As the cracks in our stretched and overburdened healthcare system continue to widen, the downstream pressures on nurses, nurse practitioners (NPs) and other healthcare providers continue to rise. It is stressful and painful for nurses to witness how the weaknesses in our system impact the lives of patients, families and communities. Nurses are there amid the anger, uncertainty, weariness and fear – providing care around the clock. We know that the working conditions are challenging, to say the least, and the needs of the population are growing at the same time that the workforce is shrinking. The picture I am painting is one that is all too familiar – one that we hear about daily. 

And yet in this sea of uncertainty and enormous stress and strain, there is a realization that nurses are a constant force of health promotion and healing in a system that is just beginning to ascertain how important the roles of nurses and NPs are, and how much more they could be.

The need for strong nursing leadership has never been more important. But what does that even mean in these tumultuous, yet exhilarating, times? I believe it means challenging ourselves to look at the problems squarely in the eye and to understand them in all their layers of complexity in order to discern a new truth, a new path forward. That means understanding what is known and unknown, what is grounded in evidence and what is not.

The Canadian Journal of Nursing Leadership (CJNL) embraces these challenges and opportunities and seeks to provide a literary platform for authors to share leadership perspectives, research findings and critical discussions of issues and innovations of importance to nurses and nursing. Our recent themed issue with a focus on Strengths-Based Nursing and Healthcare Leadership is an excellent example. Led by seminal authors and well-known Canadian nurse leaders (Pam Hubley, Marilyn Ballantyne and Mary McAllister), the issue is bursting with fresh insights as well as practical applications and inspirational innovations in leadership (see Hubley et al. 2024). I encourage you to share and talk about it with colleagues and be open to what those conversations might lead to. While this themed issue is one example of how the journal is anticipating the needs and interests of readers, another such example includes our upcoming podcasts featuring interviews with exceptional nursing leaders.

CNA Update

This issue begins with a commentary written by current and past chief executive officers of the Canadian Nurses Association (CNA) who reflect on more than a century of leadership that the organization has provided for nurses in our country (Guest and Villeneuve 2024). They trace the development of CNA to the present day and boldly identify the challenges, risks and opportunities being faced by nursing and the broader healthcare system. Their commentary sounds the alarm that the viability of CNA is under threat and issues a compelling call for leadership that does not allow this to happen – once lost it will be difficult to reclaim.

Special Focus on Nursing Retention

Following the CNA update is an article by Canada's chief nursing officer, Leigh Chapman. Chapman (2024) describes the background and lead up to the re-establishment of the chief nursing officer role after a decade-long vacancy. Some of the activities of the first year in office are described, including the legacy of learnings during Chapman's visits to nurses in every province and territory. The article affirms the contribution of nurses to Canada's healthcare system, the need for more nurses to be involved in decision making about health policy and the complexity of the health workforce challenges that requires multi-faceted strategies. Chapman (2024) introduces and describes a comprehensive retention toolkit developed by nurses that nurse leaders can use for the explicit purpose of promoting the retention of nurses.

Nursing Research

Next, there are four research-based articles that illuminate the nature of burnout, resilience and job satisfaction of a group of nurses and NPs in acute care settings; two of those articles explore innovations to address stress and burnout using different strategies.

Kostiuk et al. (2024) discuss how nurse leaders can address barriers to changing practice by engaging nursing staff in strategies that promote and foster the application of culturally appropriate skills in the workplace. They urge nurse leaders to develop strategies that provide nurses with opportunities – “time and space” – for critical reflection and cultural learning and the creation of a work environment that values learning, dialogue and change (Kostiuk et al. 2024: 24).

Harwood et al.'s (2024) article uncovers the burnout, resilience and job satisfaction experienced by NPs in acute care settings. Their cross-sectional survey of NPs found that a high percentage of NPs reported moderate to high levels of burnout/emotional exhaustion and low levels of job satisfaction with some interesting differences between NPs who worked in outpatient versus in-patient settings and NPs in their first two years of practice versus those with more years of experience. The article identifies important learnings for nurse leaders and suggests priority areas for retention interventions.

The next article, written by Weiser et al. (2024), describes an innovative fellowship for registered practical nurses to foster and support knowledge development in evidence-based practice. The article describes the structure and outcomes of the training program, including leadership development experiences and the impact on the research fellow's confidence and understanding.

The final article in the issue by Santiago et al. (2024) describes an evaluation of the clinical externship program for nursing students. Developed and implemented during the COVID-19 pandemic at a multi-site healthcare organization, the program aimed to address the shortage of staff by hiring undergraduate nursing and diploma program practical nursing students as unregulated care providers. A qualitative study using semi-structured interviews was conducted to explore the perceptions and experiences of participants involved in the program. Findings included the importance of orientation and the need for increased role clarity and the value of the opportunity for nursing students and the healthcare system.

Conclusion

As you will have noticed, this issue features articles about nursing leadership across the nursing family. I am convinced that together we are stronger. Collaboration across the nursing family is key to addressing the challenges that are all around us and, even more importantly, it is key to seizing the opportunities for positive change in Canada's healthcare system.

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