“Healthy Work Environments: nursing shortages”
Milena Perez Zambrano (219807866)
Faculty of Health, School of Nursing, York University
HH/NURS 3512 A: Nursing in the Context of Global and Environmental Health
Professor Shaina Janmohamed, RN, MN, PhD (C)
August 4th, 2023
A number of social and professional reasons have led to the shortage of nurses. in Canada,
it is derived from a combination of myriad factors among them an aging workforce, and an
increase in general the population which is translated into an increment in healthcare coverage.
These shortages of nurses are noted in the main cities, but in rural areas especially North
Territories have been facing significant challenges. (Sasso et al, 2019). The purpose of this
briefing note is to provide an analysis and recommendations to tackle this issue. Furthermore,
I will elaborate on an advocacy letter that addresses the same topic.
The rate of population growth in Canada is currently breaking records. The population of
Canadians increased by 1,050,110 in 2022. The population of Canada increased by over one
million people for the first time ever in a calendar year, marking the fastest annual population
growth rate (+2.7%) (Statistics Canada, 2023). When there is an increase in the population,
also the demand for health services progressively increases. Similarly, another factor that
contributes to nursing shortages is Canada’s aging workforce, according to Canadian Centre
for Occupational Health Safety Between 1996 and 2018, the number of senior employees in
Canada nearly tripled, increasing the proportion of elderly (55 and above) to younger (25 to
34) workers to parity (CCOHS, 2018).
Another factor to consider is nursing turnover in Canada, which is following after certain
elements. For instance, nursing burnout and deterioration of mental health in nurses,
unsupportive management, salary dissatisfaction, increased migration of Canadian nurses to
other countries like the United States and workload: patient-nurse ratio (Zaheer et al 2019).
The growing population in addition to the retirement of nurses and the slow replacement
of nurses or nursing turnover, generate a crisis in nursing shortages. This represents a problem
because the lack of nursing personnel in healthcare facilities has a negative impact on the
outcomes of patient’s health and it also represents an increase in expenditures within healthcare
institutions. For example, when it comes to nursing care, nursing shortages contribute to
healthcare-associated infections, and adverse events including errors in medications, and
patient falls. For hospitals training new personnel and advertising for positions more often
represent a higher cost (Zaheer et al, 2019). It is also paramount to take into account that
different programs/units of specialized care exist in different hospitals and the extra amount of
time that is necessary to train nurses in those fields, when nursing turnover occurs hospitals are
left with inexperience workers that struggle to provide the same and specialized level of care
as an expert nurse and among those trained the nurse-ratio increased which also impacts on the
quality of care. This problem is linked to global forces as neoliberalism has created an impact
on health workers and workplaces. For example in first-world countries it is translated to stress
among workers (Abramovitz et al, 2010). In my personal experience, neoliberalism has
affected the opportunity of care for patients. For example, in many healthcare systems around
the world hospitals are for profit, the way institutions can maintain a profit margin is by denying
services, diminishing the quality of care or increasing the nursing-patient ratio which in the end
it results in a problem that is not being addressed by public entities that supposed to protect the
communities.
Nursing shortages worsen the inequity of health care access for remote/rural areas in
Canada. Compared to the percentage of the people living in rural and distant areas, the number
of rural nurses in Canada is steadily declining (Zaheer et al, 2019). This brings to light the
discussion about health inequities among Indigenous communities, where disparities are not
only seen related to the living conditions, access to drinkable water, and housing but also to an
adequate delivery of health programs, access to specialized care, differential diagnosis and
advanced medical equipment.
In developing countries, the problems related to nursing shortages do not seem to be very
different compared to developed countries, however, third-world countries are experiencing a
global emigration of human talent in health. Low pay, unfavourable working conditions, low
job satisfaction, little prospects for professional advancement, and unstable or hostile sociopolitical situations in the home country are all push factors that drive nurses to leave their place
of origin. Additionally, other nurses migrate as a result of civil conflicts or war. In certain
countries that are developing, patient-to-nurse ratio has multiplied three times over the previous
20 years. Decrease in mental health, excessive stress, calling in sick, health-related mistakes,
patient discontent, and hospitals’ fluctuating finances are all consequences of high patient-tonurse ratios. These outcomes start a downward spiral where multiple nurses seek to leave their
country (Kingma, 2007). As it has been explained health implications related to nursing
shortages are seen in both developed in developing countries. In both cases, health systems
with social injustices pose a risk to the world's population. The development of social justice
can be aided by identifying the constraints limiting nurses' engagement in this field, given the
significant role that nurses play in developing social justice. One limitation for nurses to
participate in social action for justice is the lack of nurses in different healthcare settings. For
example, if more nurses were engaged in the community, global/planetary health, mental health
and politics with representation in the parliamentary system, some changes in terms of the
working conditions for nurses, climate change, and impact on the determinants of health could
be seen more effective. Nurses contribute to the advancement of justice by combating
disparities at the individual and collective level and working to guarantee equitable resource
distribution and access for all people to healthcare and other social services. Therefore, nurses'
involvement is necessary for the realization of social justice in the healthcare system.
The shortages of nurses affect nursing on a global scale as the holistic care that nurses
are supposed to provide is less integrative when compared to institutions that are well-equipped
with personnel. Lack of adequate nursing resources could impact patient recovery and wellbeing in multiple ways. For instance, an increase in patient mortality, an increase of one
registered nurse per 1000 inpatient days was associated with a 4.3% decrease in patient
mortality (Zaheer et al, 2019). Additionally, nursing shortages have been linked to one of the
main causes of emergency department overcrowding. Overcrowding services contribute to
inadequate opportunity in health services which can result in death, disability and increased
length of hospitalization.
Because a healthy nursing workforce has a considerable influence on patient
outcomes, maintaining its steady supply and quality must be a top priority for global health
strategies/policies. A partnership among the government and healthcare institutions,
comprehensive data collecting on healthcare workers, and emergency government funding of
health programmes are necessary to address the issue of nursing shortages. A policy that can
be implemented to tackle this problem is to establish safe patient-to-nurse ratios although this
policy may look contradictory to the lack of personnel resources, a legislative act on it will
force the allocation of funds for compliance to it. For instance, it is necessary to train more
nurses to supply the demand of shortages, for that it is necessary to create a plan with different
universities in Canada which will require financial support. A different approach would be to
look for individuals from underrepresented backgrounds and go beyond traditional target
groups. In addition to bringing in top candidates and reducing scarcity, this strategy will
promote diversity within the industry. For example, Target nursing education in Indigenous
communities can help in the long term to deliver healthcare services to those populations with
special needs care in terms of cultural sensitivity and competence, besides there is more chance
that Indigenous-educated nurses go back or stay in their communities than any other personnel.
Additionally, to prevent nursing turnover and migration of nurses it is paramount to develop
different strategies aiming to retain nurses such as incentives or benefits related to child care,
postgraduate education bursaries for specialized training opportunities, student loan-repayment
programs to alleviate financial pressures, an increase of wages or signing bonuses are necessary
as the amount of burnout experienced for nurses due to different factors is not perceived as a
good representation of their salaries according to multiple studies ( Zaheer et al, 2019). It is
also key to promoting more supportive work environments. There is certain evidence that
enhancing non-financial aspects of an organization, such as career development possibilities,
promotion transparency, and helpful supervision, might positively affect turnover or
emigration intentions (Khalic et al, 2009). Finally, special attention to internationally educated
nurses living in Canada should be considered. These nurses are one of the solutions to nursing
shortages across the country. However, they are facing numerous barriers to getting their
licenses to practice that not only discourage them to continue pursuing work as nurses but also
leave hospitals without the opportunity for hiring qualified staff.
Canadian Nurses Association should partner with provincial regulatory bodies in each
province as well as with professional body representation such as RNAO to establish different
programs to implement this policy in the country. This partnership can be implemented by
creating a committee of expert nurses that can conduct different research on the specific
considerations that need to be taken into account for the enforcement of the policy. Another
organization that can be considered is the International Council of Nurses, there is an initiative
in a leadership programme delivery in a residential workshop format that focuses on training
nurses for getting a better understanding and skills for influencing policy, this program can
contribute to training expert leader nurses that support the implementation of the safe nursepatient ratios policy.
Canada may have enough hospital beds for critically ill patients, but not enough nurses to
provide necessary, safe care, if nursing workforce investments are not made in a timely manner
and if the recommendations supported by studies are not taken into consideration.
Dear, Minister of Health of Canada, Mark Holland.
In this letter, I want to express my greatest concerns with the nurse shortage across the country
and the significant effects it is having on the populations our healthcare system serves. I
encourage you to recognize how essential nurses are to the sustainability of our health system
and do what is necessary to help fix this issue. I have witnessed first-hand how hard it can be
to obtain healthcare in our neighbourhood and especially in emergency services. The issue
affects people in towns across Canada and it is more noticeable in rural and Indigenous
communities. I consider that the issue has come to a critical point and that urgent intervention
is required to guarantee that residents in our communities have access to the medical treatment
they require. Improved working conditions and proper mental health care for nurses are among
the retention measures to keep both new and experienced nurses in the industry. It is paramount
that a safe nurse-patient ratio is established, to accomplish this, it is necessary to make the
following recommendations to solve the nursing shortage and its effects on our ability to obtain
healthcare: Maximize the number of undergraduate nursing students trained, develop retention
methods for nurses that are currently working to prevent turnover and migration of them,
allocate funding for specialized nursing care programs, accelerating and permitting the
recognition of out of country nursing credential for internationally educated nurses as well
resources to support their additional training in Canada. Attention to this policy proposed will
help to address health disparities and universal healthcare opportune access.
I look forward to hearing from you at your earliest convenience. I thank you in advance for
your consideration. I am awaiting your reply.
Sincerely,
Milena Perez, York University Nursing Student.
References
Sasso, L., Bagnasco, A., Catania, G., Zanini, M., Aleo, G., Watson, R., &
RN4CAST@IT Working Group. (2019). Push and pull factors of nurses' intention to
leave. Journal of Nursing Management, 27(5), 946-954. doi:10.1111/jonm.12745.
Statistics Canada. (2023). Population and demography statistics: Canada’s population reaches
40 million. Retrieved July 20th, 2023.
https://www.statcan.gc.ca/en/subjects-start/population_and_demography/40-million
Canadian Centre for Occupational Health and Safety (2018). Canada’s aging workforce.
Retrieved July 20th, 2023. https://www.ccohs.ca/products/posters/aging_workforce/
Zaheer, Ginsburg, L., Wong, H. J., Thomson, K., Bain, L., & Wulffhart, Z. (2019).
Turnover intention of hospital staff in Ontario, Canada: Exploring the role of frontline
supervisors, teamwork, and mindful organizing. Human Resources for Health,
17(1), 66–66. https://doi.org/10.1186/s12960-019-0404-2
Abramovitz, M., & Zelnick, J. (2010). Double Jeopardy: The Impact of Neoliberalism on
Care Workers In The United States and South Africa. International Journal of Health
Services, 40(1), 97–117. http://www.jstor.org/stable/45131099
Zaheer, S., Ginsburg, L., Wong, H.J. et al. (2019). Turnover intention of hospital staff in
Ontario, Canada: exploring the role of frontline supervisors, teamwork, and mindful
organizing. Hum Resour Health 17, 66. https://doi.org/10.1186/s12960-019-0404-2
Kingma, M. 2007. "Nurses on the Move: A Global Overview." Health Services Research
42(3 Part II): 1281-98.
Khaliq, Broyles, R. W., & Mwachofi, A. K. (2009). Global Nurse Migration: Its Impact on
Developing Countries and Prospects for the Future. Nursing Leadership (Toronto,
Ont.),22(1), 24–50. https://doi.org/10.12927/cjnl.2009.20607