|JUNE 2009 • ACCESS|
|SNNNAP in Central America|
|Database connects nurses interested in global health|
Report maps out plan for taking control of the RN shortage
Concrete strategies that could eliminate Canada’s nursing shortage — this is what is on offer in Tested Solutions for Eliminating Canada’s Registered Nurse Shortage, a CNA-commissioned report released last month at a press conference in Ottawa. The report was produced by a research team led by Gail Tomblin Murphy, director of the WHO/PAHO Collaborating Centre on Health Workforce Planning and Research. The report states that in 2007, Canada was short 11,000 full-time equivalent registered nurses working in direct clinical care in the areas of acute care, long-term care, home care and community care. By 2022, the shortage will increase to almost 60,000 full-time equivalent RNs if Canadians’ health-care needs continue to change according to past trends and if no strategies to reverse the RN shortage are put in place.
The research team designed six policy scenarios and measured their impact on the nursing shortage. CNA has called on stakeholders and governments to act on the report findings and all six scenarios, which, if implemented together, could well put an end to the nursing shortage within the next 15 years.
The first three scenarios focus on the workplace. Improving productivity and retention will have the biggest impact on the RN shortage. The first scenario tests an increase in RN productivity by one per cent per year (non-cumulative). This increase would cut the nursing shortage by close to half by 2022. Increasing the productivity of RNs is not about nurses having to work harder. Rather, it involves making changes to working practices and conditions to enable them to be more productive. The report outlines strategies for how this can be done: Removing non-nursing tasks by adding support staff will allow nurses to concentrate on direct patient care. Better use of technology and equipment and new modes of collaborative care will improve efficiency.
The second scenario focuses on improving RN retention. If exit rates for all RNs under the age of 60 were no more than two per cent, and a maximum of 10 per cent of RNs 60 or older were to retire each year, the effect would be like adding 30,000 full-time equivalent RNs to Canada’s nursing supply, cutting the shortage in half over 15 years. The report suggests ways that retention of RNs can be improved, including an example of an initiative in Ontario that allowed older nurses to spend 20 per cent of their work time on professional development. The costs of this program were recouped within two years.
The third scenario looks at reducing RN absenteeism. Right now, RNs miss an average of 14 days of work per year, double the average of all of Canada’s workers. Reducing absenteeism among RNs over a three-year period to seven days per year would be equivalent to adding 7,000 full-time nurses to the nursing pool.
The report presents research showing that strategies such as reducing job strain and overload, improving support from supervisors and co-workers, and reducing the physical demands on nurses can lead to fewer sick days. The report highlights a best practice musculoskeletal injury prevention program that was put in place in nursing homes; mechanical lifts and reposition aids were added, a zero-lift policy was instituted, and employees received training on the new equipment. Injuries dropped and violence by residents toward caregivers decreased. The program recovered its equipment costs within three years, thanks to fewer workers’ compensation claims.
The next two scenarios focus on nursing students. An annual increase of 1,000 students per year for three years would narrow the RN gap by about 25 per cent to roughly 45,000 full-time equivalent RNs. Also, more than one in four students don’t finish their entry-to-practice programs. Reducing that number from 28 per cent to 15 per cent over three years would narrow the gap by about 24 per cent to roughly 45,000. It is worth noting that the outcome of a reduction in program attrition is almost identical to the long-term effect of the substantial enrolment increase. As well, it has slightly more pronounced effects sooner than the enrolment increase.
Finally, there’s a growing concern over the ethics of recruiting health-care professionals from disadvantaged countries. CNA, as well as federal, provincial and territorial governments, supports increasing the self-sufficiency of Canada’s health workforce. For this reason, the final scenario looked at the impact of reducing international migration by 50 per cent. This would result in a larger shortage of RNs, but the effect of this change is not all that substantial — less than 10 per cent— even in the long term. This is because foreign-trained RNs still represent a relatively small fraction of the national RN supply.
CNA president Kaaren Neufeld says, “We’re excited about the promising numbers in the report. These are realistic and tested solutions to a serious problem that is affecting Canadians’ health across the country. We urge all stakeholders to build these findings into their HHR planning and management of the RN workforce.”
For information on how to obtain a copy of the report or to view the highlights document, visit the CNA website.
Jewish Eldercare Centre recognized for promoting excellence
Jewish Eldercare Centre in Montreal is the recipient of the 2009 CNA Certification Program Employer Recognition Award for the outstanding support it provides to its registered nurses in obtaining and maintaining their certification credential. The centre prides itself on its commitment to supporting staff in pursuing professional excellence that goes above and beyond the average expectations. Continuous learning, research, innovation and personal development are valued, as are those who put them into practice. This philosophy was evident in the exceptional nomination submitted by the centre’s RNs.
The final selection of the 2009 award recipient was completed with assistance from the Canadian Healthcare Association. The Jewish Eldercare Centre receives $1,000 from the Canadian Nurses Foundation to help support ongoing activities related to CNA certification.
Alberta Health Services in Calgary received an honourable mention for the assistance it gives to clinical nurse specialists in obtaining and maintaining CNA certification. CNA-certified clinical nurse specialists receive support to mentor new candidates to reach their goal of certification and to participate in certification exam development activities.
CNA also recognizes employer innovation in health-care facilities that provide unique incentives or out-of-the-ordinary tools in support of nurses pursuing certification or renewing their credential. The recipients of the 2009 CNA Certification Program Employer Recognition Award for Innovation are:
- North Perth Family Health Team, Perth, Ont. — for support it provided to nurses working in a small interdisciplinary team setting
- Northumberland Hills Hospital, Cobourg, Ont. — for encouragement and support given to its emergency room nurses to prepare for and write the exam
- Prince Albert Parkland Health Region, Prince Albert, Sask. — for providing dedicated office space and tools that enabled nurses in a study group to prepare via teleconference with colleagues working in rural communities
Symposium advances collaborative efforts in fighting malaria
The theme for World Malaria Day (April 25) was Counting Malaria Out, marking the global health community’s target of delivering effective and affordable protection and treatment to all people at risk of malaria by 2010.
Leading up to World Malaria Day, CNA, the Canadian Red Cross and Buy-A-Net Malaria Prevention Group hosted a symposium for representatives from NGOs and government agencies along with MPs and other stakeholders. The purpose was to share information on efforts to control and eliminate this deadly disease and talk about the potential for collaboration.
Mark Grabowsky, former malaria coordinator at the Global Fund to Fight AIDS, Tuberculosis and Malaria, provided the context for the discussions. In Africa, for example, where almost half of the services provided in health clinics are related to diagnosis and treatment of malaria, economic growth rates have suffered in those countries most affected by the disease. He outlined global efforts to eradicate it, noting a sense of renewed optimism because of increased funding and the development of new interventions: insecticide-treated bed nets, indoor spraying, preventive treatment for pregnant women, and timely and effective drug treatment.
June Webber, CNA’s director of International Policy and Development, echoed support for the multiple intervention approach and stressed the importance of ensuring equitable access to prevention, health promotion and treatment services.
In animated video clips from the Buzz and Bite Malaria Prevention Campaign, two talking female anopheles mosquitoes gave messages about the transmission of malaria and protection against infection. Director and producer Firdaus Kharas presented several of these lively video shorts, produced in 22 languages to date, that use humour to educate.
Symposium participants are committed to continuing their dialogue and seeking opportunities for networking and collaboration. Debra Lefebvre, a nurse and the founder of Buy-A-Net, said the symposium “represented an opportunity for greater dialogue among stakeholders, where we could share strategies to strengthen and leverage the contributions made to combat this killer disease.”
A confident INNA takes on new challenges
Knowledgeable, innovative and creative — three words used to describe nurses and nursing in Canada that apply equally in Indonesia. The Indonesian National Nurses Association (INNA), a partner in CNA’s Strengthening Nurses, Nursing Networks and Associations Program (SNNNAP) for the past 12 years, has embarked on an ambitious project: to develop a national registration system and a national regulatory entry-level exam for Indonesia’s 296,000 registered nurses.
INNA is a fledgling organization with a small staff and an even smaller budget. The challenges it faces are enormous: Indonesia is a large country with a population of some 237 million. They are spread out over both sides of the equator on 6,000 islands, each with distinct ethnic, linguistic and religious groups.
In March, CNA’s associate CEO, Jane Ellis, and Christine Rieck Buckley, manager, regulatory examinations, facilitated a week-long workshop in Jakarta, attended by 78 nurses from 15 of the 33 Indonesian provinces. The objective was to create a draft framework for developing and implementing a national exam to test entry-level competencies.
From the outset, the participants — educators, clinical practitioners, administrators and government representatives — were quick to engage in collective problem-solving to address the myriad issues, everything from how to establish competency review committees, develop test items and set pass marks to how to communicate with candidates and report results. Ellis and Rieck Buckley drew on the lessons learned in the exam development process in Canada to answer technical questions and mentor the group. If the enthusiasm of our INNA partners is an indication of what they can accomplish, they will certainly reach their goals.
CNA’s partnership with INNA through SNNNAP is funded by the Canadian International Development Agency.
Sparking public discussion and debate about patient safety
How can nurses generate discussion with the public on important issues? In April, CNA tried something new: hosting its first CIHR Café Scientifique. The event, funded by the Canadian Institutes of Health Research, brought together members of the public and experts in an informal setting (a restaurant in Ottawa) to talk about patient safety and how it can be improved.
The panel included two CIHR-funded researchers. Linda McGillis Hall (Lawrence S. Bloomberg faculty of nursing, University of Toronto) discussed the involvement of patients in her research on reducing interruptions in nursing practice. Alan J. Forster (Ottawa Hospital Research Institute) shared his research on improving the level of confidence in adverse event rating and on evaluating patient safety during hospital care. Katarina Busija, representing Patients for Patient Safety Canada, discussed the role of patients and their families in improving the system.
Café Scientifiques are held in locations across the country. At each event, a moderator introduces the health research-related topic and experts share their knowledge and perspectives with the audience. Refreshments and a question and answer period follow. Nurses interested in starting a dialogue on a health topic in their communities can apply to CIHR for funding to put on a café.
Supporting your practice: CNA’s new tools and resources
Clinical Nurse Specialist
A position statement that looks at clinical nurse specialists and the significant contributions they make to the profession and to the health of Canadians.
Return on Investment (ROI): Evidence for investing in nursing
Two new research summaries in CNA’s Return on Investment (ROI) series that provide evidence for strategies that invest in health care and save dollars at the same time.
A business case for raising registered nursing staffing levels
Increasing the proportion of care that is provided by registered nurses achieves net cost savings by reducing length of stay, adverse outcomes and mortality rates.
Costs and implications of nurse turnover in Canadian hospitals
On average, one in five nurses working in Canadian hospitals leaves his or her job each year at an average cost to the institution of $25,000.
RNs: A $ound Investment
A web-based toolkit that provides nurses with information and evidence to help them speak out in support of the cost-effectiveness of nursing services and the vital role nurses play in saving lives, promoting health and reducing costs. Managers, executives, employers and health-care decision-makers need to hear that nursing is a sound investment — in any economic climate.
May — Return on Investment: Valuing Nursing
PROFILE: EMERGING GROUP
CMNG speaks out for men in nursing
The Canadian Men in Nursing Group provides a strong, national voice for men in the profession. Its mission is to promote awareness of nursing as a viable career choice for men. Members pursue the mission by educating the public, students and other stakeholders about the nursing profession; by collaborating with other groups, organizations and health-care professionals; and by showing leadership in their communities and in international activities. Membership is open to all Canadian nurses and nursing students.
Member benefits include discounts on selected merchandise and services from CMNG partners; discounted registration fees for a variety of workshops and conferences; and free admission to CMNG events. A quarterly newsletter examines issues of interest and includes submissions from members. CMNG also provides funding for bursaries and awards.
For more information, contact president James D’Astolfo at firstname.lastname@example.org or at 905-597-6296.