THROWING MONEY AT NURSES is not likely to work. But it’s the best most of our Canadian provinces can come up with. Nurses keep telling them it’s not likely to work.
There’s been a nursing shortage in Canada for decades. The pandemic only made matters worse. Pay isn’t the heart of the problem. Working conditions are. Things like: high patient-to-nurse workloads, mandatory overtime demands, and disrespect from administrators and other health care professionals.
Paying nurses more will not fix any of it. Yet, governments just don’t catch on.
No money fix
Ontario offers bonuses of $10,000 to nurses in return for a commitment to practise in “high need” health-care facilities for a year; and incentives of $25,000 for out-of-province nurses to relocate and work in general practice for one year; as well as up to $75,000 for ICU or critical care nurses who commit to two years.
Quebec offers cash bonuses of up to $18,000 to current nurses who commit to a year’s work in particular communities. Other provinces offer student loan forgiveness, funding for on-the-job education and bonuses for nurses who come out of retirement.
“It’s a bidding war, but it’s a Band-Aid effort,” says Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU). She says nurses tell her that their primary determining factor for a move is the situation at the other end.
“We don’t think (cash incentives) make that much of a difference on where they’re going to go,” she says.
“What a nurse will decide upon will be the quality of nursing, or the area of nursing they want to be in. But the key (factor) is the workload.”
Not a new problem
Job burnout and disillusionment is nothing new among nurses. An August 2020 report by the CFNU showed that, among nurses surveyed pre-pandemic, about 27 per cent planned to leave the profession altogether as a result of job dissatisfaction.
The scale of the nursing shortage is daunting. According to Statistics Canada, in the first three months of 2021, there were 98,700 vacancies in the health-care and social assistance sector — spearheaded primarily by people leaving existing jobs — up a whopping 38 per cent from the same period the previous year.
It’s no wonder, then, that provinces and territories are willing to go to extreme lengths for recruitment.
A vicious cycle
But it’s a vicious cycle. Provinces and territories want to recruit more nurses. The main factor for nurses in deciding on a new workplace is the workload, which is primarily a function of nurse-to-patient ratio. The way to balance that ratio is to hire more nurses.
If there is a model for how an effective recruitment strategy might work, it may lie in legislation mandating those nurse-to-patient ratios, says Linda Aiken, a professor of nursing and sociology at the University of Pennsylvania.
In 1999 — in the midst of a nursing shortage — California passed legislation setting the nurse-to-patient ratio at five-to-one. Hospitals didn’t get any more money, but they met the ratios.
Making medical facilities places where nurses want to work is a much more efficient way of attacking the nursing shortage problem than with cash bonuses, says Aiken.
But incentives to attract nurse graduates do nothing to hold on to nurses with years of valuable experience.
Jen Thiele belongs to this group. She’s an RN in Nova Scotia at Dartmouth General Hospital, now into her 18th year of nursing.
Losing mid-career nurses is a looming problem, as evidenced by the CFNU survey. Thiele says the way to address it is not with cash incentives, but to listen to nurses and get at the root of the problem—the workload.
Thiele says she feels like all her years of institutional and practical knowledge are being largely ignored.
“It’s a little deflating being so far in your career talking about things that you know can make things better and you’re not heard.”
The problem, as she sees it, is that somebody has to make the seemingly paradoxical long-term commitment—to hire more nurses in order to recruit and retain nurses.
“If you put in the nurse-to-patient ratios, you make an awesome working environment for nurses,” she says. “Then people will want to go work in those environments.”
“It’s like, what comes first? The chicken or the egg?”
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