Gail Donner: On this episode of Nurses’ Voices, we’ll be talking with an expert in nursing, human resources, and then workforce planning above the current critical situation in nursing and what beats to happen in the future to solve a shortage issues.
Announcer: This is Nurses’ Voices. Nurses’ Voices is sponsored by Pfizer Canada.
It is supported by the Canadian Nurses Foundation and the Canadian Nurses Association.
Gail Donner: Hi everyone. I’m Gail Donner
Mary Wheeler: and I’m Mary Wheeler.
Gail Donner: Welcome to our first episode of season two of Nurses’ Voices. Before we begin, we’d like to thank Pfizer Canada for their generous sponsorship, but this season’s Nurses’ Voices.
We’re hearing a lot about nurses leaving their work and their profession. It’s scary! For the public and for all of us in the profession.
But what is really going on?
What do we know about who’s leaving?
Why?
And more importantly, what should we be doing about it?
To help us understand the issue we’re very fortunate to have an internationally recognized nurse joining us this evening on Nurses’ Voices.
Welcome Gail Tomblin Murphy!
Gail Tomblin Murphy: Thank You.
Gail Donner: Gail is Vice-President Research, Innovation and Discovery and Cheif Nurse Executive at Nova Scotia Health and director of the PAHO/WHO Collaborating Center on Health Workforce Planning and Research at Dalhousie University. More relevant, Gail is an expert in health system, strengthening and health workforce policy planning and research, and understands what we need to do to recruit and retain nurses in Canada. So I want to get right into it, right to the meat of the matter, if you will. And as I said in the intro, everyday, we’re bombarded with stories about nurses leaving, about burnout, the about moral distress, and, and more than that. So what can you tell us about the state of the nursing workforce in Canada?
Gail Tomblin Murphy: The pandemic definitely has shone, a light on the very important part of the nursing workforce. Nurses care, they’re compassionate, and they will work as hard as they can work to make a difference in the life of patients. And we’ve seen that each and every day. And so, when you ask about where is it that we’ve been and where are we heading?
I’ve been studying this work and have my background: I’m a critical care, and the most important work that I have done in my career is caring for patients and their families to identify what their needs are, what they need and how we can help them. We well understand retention and recruitment of nurses.
We know things that need to be in place to value nurses, right from the time that they’re students and coming and making that transition to practice. We know that there’s policy strategies that need to be in place. To make sure we have safe staffing for instance, to deliver care. We know that we need to support nurses in ways that are going to help them with their ongoing professional development.
We know there’s strategies to actually move forward, to empower nurses, to make decisions that impact them, to empower them, to be the leaders that they are. But we have fallen short. And the reason that I think we really have fallen short, is because the shortage of nurses, so the gap in terms of the nurses that we need that are required to deliver care has not always been a hot topic until we’re faced by a pandemic or until there’s a global shortage of some kind.
So health human resources has not been something that we have taken seriously across this country. And it’s not something that we have paid attention to each and every day.
Gail Donner: You said, we know what needs to be done. What does need to be done now?
Gail Tomblin Murphy: There’s all kinds of evidence that talks about strategies that need to be in place to retain nurses. Examples of that would be, we have to have appropriate staffing patterns.
We have to make sure we have enough nurses, working with other team members to have all of the technology that they need to have in place to deliver the care that people require. And they deserve. But oftentimes we have actually done staffing in ways that we have allowed vacancy rates to continue. That is, to have under filled positions, positions that should be filled in order to move to complement.
But oftentimes we save money in the system by not filling those positions. That would be an example. But so then what we do is we expect nurses to be working longer. We expect them to come back to work when they’re needed, as opposed to self-scheduling and, and balancing their life with their school perhaps, or their families or their friends or their exercise.
And because nurses are incredibly committed, for years, they have gone back to work and oftentimes extra hours, extra shifts, and it’s not to make extra money, in terms of overtime, it’s because they’re compassionate and they want to have somebody there to deliver care. So if we think about staffing, that is one.
The other thing is we really haven’t paid attention to that early career nurse. We should be courting each and every day. Students, learners, people who have chosen to come into the nursing profession and as employers, for instance offered them the positions that they will be looking for, so that they’ll stay, they feel valued.
They feel part of the system that we’re working with them on their career goals that we’re learning from them and changing a system to reflect new technology, new evidence, new ways of practice. But oftentimes we wait and nurses will graduate. And then they have to sit back and try to find a place where they can work and a match with the employer whom seems to share the values and the vision and the goals that they want.
But instead time oftentimes passes. Why is it that we have known all of this, that the evidence is there, that the practical solutions are there, ones that oftentimes still cost a lot, but we don’t necessarily put them in place.
We also know transition to practice has been an area that we’ve learned and we’ve talked a lot about.
And there’s that, that argument that often happens while academic institutions or colleges, um, would, should, should they should actually be preparing those nurses to hit the floor running. It’s like “what floor, running like what, at what pace and what’s right”. And so oftentimes the employer hasn’t been involved in enough early enough to make sure that the system is understood.
The processes of care are understood for instance, where employers are working closely with academic institutions and putting that nurse in the center of that decision making. We are seeing benefits. We are seeing the impact that that can have around the retention as well, as well as the recruitment. So the reason, the stories that I’m telling right now are not only based on evidence that has been here for many years, that people have ignored and know it actually instituted or put in place.
But because things are so bad. Let’s put COVID-19 in the middle of this. So we know across this country, That we have needs as people are in their homes, in the system and trying to get home that are very complex and very demanding. And we also know that given the care delivery team and we’re talking nurses today, that right now over 30% of the workforce is out as a result of COVID-19.
And we see that each and every day. Um, in the system, we see it light shone on it in the evening and in communities who are incredibly vulnerable already, that the light has been shone on those communities. And so things are not good. Where we are right now is things are so bad, that we are actually partnering in ways that we haven’t before. We’re arriving at solutions that I’ve talked about in terms of bringing in volunteers, bringing in unregulated and regulated workers to work in ways that we can actually deliver mass immunizations, um, in ways that we can do public health measures and, and keep trying to keep track of that.
But at the same time to deliver care to people, if you use that as an example, with COVID, which is requiring a different kind of care than ever before.
Gail Donner: I hear you saying it also has created an opportunity, an opportunity because, I’ll put it more bluntly, employers are desperate. What is going to happen post pandemic? What’s going to happen to this spirit of let’s see what we can do if we work together? How will we going to make this sustainable? Some of these initiatives, some of this it’s almost as if we can’t let the public or ourselves or the employer forget what it looks like when you look critically short of people, you need to deliver care.
Gail Tomblin Murphy: How many years have we been saying that we need to have nurses involved in decisions that affect them and impact them that they need to be central to the decisions that impact patients, that they need to work with uh, each professional teams and our medical profession in, in a way that they are, you know, influencing change. But there has been so such a history where this has not been present, and yet can’t just plan for a pandemic without thinking services as usual. So we’ve got pandemic, which is coming and going, depending on the wave that we’re in and then services as usual, people are still needing to come to emergency access and flow is an issue.
And oftentimes we know that there’s been strategies around access and flow that hadn’t been put in place. We also know that we’ve had to reduce surgeries, in order to actually deliver services as usual, as well as the pandemic.
I’m going to point the finger for a minute. I have been around a long time where oftentimes nurses have talked about RN only, and it’s a registered nurse who needs to be involved in the care and as he or she has all the competencies and nobody else does. Well, we have seen through this pandemic and more with the light that has been shone in my thinking is that there is room for our, our partners to work together differently. Students working with, then family of nursing, working with our regulated and our unregulated workers and what have you.
So, so what are we going to do and, and why now? It is, because it, it’s not just the system who’s short, like when you talk about the system needs nurses to deliver care. Think about, um, our community. Think about health promotion. Think about population health, public health. Think about caring for our people living, uh, for instance, our, our after, I’l use my own example, African Nova Scotians, our indegenous communities. This has also helped us to better understand how care needs to be delivered in a very different way. Through engaging communities. Nurses have actually led us in a very powerful way through this pandemic.
And there are many days and many nights that if nurses threw up their arms and said, “I’m done, I am out of here”. The system would crash. So what kinds of things can we put in place? Well, we can actually invest as employers. I can speak to that. We can, invest, in actual retention and recruitment— the things that Mary you and Gail have talked about for years— we can invest in ongoing professional development.
We can actually move towards preceptorship and mentorship in a way that’s not just tapping on the shoulder of experienced nurses, but perhaps it’s using our retired nurse pool, which for us has been brilliant, to come in to help to develop the programs that are needed around preceptorship and mentorship. We also, I have been privileged enough to be working and writing for the Royal Society of Canada on the nursing piece that we’re doing right now.
And this has brought nursing experts from across the country to come and talk again about what hasn’t worked in the past. Why have those policy documents sat on shelves? Why have they not had legs or teeth, or actually influence policy makers and decision makers to actually move on anything? What I’m experiencing right now is that we are actually working with our decision makers and policy makers who are asking for 30, 60, 90 day operational plans in order to sustain and to make a difference and I’m hearing and involved in long-term planning.
So I think the table is set in ways that nurses and nursing can actually influence where we are today and go forward. Um, and, and I know there’s days that we’re we you know, we need to be concerned with the U S for instance, I heard today off the, you know, um, from, from people within my work that people are being offered, go to California for three months, you make a hundred thousand dollars per month.
So the sucking sound to the south, that’s not new, that the issues about eating are young, those issues, aren’t new. We have allowed this to continue. Now it’s our opportunity. And this is the, this, this is the optimism I have now is our opportunity to work in partnerships differently and to actually make the changes.
Gail Donner: So you mentioned money yeah, the lure of the US in the short term at least, how important is moneyin recruitment and retension?
Gail Tomblin Murphy: Well, I think we have to be realistic. Money, you know, we have to make sure that there’s parity that that nurses are paid. If you look at market value and business models that they’re paid for their education for their experience, um, for a lot of different factors. And, and so, you know, people say to me at times, so how much, how much do you think that’s worth? And I’ll say, well, what do you mean? How much is it worth? What are you paying a doc? Or what are you paying up pharmacist? Or, or what are you paying? So I think market value is really important.
And I don’t, I don’t think nurses have done a really good job of talking money, that when we young and, and, and starting to look for employment, it’s like, well, what will my shifts be like? How much vacation? Like, I think we need to be asking how much money and there needs to be. Um, you know, we need to look at incentives.
We need to look at, unions have done a very good job around collective agreements to actually make sure that we have ongoing professional development, that and many other important incentives, but they’ve also helped us at times to look for increases that we should be. We should be getting, I work in a system where there’s a lot of emphasis on the medical profession.
I’ve worked in a system where as the chief nurse exec, where we continue until very recently, um, to not even, not even to encourage our, our optimization of, of scope. Why is it a year ago? Less than a year ago that we had nurse practitioners under employed. That makes no sense to me when we know the impact of those practitioners, have for 20, 30 years..
The difference that they can actually make. And, and because part of that has to do with physicians. And when physicians are in master agreement, you have to be incredibly careful. And once they’re happy that we can talk about salaries, we need to be talking across the board about salaries and incentives.
We need to pay and nurses many, many, um, work over time. Many are finding ways to get the, the money and the incentives that they’re looking for. But our studies for many years have shown, that the more over time that nurses do and the poor staffing patterns that we have and the impact they, that is a reduction in the quality of care.
Um, the, the emotional and physical exhaustion of nurses and all those things even involved and then studies for for many, many years. So we need to be talking about incentives and we need, and, and salary is part of that.
Mary Wheeler: So the nurse that’s working at the bedside, what does he or she need to do to move this agenda forward?
Gail Tomblin Murphy: When it comes right down to it, it’s a system problem. And you know, we too often have blamed the individual. If we went around anywhere today in any of our, our regional hospitals, in our long-term care, our community care, anywhere, nurses would be at the breaking point. They’re exhausted, frightened, they’re fearful.
And what I would say right now is with our new government and our new health transition team, there’s some hope. Why is there hope, it’s because of a premier, a new premier, and our minister of health, for instance, she’s a nurse and we’ve got a very strong team who have went to every end of the province.
The difference is they had a listening tour, they listened. The difference right now, is from that listening tour, there are plans: 30, 60, 90 with investments, money, people and strategies. So some of the strategies that I opened with in terms of optimization of scope, mentorship and preceptorship early transition programs and, and hiring nurses um, for instance, when they’re early learners in their second year of the program, we’ve talked about those things before the difference now, and I hope, and I would put a plea out to governments and systems across this country to actually rectify at this point to actually invest in these strategies. And if we don’t, and if there isn’t that commitment to do it differently this time. And I think we need to be incredibly concerned.
We have had these huge gaps for many, many years. The strategies have been before us, but oftentimes the political piece is getting in the way. Well the pandemic has actually made, uh, whether you’re a political player, whether you’re a decision-maker, whether you’re a community member. Um, whether you are, it doesn’t matter what part of the system that you find yourself in. But most importantly, that the changes now are incredibly important. You look at the media every night, we have our infectious disease experts who are talking about, we have our, our ICU physicians and this and that.
And then the stories they capture of nurses are the nurse who’s just falling apart.
Mary Wheeler: Exactly.
Gail Tomblin Murphy: Ok, they are falling apart, but give them the voice to actually talk about: what are the problems? What would make a difference? What would make a difference for them? Um, for them to be home with their families, um, to have some downtime and add to that through at least 30% of the workforce is out because of they’re positive themselves, or they’d been a contact with somebody.
So, you know, I, I think that there it’s a system issue on, on so many levels, but I am very optimist. And it’s for work that you guys have done, and many others have done. If we can put feet to the fire at this, this, this is a last go of actually investing in retention recruitment strategies, because now is our opportunity.
And I am fearful that if this passes and we move into a place where we become complacent, it’s an endemic and we’re going to live with this. And then the next surge comes. So I, I, and I really believe, um, from a lot of different perspectives and, and, and involvement that I’ve had that now, now is now is the time, but we’ve got to listen and we’ve got to respond.
How many times have we talked 80/20, where 80% is care delivery. 20% is for nurses to actually, you know, develop their leadership skills to mentor to precept, to maybe get involved in some research or do, do something different. If we mean it, and we value the nursing workforce, now is the time to make those differences.
Gail Donner: You’ve gotten traction in Nova Scotia. I’ve been impressed that the Royal society, I don’t know, have they ever done anything about nursing?
Gail Tomblin Murphy: Never. Actually put in our report at this point. And this consisted of people like me, who’ve been involved in this for some time from BC, right through, to Newfoundland, including our indigenous community. We have put an equity, diversity lens, definitely, on, on, on this inclusiveness type of lens, we have had people who’ve been involved in this work for years. People like Doris Grinspun, bun, like Gretta Cummings, like Kathleen MacMillan, um, like Judith Oulton, uh, like Josephine Muxlow. There’s just, and people came together and I thought, oh my goodness, this is going to be a challenge.
So how do we land on you know, recommendations that are going to have traction that aren’t the same old ones that sit on somebody’s desk. What are those pragmatic types of strategies? So this was work, um, that, uh, is, is actually illustrating and the voices of nurses. Um, but, and so we used a lot of different ways.
We interviewed a lot of nurses and key informants. We actually did, your rapid review kind of synthesis systematic reviews, but we also pulled in factors prior to, um, pandemic during pandemic and what this means in terms of the the future. So now we do have the opportunity to see together, all of us, uh, to make a difference.
And it’s going to take all of us working together at this point, and it’s hard to rise above rise above the challenges and the obstacles. But it’s thinking about what obstacles need to be moved, what rocks needs to be moved to see the other side.
Gail Donner: Right. You know, you made a comment earlier about, uh, working together because within nursing, of course we have our own, uh, silos, if you will. And, uh, it, I, I like to hope when I listen to you that this will create an opportunity maybe for the partners within the profession to have together, maybe around the Royal Society paper I don’t know, but something needs to bring folks together and stop the finger pointing within our, uh, you know, between and among our colleagues..
Gail Tomblin Murphy: I agree. And if you think of the examples in long-term care, for example, if you think about what’s happening every day in our emergency, in our critical care and our med-surg areas, if we think about. Um, you know, any sector, as we think about public health and immunization and testing and, and contact tracing and all of that, we’ve only been, we’re only moving towards success by working together.
So it’s thinking about what are the competencies and, and what is knowledge and skills that providers have. And let’s put them together to work together as opposed to, um, you know, the protectionism and, and the silos, those that in nursing has been very rough on nursing. And I think that we’re at a time and a place that, uh, this, this scenario has changed that we see licensed practical nurses working incredibly well, registered nurses with nurse practitioners and, and our PCWs and, and others.
So I think that, uh, then the day has come to remove some silos and, and I, I think we’re getting there.
Mary Wheeler: This is for me, Gail, a good new story. And I think it will be timely, even this document you say is about to be released. Um, this first episode of Nurses’ Voices, um, I think it will be good that we attach some resources so that it goes back to my original, the question I keep asking that nurse at the front line.
Instead of saying, well, that’s nice for them to be talking about it, but what does this really mean to be able to make the linkages and to show the strategies. So I’m really, I’m optimistic also just based on our conversation. But before we close, I’d be curious on a personal note. Um, it just, you’re very passionate about this topic. You talked at the beginning that you started in critical care as a clinician. So how did you make the shift?
Gail Tomblin Murphy: Thanks for asking that. And I think probably the best part of my career ever was being a critical care nurse and being in the middle of, of the life of patients and, and their families and loved ones in a way that we cut right to the chase.
You know, it, that the conversation was always very valuable. It was meaningful to, to the patient, which is most important. And that passion, you know, really led me to trying to bring that passion. And I taught critical care nursing. And then I went into nursing education and, and, you know, was history. I did my PhD, which I think the focus on understanding the needs of people and the care that they need and who delivers that care and, and different ways that we can do that.
Was I thought at the time, something that everybody knew a lot about. That’s what I’d think by passion has continued because it’s been focused on the needs of people in building systems around that and the workforce as well. Um, I feel coming into this position after 30 years in academia, which I loved each and every day of and running an international research center.
I really believe right now that my passion and my vision and, and working to your point with our front line. To be part of solutions, as opposed to people telling us what we should be doing. Um, this is, and, and really it’s, it’s, it’s running an innovation portfolio. So it’s coming, always thinking, never going to know, think about how do we actually come up with innovative solutions to do things differently and to test, to try them and to evaluate them.
So we need to have passionate leaders. We need to have people who don’t themselves, as leaders don’t get burned out, that they feel passionate and we’ve got to find ways to support that. And you know, you know, Mary to you and Gail who have for many years and continue to move forward the importance of just that passion, uh, leadership, empowering people and finding realistic strategies to do that.
I think you’ve been incredibly helpful and I would really encourage you to continue to share your messages because they definitely are sticking.
Gail Donner: On that note. I think it’s very appropriate for us to say thank you, very much. You’ve definitely given all of us lots to think about. That’s what sure. And I think following up from what Mary said, when the Royal society paper comes out, we’ll make sure that our colleagues have access to it. And nurses bring it to the attention of their employers and colleagues et cetera.
So.
Gail Tomblin Murphy: It sure is.
Gail Donner: Let’s just say thank you very very much.
Mary Wheeler: Thanks a lot Gail.
Gail Tomblin Murphy: Thank you. Thank you for inviting me. And we definitely will make sure that you get everything that, that, you need to, to help with some of this. And I’m glad we’ve made this connection. And I look forward to our ongoing work together. Very important work.
Gail Donner: Thank you for joining us for the first episode of season two of Nurses’ Voices. We’ve been talking about a timely, but very complex issue, and we just touched the surface, but hopefully this has answered some of your questions and concerns and given you some food to thought. Thanks again. And we look forward to seeing you in future episodes.
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