Nursing Shortages in Canada

Introduction

Nursing is the largest, the most diverse, and one of the most respected of all the health care professions. There are more than 431,769 nurses in Canada for the year in 2018. This represented 303,146 registered nurses (including 5,697 nurse practitioners), 122,600 licensed practical nurses and 6,023 registered psychiatric nurses (Canadian Nurses Association,2019). In 2018 the Canadian Institute for Health Information (CIHI) show that Ontario has the worst RN-to-population ratio in Canada. RNAO calculations based on CIHI figures show the province has only 669 RNs per 100,000 people compared to 828 RNs per 100,000 people across the rest of Canada. There is a huge shortage of nurses in New Brunswick where only 8167 nurses are working in the province for an estimation of 761,214 population (World Population review.com).

The shortage of nurses in Canada is a current issue. Demographic changes, such as large aging population,  majority of registered nurses are 50 years of age or older and a valuable service in drawing attention to the problems that are driving nurses out of the profession, issues such as workload, overtime, scheduling, abuse and violence, and a lack of professional autonomy. Various articles have given the reasons of nursing shortages, statistical analysis and how to overcome the shortage of nurses. I have selected three articles from CBC news, AU library Journal and Huffington post Canada. These three articles focused on reasons shortage of nurses in Canada and strategies or plan to be taken to increase the nurses in provinces. This thrived me to choose nursing shortage as current issue in Canada. I like to address about why there is a nursing shortage and the actions to be taken by the respective governing bodies.

Summary of Articles:

1. Media source:

The news posted on The Huffington Post Canada presented the issue of nursing shortage in Canada, Canada is among many developed and developing countries facing a shortage of nurses, according to a survey released from job-indexing site Indeed.com. The Canadian Nurses Association estimates that country would be shortage of 60,000 nurses by 2022.One of the provinces in Canada, Montreal is facing gridlock at its emergency rooms after the provincial government cut costs by integrating several hospitals and reducing staff.

A Montreal health care manger expressed that many nursing staff have exited from the nursing profession. But Health Minister Eric Hoskins reaffirms the overall number of nurses in Ontario has grown by about 8,000 over the past four or five years they are employing many new nurses. There are different issues or concerns that nurses are stepping out from the profession. One of those is stress that comes with a nursing job is among the things holding people back from choosing the profession. When there is an insufficient staff in the unit or hospital, nurses are working beyond the hours what they have, irregular shifts and long hours often struggles to refill roles. Stressing out can lead to dissatisfaction of job as a result, patient care can suffer. In order to attract people a better compensation, greater professional autonomy, stronger management and training programs, and more flexibility in location and scheduling is needed.

2. Scholarly source:

According to this article the Canadian Nurses Association (CNA) estimates that a nursing shortage in Canada will rise to 60,000 registered nurses by 2022. It is also estimated that approximately 14–61% of new nursing graduates will change nursing roles or exit the profession.

A qualitative research study was done by Kathryn M. Chachula, Florence Myrick, Olive Yonge (2015) to explore the factors and basic psychosocial process involved in the decision of newly graduated registered nurses who wants to exit the nursing profession in western Canada. A purposive, convenience and theoretical sampling technique were used to select the nurses. This study was conducted among eight newly graduated nurses who are willing to leave nursing profession. An unstructured and semi-structured interview were conducted to the participants in the study. A Glaserian grounded theory method is used to articulate what factors influences these newly graduated nurses to exit from nursing profession permanently. Authors illustrated that coping with a backed-up health care system was strained, rigid, and non-responsive, as well as a bureaucracy in which nursing practice felt stifled. Upon conclusion by this study reveals that majority of the nurses enlisted the issues that poor working conditions, high patient loads, and cutbacks all contributed to this negative climate, in which new nursing graduates struggled to adjust to workload and adapt to shiftwork. Increasing nurse-patient ratios, heavy workload, prolonged working hours, altered shifts and long working hours. Implications made by the researchers, if the practices are fostered with the help of interpersonal team, nursing education, health care policy and workplace culture then we can interrupt the process of new nurses choosing to leave the profession.

3. Web site source:

The web site article by Goveia, (2017) addresses about the challenges faced by nurses at Saint Elizabeth Health care in managing too many tasks in a very short time. Through the review of struggle faced by nurse at the hospital, the article presented the impact of nursing workload issue in Canada. The manager at Ontario based home care organization asked one of the nurses to take photos about things that obstruct their work. The website article gave detail about the images captured by nurses. Pictures showed that nurses skipping their breaks, being worried about safety of patient and minimum interaction with senior management. The survey result was further evaluated by Canadian Healthcare Manager after hosting a round table discussion. The survey was successful in presenting the big picture, which was few staffs and large number of patients in hospital. The article also accepted nursing as a demanding job where their role should be appreciated. It also revealed that managers were not aware about time crunch issue of nurses thus indicating that nurses are not

claiming their overtime. The article mainly suggested shifting to the electronic health record to address nursing workload issue in Canada.

Critical Analysis of Three Articles:

By the review of three different types of article covering the topic of nursing shortage in Canada, one can understand the difference in documentation process of authors. The credibility of authors can be evaluated by their education, research interest and their past research work. The citation of author’s name in other sources or bibliography is also reflective of the credibility. Hence, among popular media article, journal article and the website article, Chachula, Myrick & Yonge, (2015) are the most credible authors. Kathryn Michelle Chachula is main author of the work and has qualification in the Master of Nursing. Her research is encompassing teaching and learning in nursing education, simulated learning environment and transition experience of newly place nurses and RN entering the workforce (Brandon University 2017).  Hence, from her research interest, the credibility of the work is understood. Goveia, (2017) and (Tencer, 2017) are not credible authors because they are reporters and have no formal education or research experience in the field of Nursing. Hence, without any research done with target subjects, their work cannot be considered a credible source.

Documentation is the important part when you publish a research study or any article. There was massive a difference seen in online articles and journal articles in terms of documentation. For example, in case of Chachula, Myrick & Yonge, (2015), the presentation and documentation of work was different. Hence, it is a research study she presented article in the form of clear headings like introduction and background, literature review, study design, methodology, result and conclusion. Such documentation by Chachula, Myrick & Yonge, (2015) clearly gave an idea behind the main intention for work and reason behind high rate of exit from nursing profession in Canada. In contrast, the documentation and presentation style found in Huffington post article and website source was in the form of news reporting with dates and

presentation of information was in subsequent paragraphs. These articles haven’t given reference or citation which one could refer to validate the findings.

Upon reviewing the three-article reporting about nursing shortage issue in Canada, the most critical aspect is to determine whether all the authors present same fact or disagreement exist between authors. In case of the news article states that stress is the main factor that nurses are stepping out from the nursing profession. Working in a stressful environment, long hours of working leads to dissatisfaction towards job (Tencer, 2017). However, his argument is also in agreement with Goveia, (2017) claim as it gave insight into the poor working condition of nurse by giving details about the snapshot captured by nurses. Therefore, the factors behind nursing shortage in Canada were clearly understood from the two articles. These two articles were very brief in their information. Contrarily, the research study by Chachula, Myrick & Yonge, (2015) done a systematically with too many information related to psychology behind nurses exiting the nursing profession. This research gave a contrasting viewpoint regarding the reason for exit of nurse which was not extensively covered in other two sources. It reveals that heavy workload, poor staffing pattern, prolonged working hours and due to less staff in the hospitals and increased nurse patient ratio causing the nurses to exit permanently from the profession. Hence, the journal article is useful piece of evidence as it gave direction to adapt policy and health care models in Canada that makes work environment favorable for nurses to practice with full abilities.

Personal and professional values influence your views on this issue.

Nurses play a key role in providing direct care to the patients. They develop a plan of care, working collaboratively with physicians, therapists, patients and their families and other team members, that focuses on treating illness to improve quality of life. If these nurses are being shortage in the hospitals or long-term care facilities, then that would be a massive collapse of health care system in Canada. I personally found the journal article is the most useful as it explored in-depth all factors that forces nurses to leave the job. I agree

with the point that providing favorable work environment is necessary to attract and retain more nurses in the profession.  My professional work value of patient safety and my personal value of compassion for nurses if there is a positive work environment at workplace that will be a motivating factor for nurses to demonstrate better competency and seriousness in maintaining safety of patient.

The nurses who graduated from Canadian universities are moving to different provinces where everyone is willing to stay in metropolitan cities rather working in rural or remote areas. If the government could provide some relocation incentives to the nurses by providing accommodation or wage for relocation for the nurses who are willing to work in rural areas or where the nursing shortage is high, that would be a great idea to stop migrating the nurses to other provinces. Once the nurse patient ratio is reduced to normal level then automatically the heavy workload, prolong hours of work and shift shuffling will be reduced.

Internationally educated nurses are seeking for eligibility to get a licence, the process itself taking minimum 2 years in the meanwhile they are working in different sectors rather than in health field. Delay of licence resembles changing into different fields. If you have any job opportunities in health field rather than nursing for IENs that would be a great thing we cannot lose IENs changing their profession. Centre for Internationally Educated Nurses is one of the centres which supports IENs by showing the path, guiding them towards the successful completion of certification or registration.

Conclusion

To put it in a nutshell, the solution to end the shortage of nurses is to provide great opportunities at workplace for nurses who graduated in Canada and guide IENs to work on their registration and recruit more nurses. Once there is a decrease of nurse patient ratio then idiotically heavy workload on each nurse will reduce which provides a high-quality care to patients and nurses have good job satisfaction and remain in the same profession. Hence, shortage of nurses in Canada would be resolved by using these approaches.

References

• Canadian institute of health information (2019). Nursing in Canada, 2018, Retrieved from https://www.cihi.ca/en/nursing-in-canada-2018.
• Canadian Nurses Association (2019), Nursing statistics. Retrieved from https://www.cna-aiic.ca/en/nursing-practice/the-practice-of-nursing/health-human-resources/nursing-statistics
• Daniel Tencer. (2016, May 31). The Huffington Post Canada, Canada Suffering Nurse Shortage, Though Other Countries Have It Worse: Indeed.com. Retrieved from https://www.huffingtonpost.ca/2016/05/30/nurse-shortage-canada_n_10208080.html
• Goveia, T. (2017). Comparing Notes on Workload, Patient Care and the Use of IT | Canadian Nurse. Canadian-nurse.com. Retrieved 20 December 2017, from https://www.canadian-nurse.com/articles / issues/2009/april-2009/comparing-notes-on-workload-patient-care-and-the-use-of-it
• Kathryn M. Chachula, Florence Myrick, Olive Yonge. (2015). Letting go: How newly graduated registered nurses in Western Canada decide to exit the nursing profession. Nurse Education Today Journal, 35 (2015), 912–918.

         Registered Nurses Association of Ontario (2018). Ontario has the worst RN-to-population ratio in Canada: Province must hire more RNs to end hallway nursing. Retrieved from https://rnao.ca/news/media-releases/2018/06/14/ontario-has-worst-rn-population-ratio-canada-province-must-hire-more-

• World population review (2019). New Brunswick population,2019. Retrieved from http://worldpopulation   review. com/canadian-provinces/new-brunswick-population/