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Health policy expert Lisa Little says nurses should be seen as an ‘investment,’ not a cost

Looming global nursing shortages mean governments must act now

Dec 6, 2021, By: Laura Eggertson
Courtesy of Lisa Little
Lisa Little says governments need to make nurses the lynchpins of their health-care systems, a shift that will require political work and advocacy. “What we need is leadership — people who are willing to take risks. More of the same is not going to get us anywhere.”

Health policy consultant Lisa Little knows something she’s afraid most governments don’t appreciate.

“Without nurses, you don’t have a health system,” she says.

Little — a registered nurse — has spent the last 30 years of her career urging governments in Canada and around the world to use nurses creatively as the lynchpins of their health-care systems.

The COVID-19 pandemic highlighted nurses’ essential role as no other crisis has since the Spanish flu pandemic more than a century ago.

But for all the social media shout-outs and cheering in the streets, nurses around the world are still fighting for priority vaccinations, effective personal protective equipment, and adequate pay, Little points out.

Thoughts of colleagues who wore garbage bags instead of proper PPE to protect themselves and avoid carrying COVID-19 home wake her up at night.

She points to Alberta, where nurses recently took to the streets to protest planned pay cuts.

“Governments still see nurses as a cost,” she says. “They need to shift to seeing us as an investment. The evidence has long been there on the effectiveness of nursing services in terms of financial savings to the health-care system.”

Shortages predicted

Even before the pandemic, the world was facing a shortage of 10.6 million nurses by 2030, according to the International Council of Nurses (ICN). Little has been a member of the global federation’s board since 2017, representing the Americas. Her term was recently renewed for another four years.

In a report Little co-authored in 2009 — more than a decade before the pandemic — the Canadian Nurses Association estimated Canada would be short 60,000 registered nurses by 2022.

COVID-19 has accelerated the human resource crisis. According to the World Health Organization, there have been more than 115,000 COVID-related health-care worker deaths, with many of them being nurses. ICN feels this figure is likely to be much higher, Little says.

Those deaths and the strain the pandemic puts on nurses has forced many to retire early or leave the profession, increasing the looming shortage to 13 million nurses worldwide.

The nursing shortage is Little’s biggest worry. A critical care nurse before joining the Canadian Nurses Association and then starting her own business as a consultant, Little understands the pandemic-induced strain nurses are under.

Advocating for nurse practitioners has long been one of Little’s passions.

Mass traumatization

She and her global colleagues refer to it as “mass traumatization.”

After working for over 18 months with limited resources and tremendous workloads, often without holidays or breaks, many nurses are taking leaves or outright quitting.

In response, provinces are competing to hire the limited supply of nurses in Canada. Some hospitals in Ontario are offering bonuses of up to $75,000 to nurses willing to move to the province and work in its ICUs.

That competition will only further worsen health inequities, Little says, with richer areas and hospitals having deeper pockets to attract and retain nurses.

The solution is to fund more seats in nursing schools and online education streams, Little believes, rather than hiring nurses from other countries in “an unethical migration.”

Little has been specializing in human resource issues in nursing for most of her career. Working on national frameworks, policy initiatives and advocacy can deliver widespread change for both nurses and patients.

“Being able to stay grounded in nursing and contribute at a policy level is very rewarding,” she says.

Virtual network

Little’s skills were in instant demand at the start of the pandemic, as governments strove to balance limited nursing supplies with increased demands. Nunavut hired her to help the territory implement a virtual public health nursing program to manage COVID-19 outbreaks amidst its chronic nursing shortage.

She built a virtual network of 40 public health nurses across Canada who tracked contacts and monitored people who had COVID-19 symptoms or tested positive in the territory.

“Some of them had other jobs, and they helped us on the weekend just because they were so committed to making sure the Nunavummiut got proper access to public health care for COVID-19,’’ Little says.

She’s also helping the government with such strategies as using nurse practitioners to provide primary care in the territory.

Advocating for nurse practitioners has long been one of Little’s passions. During her 10 years at the CNA, she managed the health human resources component of the Canadian Nurse Practitioner Initiative. In 2006, the initiative published Nurse Practitioners: The Time is Now, which made 13 recommendations on how to integrate nurse practitioners into the Canadian health-care system.

For three years leading to the report’s publication, Little travelled across Canada speaking to nurse practitioners, developing models of practice, education, recruitment and retention strategies, and deployment plans.

“It was a fundamental piece of work that helped push nurse practitioner progress forward,” Little says.

Underused NPs

Today, she’s proud of the growing numbers of nurse practitioners working in a greater variety of settings than when she began her work at CNA.

Now that the COVID-19 response has proven the value of virtual care, Little hopes improved delivery platforms will accelerate the use of nurse practitioners as health-care employers marry the two resources.

But she believes nurse practitioners remain underused. They could be more widely deployed in chronic disease management and for less acute cases in emergency departments, she says.

Nursing expertise was also generally underused in Canada’s vaccine rollout, she says. Typically, public health nurses develop and manage flu clinics in every province and territory. But during the pandemic, nurses were often not at the decision- or policy-making table during the rollout.

There was no nurse on the Ontario COVID-19 Science Advisory Table, for example, Little says. In some provinces, nurses were not even on the priority vaccination list.

“Nurses and doctors should be equitably involved,” Little says. “Unfortunately, the health-care system still puts the doctor in charge. … In Canada, we didn’t maximize the expertise of public health nurses in the vaccine rollout or overall management of the COVID-19 outbreak.”

Political work and advocacy are required to make these changes.

We need leaders ‘willing to take risks’

“What we need is leadership — people who are willing to take risks. More of the same is not going to get us anywhere,” she says.

Little continues to play that leadership role at ICN.

One of her biggest accomplishments is turning the organization’s biennial congress into a virtual event.

Virtual attendance made the event more accessible, especially to nurses in low-income countries who now have no travel costs and reduced registration rates.

“It was one of our strongest congresses, with more workshops, symposiums, concurrent sessions, and main speakers than we ever had before,” she adds. “Lessons learned during COVID-19 were centre stage.”

The combination of Little’s consulting work with Nunavut and other clients, and her volunteer work at ICN, has made the last 18 months the busiest of her career, Little says.

She tries to spend her scant downtime kayaking, swimming, and walking with her partner, Jacques Desjardins, in their home north of Winchester, Ont. Eventually, she hopes they can travel again, with Portugal or Ireland on her bucket list.

Meanwhile, she continues to give back to her local community as well — chairing the board of a nursing home in Winchester.

“I’ve worked with a lot of great people,” she says of her experiences to date. “It’s allowed me to learn along the way, and bring the strength from clinical, teaching, management, and policy work at the Canadian Nurses Association to bear.”

Laura Eggertson is a freelance journalist based in Wolfville, N.S.