Empowering and valuing the role of nurses is key to keeping the workforce on the job during this challenging time
By Elizabeth Arpin
April 26, 2023
Still too often today I am told about the shortage of nursing staff, when in Quebec there are more nurses per capita than anywhere in Canada. In fact, Quebec can count on 7.62 registered nurses in direct care per 1,000 inhabitants, compared to 7.02 in the rest of Canada (OIIQ, 2021). In addition, the number of employees continues to increase. So what about this crisis that has been going on for 25 years? The causes are multifactorial, ranging from working conditions to training, including the organization of care and governance. So I prefer to talk about lack of availability or sub-optimal use of our workforce.
Thus, a fundamental aspect remains: do you know what a nurse does?
Very recently, studies (Déry 2021) and data from the field showed us that our nurses did not occupy their field of practice to their full capacity and in particular spent almost half their time on administrative tasks consisting, for example, to complete queries or transcribe data. Also, our nursing staff still devotes a lot of their time to assistive care, such as help with food, hygiene, taking medication, especially in residential and long-term care centres. These examples bear witness to the suboptimal use of activities reserved for registered nurses, which contributes to an unfounded increase in the needs of the workforce, while many reports confront us with the growing needs and complexity of care. The role is all the more misunderstood as there persists a public image of nurses who help and support, rather than an image of professionals who assess, treat, teach and coordinate care.
Nurses have the largest scope of practice after doctors. Their training focused on biopsychosocial sciences prepares them for great responsibilities, such as the evaluation and monitoring of physical and mental condition, the initiation and performance of invasive diagnostic examinations, follow-up, disease prevention activities , health promotion including teaching self-care, and so on. These activities are often reduced or even obscured by the need for interventions or tasks that can be performed by other professionals or support staff. This dichotomy between the skills acquired during initial training and the experience of the role in the care settings leads to absenteeism as well as a certain exodus from the profession, thus closing the vicious circle in which our health establishments have become bogged down.
At a time when the shortage of nurses is at the heart of concerns and regularly makes the headlines, the solution does not lie in adding financial incentives or, even worse, in lowering the level of skills required to care our aging population and whose clinical needs are constantly changing. A multi-faceted response is required, including the need to reorganize the work in depth, so that our professionals are assigned to acts for which they have been specifically trained, and thus ensure an optimal match between the needs of patients and the nursing care provided. Promoting their role is an essential element in retaining our nurses within a health system that aims to be accessible to all.
Let's give nurses back their place, stop scattering them and diluting their skills. Let's give them a voice to exhibit their knowledge. In the current context where the needs are great, the expertise and the optimal contribution of our professionals are central; let's make sure to call on their know-how and promote their role wisely!
Ordre des infirmières et infirmiers du Québec (OIIQ). « Rapport statistique sur l’effectif infirmier et la relève infirmière du Québec 2020-2021 », 2021. Disponible à https://www.oiiq.org/en/rapport-statistique-sur-l-effectif-infirmier-et-la-releve-infirmiere-du-quebec-2020-2021?inheritRedirect=true
Déry, J., Paquet, M., Boyer, L., Dubois, S., Lavigne, G., Lavoie-Tremblay, M. « Optimizing nurses’ enacted scope of practice to its full potential as an integrated strategy for the continuous improvement of clinical performance: A multicentre descriptive analysis », Journal of Nursing Management, 30(1), 2021. Disponible à https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.13473
Elizabeth Arpin, RN aut., M. Sc., is national director of nursing care and services in Quebec’s Ministry of Health and Social Services. She holds a master’s in nursing degree, an EXTRA Fellowship from the Canadian Foundation for Healthcare Improvement, and is currently completing a second master’s in public administration. She began her role as national director of nursing care and services during the first wave of the pandemic on an interim basis and was officially appointed in August 2020.