizations to enhance the working conditions of nurses. Canadian nurse leaders play a critical role in the implementation of the toolkit.

Introduction

Over the past 20 years as a registered nurse, I have gained a deep understanding of nursing by working in both front-line and clinical leadership capacities. My professional experience spans various settings and includes clinical care, education, research, administration, policy and advocacy. Before becoming the chief nursing officer (CNO) for Canada, I was the inaugural director of clinical services with Inner City Health Associates in Toronto.

The role of the CNO was reinstated after being vacant for almost a decade – I was appointed to the position in August 2022, and my experience since then has been profoundly impactful both personally and professionally. When I initially started in the role, I made a commitment to visit every province and territory to hear from nurses first-hand about their experiences working on the front lines in academic, clinical and community settings. As of January 2024, I can officially say that I have visited nurses from coast to coast to coast, even getting above the Arctic Circle to engage with nurses in Inuvik, Northwest Territories. The opportunity to hear from nurses from across this country has been an incredible experience and is also an essential part of my role to ensure that I am able to represent their diverse perspectives at the federal level. Across the country, nurses have been extremely generous when engaging in dialogue, and I am incredibly grateful for their willingness to share their stories about the realities they have faced due to the COVID-19 pandemic and those that they continue to face due to health workforce challenges.

Nurses continue to show up every day and every night to provide excellent care under challenging circumstances in our current healthcare systems. Within my CNO role and as a nurse myself, I understand the important contribution of nurses and aim to increase their visibility and input in decisions affecting the profession. Nurses make up the largest group of regulated healthcare professionals in this country and it is important for their perspective to be top of mind for policy and decision makers in Canada; the health of our population depends on it.

Health Workforce Challenges

The current health workforce challenges are complex and multi-faceted, requiring innovative and comprehensive mitigation strategies. According to the 2022 Canadian Federation of Nurses Union survey results, 59% of early-career nurses, 56% of mid-career nurses and 20% of late-career nurses were considering leaving their current job by 2023 (CFNU 2022: 4). In addition, the latest data published by the Canadian Institute for Health Information demonstrates that surges in healthcare job vacancies suggest demand for healthcare is outpacing the gains in supply (CIHI 2024).

At the federal level, there is recognition that the health workforce challenges are a shared priority between the provinces and territories and that there is a great need for collaboration to support Canada's health workforce. At the Federal, Provincial and Territorial Health Ministers' Meeting (HMM) in October 2023, health ministers met to discuss the many health workforce issues and put forth the following strategies that will require collaborative effort on a national scale:

• Retention: Reducing rates of stress and burnout and improving workplace culture, flexibility and wellness so that health workers can stay in their jobs.
• Domestic education supply and demand: Enhancing Canada's capacity to produce a domestic supply of key health professionals, including more training opportunities for Indigenous Peoples that meets the national demand for care and keeps pace with a growing and aging population.
• Foreign credential recognition: Making Canada a country of choice for healthcare providers by reducing the time it takes for internationally educated health professionals to join our workforce.
• Labour mobility: Supporting an agile and flexible workforce to support access to care.
• Health workforce and data planning: Improving the availability, sharing and standardization of health workforce data to support health workforce planning (Government of Canada 2023).

The actionable items discussed at the HMM and among other key decision makers are critical and include healthcare systems that support nursing retention. While recruitment will remain an ongoing endeavour for any healthcare organization or health authority, we must shift our gaze to exploring how we are keeping nurses in the profession and encouraging the return of those who may have left. Stated simply, we cannot recruit our way out of the current crisis. Yet, if we change the way in which we value nurses' contribution to care, it will go a long way toward fixing our health systems across the country. It is imperative that we think about the current health systems' constraints in an innovative manner and put forth concrete strategies that will initiate real change. Nurses in leadership positions can have a tangible impact on nursing retention by implementing strategies that improve the working environment for nurses.

Nursing Retention Toolkit

Nurses are critical in providing high-quality care, but they are facing many challenges in their day-to-day work; high patient workloads, increased acuity and moral injury among other factors are causing many nurses to leave the profession. In order for them to stay, we need to support nurses.

Information garnered from my cross-country engagement prompted the development of the “Nursing Retention Toolkit: Improving the Working Lives of Nurses in Canada” (Government of Canada 2024) to help improve the working lives of nurses from coast to coast to coast. The toolkit is the result of a pan-Canadian collaboration in partnership with the Canadian nursing community and with nurses who are committed to optimizing the working conditions of nurses in Canada. It was co-created by a diverse group of nurses brought together in June 2023 at the Nursing Retention Forum (Health Canada 2023). The group comprised nursing experts, including point-of-care nurses, nurse-employers, decision makers, nursing regulators, union representatives and others. As a resource created by and for nurses, it draws on evidence-based practice, lived and living experiences of point-of-care nurses and insights from nursing professionals at all career stages, including nursing students. The aim of the toolkit is to provide Canadian nurse employers and healthcare organizations with practical strategies and tools to improve the retention of nurses. The intended audience of the toolkit includes employers, organizations and health systems, as well as health system administrators.

The toolkit focuses on eight core themes that impact nurses' day-to-day working life in the domain of clinical care and provide corresponding tools that Canadian employers can implement. Each of the core themes is underpinned by the values of respect, anti-racism and anti-oppression, transparency and accountability. In addition, each theme has a goal statement and accompanying initiatives that can be used as a guide for employers and organizations to implement as strategies that target retention. The order in which the eight themes appear does not indicate priority or sequence; each theme may have greater or lesser relevance depending on the local context of the specific employers, organizations or health systems.

The themes are listed as follows:

1. Inspired leadership. The goal of this theme is to empower nurses of all levels, roles and settings to experience fulfilment in their work and become leaders within their organizations. The initiatives include cultural change, leadership competencies and emerging nursing leaders.
2. Flexible and balanced ways of working. This theme involves promoting nurse autonomy and flexibility in scheduling and career progression; initiatives tied to this theme include flexible work design, scheduling systems and workplace resources and amenities.
3. Organizational mental health and wellness supports. The goal of this theme is to increase timely and comprehensive access to appropriate and effective preventative and acute health and wellness supports, with an urgency and focus on mental health supports. Initiatives include zero tolerance for violence, bullying and racism; moral distress and injury care; and best practices for vacation and time off.
4. Professional development and mentorship. This theme focuses on providing options for nurses across the entire career span to help them enhance their skills and pursue their career goals. Initiatives include transition programs and mentorship programs, as well as career pathways and bridging programs.
5. Reduced administrative burden. The intent of this theme is to free up nurses to focus on the tasks and care that they are uniquely skilled to provide. Initiatives tied to this theme include work re-design, digital preparedness and documentation requirements.
6. Strong management and communication. The goal of this theme is to promote cultures of transparent leadership and mutual respect between management and point-of-care nurses. Initiatives to support building these cultures include nursing management competencies, supporting nursing leaders and nurse engagement and listening.
7. Clinical governance and infrastructure. This theme will help to ensure that supportive clinical governance and infrastructure are in place so that nurses have a core role in decision making and are at the forefront of driving the development of a sustainable health system. Initiatives include structured participatory governance, nursing shared governance and nurse-led models of care initiatives and practice standards.
8. Safe staffing practices. The goal of this theme is to support physically safe and psychologically brave workplaces by implementing staffing practices that reflect factors like patient acuity, nurse experience and work-life balance. Initiatives included to support this theme are clinical supports and safe staffing framework tools.

It is my hope that the toolkit will spark change in how we think about and value nursing work and build on the work that others have done to improve nursing retention in Canada.

Considerations and Next Steps

The toolkit provides a framework that can be utilized as a key resource for employers and organizations to enhance the working conditions of nurses. I encourage employers and health authorities to share the toolkit through their social media platforms, via e-mail, at staff meetings, with colleagues and with other healthcare organizations. These activities will promote awareness of the toolkit and its contents. I would also encourage all readers of the toolkit to connect with organizations throughout Canada that are highlighted in the toolkit as references, resources and examples. These connections will help scale up initiatives that we know have had success in other organizations and allow for collaboration and the development of strategic partnerships. Finally, I would recommend adopting and implementing the references, resources and examples of the themes that have the most value for particular organizations or health authorities. There is no “one size fits all” approach to address the current health workforce challenges, yet, at the same time, there are many innovations that can be scaled and spread.

Conclusion

The reinstatement of a federal CNO came at a critical time in healthcare – the current state of healthcare has revealed an opportunity for real change. As nurse leaders, we must take advantage of the opportunity before us to address these challenges and build a more equitable, resilient and sustainable system for the future. Collaboration with the nursing community is an essential part of my role, and I want to thank nurses from across the country who have provided feedback, asked critical questions and been engaged in uplifting the profession, despite the current challenges. There are many differences in the profession and throughout Canada; however, we are stronger when we come together as nurses in a unified manner. From my pan-Canadian perspective, there is tremendous optimism that together, we can find opportunities to emerge out of the difficult times that we find ourselves in. Through my role, I am committed to ensuring that the voices of the profession are woven into decision-making processes at the federal level.

It is imperative that we continue to work together to ensure that the voices of the profession are woven into health systems planning and the transformation that is needed in healthcare across Canada. Nurses are most proximal to the point of care and have a key role to play when it comes to health systems transformation.

It was an honour to collaborate with the nursing community to develop the toolkit. I continue to be inspired by nurses across Canada, and I know that when we work together, we can create solutions that will drive meaningful change in healthcare systems. Canada is fortunate to have nurses with such great knowledge, expertise and professionalism in our health systems; despite the complex and ever-changing healthcare environment, nurses respond with humanity, composure, expertise and competence. It is clear that the profession needs support now more than ever. Ensuring a robust and sustainable workforce is essential in increasing wellness in the profession and respect for the work that nurses do every day. It is my goal to make nursing a profession of choice in Canada. Ultimately, it comes down to how nursing work is respected and valued. The Nursing Retention Toolkit is a great starting point to initiate lasting positive change and improve the working lives of nurses in Canada.

Correspondence may be directed to Leigh Chapman by e-mail at leigh.chapman@hc-sc.gc.ca.

Comments

Lorelei Gibson wrote:

Posted 2024/07/24 at 12:49 PM EDT