Stakeholders recognised the need to improve workforce planning and link patient needs to the gaps in the nursing workforce. No longer can we assume that the current number or mix of staff we have are appropriate for health care needs. An element missing from our workforce planning is matching and linking workforce to population health needs.
Nurse comments:
• Nurses reiterated that one size does not fit all in terms of solutions to the nursing problems. They were interested in provincial directions but local action. They saw a broad network of recommendations stemming from global and national policies and best practices, and leading into localised workplace solutions. Nurses said solutions must be pragmatic and value existing work. Solutions need to be linked to existing initiatives and programs so nurses don’t feel they have to continually prioritize a never ending “to do “ list with few resources and time that is taken from patient care.
• Nurses expressed strong support for the provincial government to continue to take leadership roles in developing improved planning that goes beyond the “counts” of nurses and incorporates predictive modeling to assist in proactive workforce planning.
• Nurses expressed concerns over the IEN initiative commenting on a lack of information about the recruitment efforts, and seeing the IEN as a replacement for new graduates that should have been given preference. They saw this as an example of a solution that did not work in tandem with others.
• Many nurses questioned the lack of emphasis on the Aboriginal nurse workforce and the piecemeal approach to these recruitment efforts
“We are doing some of the right things with recruitment and retention but we need to do more of them and do them better. We need to build on these to plan for the number and type of health professionals required.” Expert panel participant
• Nurses talked about the need to move to more preventative models of care and invest heavily upstream in primary health care.
• In commenting on the need for a change, nurses said the traditional strategies would not work because the cycle of highs and lows is not the same for the workforce today as in was in the past.
• Nurses commented on the positive impacts of existing professional development initiatives, mentorship and other recruitment and retention initiatives of the Ministry of Health.
Compensation
Respondents commented on the inequities in salaries between those nurses covered under the SUN collective-bargaining agreement and those that were not. Nurses working on reserves and faculty members of NEPS felt particularly disadvantaged. Nurse managers expressed their dissatisfaction with the inadequate compensation for their positions. LPNs felt the wage discrepancy between themselves and RNs was huge. Many reported that RNs resent LPNs for taking their overtime, while LPNs resent the RNs are doing the same work for more pay. Non-union nurses were concerned that their wages were grossly inadequate as compared with their union colleagues.
“Nurses need to be adequately compensated for their work and their contributions to health care. But how do we measure work and contributions? A lot depends on who is measuring. Every one feels they deserve more and the others get too much.” Leader RN
Recruiting
Recruitment is an important strategy in building the workforce of the future as well as addressing the nurse shortage of today. The province has developed effective recruiting grants and programs to assist new graduates, IENs, expatriate nurses and others to come to Saskatchewan.
Nurse comments:
• Nurses felt the province has done a good job at promoting the province as a good place to live. People want to live here because of realistic real estate prices, affordable cost of living, spouse employment, and it is close to major centres. • Nurses felt that the provincial recruitment initiatives were effective. Student loan
payback assistance, mentorship program, international support groups for nurses, guarantees of work, were all felt to be positive incentives for people to come to work in Saskatchewan. Others felt that attempts to build positive workplaces that were welcoming, healthy, and supportive would help draw nurses to Saskatchewan.
• Some expatriate nurses felt that engaging our communities to participate in making them feel welcome was an important reason why they stayed. The government offering bursaries, incentives, return for work programs, and moving expense reimbursement were all part of the package that convinced them that they should come. Nurses said the reason they came had little to do with the job “I think that rural hospitals need to start promoting the advantages of
working in a rural area, especially to those people who are originally from rural areas because they would probably be more likely to return to rural Saskatchewan. For example, the variety of experiences and patient populations that would be cared for. I think that it is also important to support new nurses in rural areas because it can be very overwhelming at times. So, having attractive recruiting programs, mentorship programs, orientation of one month or longer, and education like ACLS and time with a nurse educator prior to working would help nurses feel more prepared. If you want them to come you have to make it worth their while.” Rural RN
and even less to do with the workplace. Of more importance was being close to their families and being in a safe community to raise their children.
• Some rural nurses expressed concern that there needs to be more support to attract nurses to come to rural and remote areas of the province. Housing in rural Saskatchewan was an issue. Many felt in rural health regions were not doing enough to promote the advantages of working in a rural area.
• Nurses commented that the recruitment grants with the return for service was a highly effective means of recruiting. They felt that nurses would remain long- term if they put down roots into the community.
• Nurses commented on the need to expand our efforts to recruit aboriginal nurses. Many thought our efforts in IEN recruitment was a quick fix, and that long-term our future was with the aboriginal community
Retention
Experts and nurses told us that retention of current employees was the most important task in building the future workforce. Meeting the needs of an older workforce, retaining those who are already working hard to advance health care, and creating a workplace that supports the engagement of nurses will do more to prevent a future shortage of health professionals than will recruitment on its own. The province and regions have already embarked on a number of important initiatives but most nurses felt that much more needs to be done.
“Why is there a belief that nurses are tantalized by money? Of course it is a necessary part of the whole but I am willing to bet that 95% of nurses in the workforce would tell you that their main concern is having the ability to care for patients in a comprehensive and quality environment where they can expect their resources (both human and technology) will be in good working order, that there will be someone to answer their concern and care when they are voiced. We need enhanced retention incentives that are aligned with governments and health regions strategic goals. People need to be happy and have a good place to work and a good, safe, sound environment to work in to want to stay.” RN
Nurse comments:
• Nurses felt that the key to retention is valuing and respecting the role of nurses. Recognition and support from nurse managers and senior leaders is crucial if we are to change our work environments so as to keep our employees here.
• We need to develop better incentives for older nurses to stay and mentor young and upcoming nurses. Senior nurses need the ability to decrease their hours without affecting their pensions and the flexibility of shift scheduling to allow them to have a work/life balance. Others called for long-term employee incentives and other financial rewards for staying in the system.
• A frequent comment was regarding the need for increased professional development and opportunities for more project work and research. Many senior nurses indicated they still wished for challenge in their jobs. To them the contribution they made as a nurse was quite important.
• Some nurses were sceptical as to the effectiveness of retention initiatives. They felt overworked, stressed and had too much administration to do. The sentiment was that until the workplace issues were dealt with nurses would not be staying.
These voices have given us a perspective of the breadth and depth of the concerns being expressed by nurses throughout Saskatchewan. Many of these comments are indicative of mistrust, frustration and anger. To many who have lived through the hardship of the nursing crisis, the breaking point is near. They have felt victimized by an uncaring system that for nearly 30 years has been indifferent to their cries for attention. For others, the voices reflect not hopelessness but rather optimism. We heard a common theme expressed through the consultations that there is a feeling of excitement about the future. These voices said that in spite of the difficulties there is a new willingness to examine possibilities, to harness collective energies and to chart out a new path. That is the message of hope that we have been left with after 6 months of listening. Much is possible if we are prepared to engage each other in discussion of change.