Six steps urged to reverse RN shortfall


Globe and Mail

May 12, 2009

Canada could have a shortfall of 60,000 registered nurses by the year 2022 – the equivalent of losing the entire nursing work force of British Columbia and Alberta – according to new research.

The study, commissioned by the Canadian Nurses Association, warns that this could have dire consequences on providing care, particularly to the growing legion of seniors living with chronic illnesses.

But researchers said the shortages could be averted and care bolstered by instituting a series of simple policy measures that would make nurses more efficient, healthier, happier and on the job longer.

“There’s no one quick fix but there are solutions that are feasible, doable and that don’t cost a lot of money,” Gail Tomblin Murphy, a nursing professor at Dalhousie University in Halifax and lead author of the report, said in an interview.

There are currently 217,000 registered nurses (RNs) in Canada, the single largest group of health-care providers.

But that work force is aging and, increasingly, nurses are leaving the profession early because of the physical and mental strain, and the lack of flexibility in their work schedules and time for education and research.

“We can’t just close our eyes and hope things will get better. We have to take action to avoid shortages,” Dr. Tomblin Murphy said.

She said authors of the new study decided to focus not on dire predictions but on solutions. Specifically, they proposed six policy initiatives:

Increase RN productivity: Increasing productivity by just 1 per cent a year (non-cumulative) would reduce the shortage by close to half by 2022, according to the analysis. But the authors stressed that “increasing the productivity of RNs is not about working harder. Rather, it involves changing working practices and conditions to enable nurses to be more productive – in other words, to work smarter as opposed to harder.”

Reduce absenteeism: RNs take, on average, 14 days of sick leave annually, twice as much as the average Canadian worker. Reducing absenteeism by half would be the equivalent of adding 7,000 nurses to the work pool.

Increase enrolment in nursing programs: The report recommends adding 1,000 new spots in nursing schools annually for the next three years. Doing so would add 15,000 nurses by 2022, though the benefits of such a policy would not start to be seen before 2015.

Improve retention of practising nurses: A large number of nurses leave the profession at a young age – about 2 per cent a year in the 25 to 39 age group and 11 per cent in the 60 to 65 group. The report suggests that experienced nurses want more balance and flexibility in their work. It recommends the institution of policies such as 80/20 staffing, where 80 per cent of time is spent on direct patient care and 20 per cent on professional development. Organizations with 80/20 staffing have much higher retention, along with less absenteeism. Getting more nurses to work to retirement age could add the equivalent of 30,000 RNs to the work pool.

Reduce attrition rates among nursing students: About one in four nursing students do not complete their program or do not practise after graduating, a loss of a huge potential work force. Hanging on to half of those students would be the equivalent of 15,000 nurses.

Reduce the recruitment of nurses from developing countries: The report states that it is unethical for Canada to be pilfering nurses from poorer countries, so “in-migration” should be cut by at least 50 per cent. Doing so would, potentially, worsen the shortage but the impact would be minimal because immigrant nurses make up only a small percentage of the work force.

The report notes that no single one of these policies would make up the shortfall, so there needs to be a combination of several measures.

“These are not complicated or expensive things to do,” Kaaren Neufeld, president of the Canadian Nurses Association, said in an interview.

“If we deal with this and stop this shortage from getting worse, we will provide better health care to all Canadians,” she said.

According to the report, Canada already has a shortfall of 11,000 RNs so action is urgently needed.

Earlier research has predicted a much more severe nursing shortage in the years to come, but the new report stresses that the methodology is better, allowing more accurate projections.

In particular, in the past there has been an assumption that future demand for health care is a function of the current supply of health-care professionals (supply-based planning) instead of an approach that estimates the future requirements of the population (needs-based planning). The report predicts that the nursing shortage will not be unique to one area but hit hard across the health-care spectrum.

The majority of RNs in Canada work in acute-care settings such as hospitals.The need for acute-care nurses will increase to 179,000 from the current 131,000 by 2022, the report found.

The need for long-term-care nurses will increase to 36,000 from 27,000, the demand for community RNs will grow to 28,000 from 25,000, and the requirement for homecare RNs will increase to 8,900 from 6,900.

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