Nurses may be in high demand, but their working conditions are far from high quality.
According to a comprehensive study on the country’s nursing workforce, nurses are working more overtime, have more work tasks, and are pulling more casual shifts — all partly due to the shortage of nurses.
The shortage is having a direct impact on nurses’ physical and mental health. They are reporting higher rates of absenteeism, emotional exhaustion and higher injury claim rates than workers in other professions, reports Building the Future: An Integrated Strategy for Nursing Human Resources in Canada.
“Part of the issue of the conditions of practice is related to shortage, because it has to do with overtime. It has to do with patient staff ratio, which is not optimal. It has to do with the span of control being wider than perhaps it ought to be, and it has to do with increased workload,” said Sharon Sholzberg-Gray, president and CEO of the Canadian Healthcare Association, which represents hospitals and other health-care institutions.
“The thing that’s difficult for the public to understand is all this is done against recent increases in investment in the system. And yet there’s a disconnect between the promise of enhanced access to care and quality of care, and the reality, which is there isn’t enough money to pay as many nurses as are required. There isn’t enough money to create more seats in nursing schools.”
Building the Future is a joint project of many nursing stakeholder groups, including the Canadian Federation of Nurses Unions, the Canadian Healthcare Association and the Canadian Nurses Association. The study drew on focus groups, interviews and surveys of 40,000 nurses, senior nurse managers and chief executive officers.
According to the study, by next year, Canada could lose about 30,000 practising registered nurses if they retire at age 65, and 64,000 nurses if they retire at 55.
However, half of the nursing education programs have not had the resources to expand enrolment. Even if enrolment had been increased, acute care and community practice environments don’t have the capacity to provide placement opportunities to more students.
Sholzberg-Gray said the problem is mainly the fact that there’s not enough funding.
“I don’t know how many times you’ve heard, ‘We keep putting money into the system and it’s going into a black hole.’ And of course it’s not. It’s going into pay the people in the system who serve the public’s needs. And people don’t understand that it’s a labour intensive system, and that 75 per cent to 80 per cent of it goes into paying the people who provide care.”
Around the same time that Building the Future was released last month, a smaller report came out saying systemic racism persists in the nursing profession, and attempts to call attention to it are often met with inaction if not outright retaliation.
Rebecca Hagey, associate professor in community nursing at the University of Toronto, said she didn’t set out to measure the prevalence of racial discrimination in the report released by the Canadian Race Relations Foundation.
Instead, she presented findings from a pilot survey of 62 nurses, only five of whom were Caucasian. Of the 62, about six in 10 felt race and ethnicity had an effect on relations with patients (39 of 62), on the hiring of nurses (39 of 62), on relations with colleagues (38 of 62) and on relations with managers (37 of 62).
About half felt that race and ethnicity affected where people were assigned to work (33 of 62) and access on training (30 of 62).
Hagey said many of the visible minority nurses that she spoke with for the report had a “difficult and long recovery” from the experience. “Some of them don’t want to have anything to do with nursing anymore. They’ve left the profession and have closed off that part of their life.”
One of the study’s participants, who asked to be identified only as K. J., told Canadian HR Reporter of one moment when frustration and sadness overtook her and drove her close to simply walking out of the Toronto-area women’s health clinic where she had been working since 1995.
As a Korean nurse working among a primarily Caucasian nursing unit, she often felt excluded from training opportunities because she would be the one filling in for others when they went to seminars.
One day, she came to work with lingering symptoms of a persistent bout of bronchitis, only to be told that she was given another shift that no one wanted. “This time I had to say no; I hadn’t been well,” said K.J., adding that she was immediately told that she was inflexible.
The comment hurt because she was never in the habit of turning down shifts before. “It made me sad,” said K.J. Although there’s no way of proving the way she was treated was racially motivated, “You feel it in your gut. It’s not something that you want to accuse people of, but you know when it happens.”
Hagey said she released the report in the hope of prompting a province-wide study on the topic, particularly one tracking the backlash that happens to nurses as they move through grievance and human rights complaints processes.
The issue is important, said Hagey, because “it’s common sense that as we rely more and more on international recruiting for getting enough nurses in the country, we would be well-advised to have a retention strategy for those nurses. And one of the issues we have to address in that retention strategy is racism.”
According to a comprehensive study on the country’s nursing workforce, nurses are working more overtime, have more work tasks, and are pulling more casual shifts — all partly due to the shortage of nurses.
The shortage is having a direct impact on nurses’ physical and mental health. They are reporting higher rates of absenteeism, emotional exhaustion and higher injury claim rates than workers in other professions, reports Building the Future: An Integrated Strategy for Nursing Human Resources in Canada.
“Part of the issue of the conditions of practice is related to shortage, because it has to do with overtime. It has to do with patient staff ratio, which is not optimal. It has to do with the span of control being wider than perhaps it ought to be, and it has to do with increased workload,” said Sharon Sholzberg-Gray, president and CEO of the Canadian Healthcare Association, which represents hospitals and other health-care institutions.
“The thing that’s difficult for the public to understand is all this is done against recent increases in investment in the system. And yet there’s a disconnect between the promise of enhanced access to care and quality of care, and the reality, which is there isn’t enough money to pay as many nurses as are required. There isn’t enough money to create more seats in nursing schools.”
Building the Future is a joint project of many nursing stakeholder groups, including the Canadian Federation of Nurses Unions, the Canadian Healthcare Association and the Canadian Nurses Association. The study drew on focus groups, interviews and surveys of 40,000 nurses, senior nurse managers and chief executive officers.
According to the study, by next year, Canada could lose about 30,000 practising registered nurses if they retire at age 65, and 64,000 nurses if they retire at 55.
However, half of the nursing education programs have not had the resources to expand enrolment. Even if enrolment had been increased, acute care and community practice environments don’t have the capacity to provide placement opportunities to more students.
Sholzberg-Gray said the problem is mainly the fact that there’s not enough funding.
“I don’t know how many times you’ve heard, ‘We keep putting money into the system and it’s going into a black hole.’ And of course it’s not. It’s going into pay the people in the system who serve the public’s needs. And people don’t understand that it’s a labour intensive system, and that 75 per cent to 80 per cent of it goes into paying the people who provide care.”
Around the same time that Building the Future was released last month, a smaller report came out saying systemic racism persists in the nursing profession, and attempts to call attention to it are often met with inaction if not outright retaliation.
Rebecca Hagey, associate professor in community nursing at the University of Toronto, said she didn’t set out to measure the prevalence of racial discrimination in the report released by the Canadian Race Relations Foundation.
Instead, she presented findings from a pilot survey of 62 nurses, only five of whom were Caucasian. Of the 62, about six in 10 felt race and ethnicity had an effect on relations with patients (39 of 62), on the hiring of nurses (39 of 62), on relations with colleagues (38 of 62) and on relations with managers (37 of 62).
About half felt that race and ethnicity affected where people were assigned to work (33 of 62) and access on training (30 of 62).
Hagey said many of the visible minority nurses that she spoke with for the report had a “difficult and long recovery” from the experience. “Some of them don’t want to have anything to do with nursing anymore. They’ve left the profession and have closed off that part of their life.”
One of the study’s participants, who asked to be identified only as K. J., told Canadian HR Reporter of one moment when frustration and sadness overtook her and drove her close to simply walking out of the Toronto-area women’s health clinic where she had been working since 1995.
As a Korean nurse working among a primarily Caucasian nursing unit, she often felt excluded from training opportunities because she would be the one filling in for others when they went to seminars.
One day, she came to work with lingering symptoms of a persistent bout of bronchitis, only to be told that she was given another shift that no one wanted. “This time I had to say no; I hadn’t been well,” said K.J., adding that she was immediately told that she was inflexible.
The comment hurt because she was never in the habit of turning down shifts before. “It made me sad,” said K.J. Although there’s no way of proving the way she was treated was racially motivated, “You feel it in your gut. It’s not something that you want to accuse people of, but you know when it happens.”
Hagey said she released the report in the hope of prompting a province-wide study on the topic, particularly one tracking the backlash that happens to nurses as they move through grievance and human rights complaints processes.
The issue is important, said Hagey, because “it’s common sense that as we rely more and more on international recruiting for getting enough nurses in the country, we would be well-advised to have a retention strategy for those nurses. And one of the issues we have to address in that retention strategy is racism.”
