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Nursing Welfare and Retention in Canada

Nursing Welfare and Retention in Canada
Despite what many are hearing today, local and national nursing shortages were present long before COVID; the pandemic just exacerbated the already existing problem.   As such, nursing welfare and retention are important issues in the Canadian healthcare system currently.  Nurses play a critical role in patient care and their job satisfaction is critical to the overall quality of care provided. The Canadian Nurses Association (CNA) has identified several factors that can impact nursing welfare and retention.
Get ahead of Burnout Long hours and high patient caseloads have become the norm rather than an exception, all to the detriment of quality patient care.  Once the pandemic hit, the enormous influx of patients combined with the anxiety around getting infected themselves, many nurses decided to leave the industry.  Those who stayed took on the additional burden, worsening the “overstressed & overworked” predicament they had already been in. Nonetheless, RNs & RPNs weathered the storm and continued to do what they do best.  Ironically, the burnout was not their biggest complaint, for that was much too complex and intricate.  It was much simpler than that:  it was the lack of appreciation from their management and patients. Nurses reported that this affected whether they felt overstressed and overworked significantly more than the actual physical job itself.
What can be done? Work environment and employee appreciation start from the top down.  To address this issue, some hospitals have implemented staffing ratios to ensure that nurses have a manageable workload.  Anticipating future leave of absence, sick time, and the creation of nursing pools via internal hires or external agency usage to ensure burnout can be prevented from a nursing ratio perspective
2. COMPENSATION – fair wages
Nurses in Canada are well-compensated compared to many other countries, but there is still room for improvement. Some nurses feel that they are not paid fairly for the work that they do and this is a direct result of the increasing age in population, acuity of patients, complex care, longer hospital stays, increase in comorbidities, departmental cuts, internal budgetary issues for filling vacant roles, and the increased workload over the past 2-3 decades. The CNA advocates for fair compensation for nurses to ensure that they are valued for their work. 
What can be done? An analysis of the nursing wages needs to come from the top down, whether this is provincial, a health authority, or a facility/clinic. Assessing the pain points within the healthcare system as a whole and individually and listening to the concerns of the nurses is needed in order to retain your current staff retention (delete this word as it already mentioned “retain your current staff”). This would include:
• Assessing higher wages that meet or exceed the CPI index annually. 
• Prohibit wage freezes provincially that affect the nurse’s ability to increase their wages year to year. 
• Review the increases other essential services have received over the past few decades and match increases going forward on the same trend. 
3. PROFESSIONAL DEVELOPMENT – education/leadership roles
Professional development is also important for nursing retention. Nurses need and want opportunities to learn and grow in their careers. This can include:
• continuing education opportunities
• mentoring programs
• career advancement opportunities
Creating these opportunities on the job allows nurses to improve their skills, resulting in professional growth and a greater sense of satisfaction, empowerment, and autonomy in their roles as nurses
What can be done? Creating internal programs or reimbursements to for colleges and/or university programs provides nurses with new, updated, and in-demand skills – a crucial step forward that benefits both nurses and their patients.  Due to factors like time constraints outside of their current roles, financial means, and personal responsibilities, many nurses find it difficult to enter long-term educational curriculums. Setting up internal education courses for specialization, enhanced skills, and leadership will promote satisfaction and retention of your employees to stay with your organization.
4. PARADIGM CHANGE – Nurses are your experts
Nurses are your front-line employees in the trenches, day in and out. They understand the shortages across all departments. They understand the shifting needs in acuity. They are your leaders. They have a wealth of knowledge to bring to the table and they work autonomously in their practice. Nurses are leaders in healthcare at their core. There are 2 approaches to nursing leadership: 
1. Patient-focused leadership is whereby the nurse is the expert on what each patient needs and what needs to be put in place for this success. 
2. Organization and System Leadership where the nurses understand what they and other departments need, and where healthcare is lacking, and come up with strategies and ideas on how to improve this. 
The general public does not understand what education, training, and roles nurses play in healthcare, and thus the public needs to be educated to know better.  
What can be done? Nurses are so much more than what the public eye sees. Most nurses have a degree in both healthcare AND nursing. Many upgrade these skills to a Master's or Ph.D. level, equaling to the same number of years it takes to become a General Physician. Nurses capabilities include, but are not limited to:
• understanding the inner workings of the body, down to a cellular level. 
• Full competence in diagnosis but are limited currently to passive nursing diagnoses. 
• Holistic level healing (mind, body, and spirit). 
• ability to assess a patient and provide recommendations to physicians for treatment and medication administration. 
• Ability to read laboratory reports, review MRIs, CTs, and Ultrasounds, and identify the prime concerns. 
• adept in pharmaceuticals and are usually the final line of defense in a medication order error. 
Nurses have a vast array of skills that encompass many roles throughout the hospital. They are taught leadership and development in university. Public education needs to be present and at the forefront. Credit needs to be given where it is long overdue.  
5. WORKPLACE CULTURE – a safe and supportive environment
This is critical for nursing welfare and retention. The term “Nurses eat their young” is still ever-present in the healthcare system. There is a culture of newer, less experienced nurses entering the profession and a hierarchy of senior nurses “paying their dues”. This is one reason of many why new grads usually leave the hospital or profession within 2 years. 
The other hindering factor that needs to change is workplace violence and the authoritarian approach. Nurses' licenses are threatened if they are not willing to stay overtime or stay for an additional shift due to shortages. Strict scheduling with no flexibility hinders the ability of nurses to manage their professional priorities and their personal responsibilities. If a nurse is sick or injured, the support system is not in place to assist them with returning to their roles. This nurse is often labeled as  “not a team player” or a “burden” on their colleagues.
What can we do? Promoting diversity and equality amongst all nurses needs to be put in place for retention. Implementing policies and procedures, or a zero-tolerance to workplace violence is a must. Many facilities have a zero-tolerance policy but it is not correctly and/or adequately enforced. Putting in processes to prevent backlash or being labeled a whistleblower and supporting the nurses with their concerns is a far better approach. The nurses will feel heard and less fearful of repercussions and/or retaliation from both superiors and colleagues. 
Nurses need to feel supported and valued by their employers, colleagues, and patients. Ensuring there are appropriate consequences, resolutions and proactivity in place across all areas of nursing for patient/family violence and abuse is crucial.  As frontliners, they are often the first ones to provide care, but also the first ones to endure any and all types of assault and mistreatment.
Other areas to improve in the workplace culture can include:
• regular feedback sessions
• recognition for their work
• a positive work environment
• mental health support
• flexible shift opportunities
• support from management
• opportunities for collaboration and interdisciplinary teamwork
Overall, nursing welfare and retention are important issues that require attention from healthcare leaders and policymakers. By addressing workload, compensation, professional development, and workplace culture, we can ensure that nurses feel valued and supported in their important work.