The Importance of Systemic Change and Workplace Improvements for Nurse Retention

Over the last two decades, there has been a global shortage of nurses both in practice and academia. The World Health Organization (WHO) is estimating a projected shortfall of 10 million health workers by 2030. In recent times, this has been attributed to COVID-19, which has exacerbated the problem, however causational factors long predate the pandemic, and this outlook overlooks these important issues.  

Contributing Factors to the Nurse Shortage: 

There are numerous complicated factors that have impacted the ability for employers to retain their nursing staff, which according to a review sponsored by the Royal Society of Canada, are interrelated and transcend multiple external levels of influence: individual, relational, historical, organizational, cultural and even political. Here are some of the contributing reasons for high turnover in the profession: 

1. An under-investment in education and training

   According to the WHO’s evaluation of the health workforce, one of the significant contributions to the continuous shortage of nurses is a chronic under-investment in the education and training of health workers in some countries, and inconsistencies in education and employment strategies. This has also made the deployment of healthcare workers to rural areas difficult.

2. COVID-19

   The Facets investigation into Canada’s nursing workforce post-pandemic suggests there has been a significant increase in nurses’ workloads and by extension, the associated levels of stress. The findings of this study even suggest we are at a tipping point of systemic burnout. This has and will continue to cause nurses to leave their positions and the profession, which is most notably affecting acute service areas.

3. Systemic stress

   While COVID-19 has worsened the levels of stress and burnout among the nursing workforce, the cause should not be narrowed to the pandemic. The Canadian Federation of Nurses Unions (CFNU) highlights in their research that nurses were already showing alarming rates of employee burnout pre-pandemic. This suggests a wider systemic problem has been overlooked and there are longstanding issues with the profession that need to be addressed. 

Solutions to The Nursing Shortage  

Typically, solutions at both the organizational and governmental levels have focused on efforts to improve the education and recruitment of nurses. For example, the Government of Canada has put in place several initiatives to help internationally trained nurses get their foreign credentials recognized and find quality jobs. This, however, is short term and has overlooked the need for changes at the systemic level and necessary improvements to the workplace. Research has suggested that some of the evidence-driven methods that should be implemented to mitigate the nursing shortage are:   

1. Empowering nurses and their voices

   In the aforementioned Facets investigation, a key finding was that nurses felt undervalued, as they are underrepresented in key planning and decision-making processes. Ensuring a robust level of nursing perspectives are heard among organizational management and system stakeholders was recommended. According to the research, “efforts to increase nursing engagement in planning and decision-making processes should aim to recognize and value nurses’ critical contribution to care delivery, leverage nurses’ wealth of knowledge and expertise to develop solutions that address the key challenges they face at the point-of-care, support the overall well-being of nurses, and establish policies that adopt Indigenous and EDI lenses”. 

2. Improvement of working conditions

   The retention of nurses is contingent on the improvement of their current working conditions, especially post-pandemic. Mental health and well-being support being made available to nurses in the workplace as well as sufficient time off is now essential. The ability to disconnect from work has suffered greatly throughout the nursing shortages, however our previous blog outlines the proven importance of psychological detachment from work. The CFNU also suggests that the staffing and workforce planning should be evidence based, since further research and resulting data would properly equip workplaces to forecast healthcare needs, tackle shortages and create a more responsive healthcare system overall.

3. Ethically sourcing internationally trained nurses

   According to a post in Canadian Nurse, hiring internationally trained nurses is a good way to strategize curbing the nursing shortage, however given this is a global shortage, it must be done in an informed and ethical way. It highlights that in Canada, there is already a pool of internationally educated nurses (IENs) who have migrated here or have permanent residency but are however struggling to get jobs in our healthcare system. The continuation of incentives and programs to help IENs already in Canada find good jobs and get their required credentials would assist in creating the next generation of the nursing workforce, without actively sourcing from other countries and contributing to the global problem. This has been highlighted as problematic by an article in The Economist. 

Hines Health Services is committed to the improvement of our medical services and the occupational health industry. If you need assistance with highly trained medical staff or how to enhance your nursing staff’s employee experience, contact us today! contact us today!