For those of us who have been leaders in the health care system for decades, the continuous day-to-day grind of watching frontline clinicians and professionals work their magic to care for patients and families has been admirable. For many years, we have known that the system needed significant change and transformation. As leaders, we discussed frequently the conditions and challenges to our misaligned health system and eagerly embraced new strategic plans and priorities that would aspire or enable us to create a higher functioning approach, performance, quality that would be better for our patients, their families and our staff.
Many of these projects and plans were successful at a micro level using process re-design and lean strategies that added to the quality of care and service delivery. But the demand, volume of care and ever-changing population health dynamic placed continued pressure on the system, giving way to a growing need for health system overhaul.
There has been no shortage of articles written, white papers, conferences, debates, and panel discussions about the need to redesign our approach to health care in Canada. With the onset of COVID-19 and the events of the last few years, there is a more desperate plea from health providers to “Just Get On With It” with the system transformation. We all watch the headlines across the country and experience firsthand the slow pace of system integration at the macro and micro level, the crushing impact of the health human resource shortage, the heart wrenching stories of system failure, long waits and inaccessibility. Last year will also be remembered for the spread of issues that spanned the entire population – from the pediatric hospital system to adults and seniors care. The entire system has been under duress with capacity issues. We all agree the decline has not happened overnight and will deteriorate further if we are unable to treat this crisis like any other emergency and create the forum and process for advancing transformational and sustainable change.
So where can we start? Zoning in on one specific area or strategy is no easy task, however, for the purposes of this blog I will focus on nursing.
As a professional nurse, I have seen the shortages everyday and shifting that is occurring from one sector to another as nurses take advantage of higher pay levels, workload and benefits. While I do not have all the answers, there are changes that can support the current environment:
- Nursing Work Environment The overall work environment and pressures related to nursing care have continued to be a factor contributing to nursing stress and burnout. The disruption from COVID-19 and the intensity of care demands have prompted nurses and other health care professionals to give up – there just isn’t enough strength to continue – the pandemic has taken something from these dedicated professionals emotionally. Ongoing attention to improving work conditions, providing focus on safety while at work, freedom from harassment and discrimination, a balanced work schedule along with opportunities for growth, education and leadership are essential.
- Cross-Sector Alignment of HR Strategies on Pay and Benefits We are seeing nursing movement in the system as there are inequities across the different sectors. Having strategies that ensure nurses are treated and valued equally can certainly help support and stabilize the system. Many nursing staff have expressed that they do not want to change or move from one sector to another, however, they are moving into organizations and sectors where they receive higher pay and more generous benefits packages with sign-on bonuses to help them deal with the rising costs of inflation. As well, we have to address the issue of remuneration – what is the reasonable level that will be sufficient to attract, retain and motivate nurses to work in the field?
- Nursing Agencies Over the past three years we have seen the rise of agencies working to further disrupt the nursing environment and obtain hefty profits. They poach nurses from public providers by offering them a significantly higher hourly wage (although without benefits) and gouging health care providers who are desperate for nurses. We are already starting to see that those nurses who left to work with agencies, while they may have a higher salary, are not satisfied as they no longer have the support of team members or the benefits of being a part of an organization with a positive culture and values. These benefits cannot be understated and this is an area that the nursing agencies lack. The work pressures and challenges continue and money as an incentive is short lived, hence the need to focus on creating better work environments, steady schedules, fulfilling assignments and other supports that protect our valuable nursing staff.
I’ll also share the 2020 World Health Organization report, State of The World’s Nursing, as it provides a comprehensive overview of nursing with additional researched information and strategies that we can certainly work on to improve the nursing workforce. The report has a strong emphasis on investing in nursing education, creating more jobs to address the shortages and inequities in nursing as well as strengthening nursing leadership for the future.
All of this make sense and we need to be bold enough to just get moving on what needs to be done.