BC is pushing to add thousands more nurses. But nurse educators say the field needs major change first

This week, May 8-12, marks national nursing week. And though the value of nurses in our healthcare system is clear, the nurses holding those positions and doing the work on a daily basis are facing ongoing challenges.

“Half of nurses currently working wish to change jobs. Ninety-four per cent are showing signs of burnout, and 83% say they are so understaffed they worry for the quality of care they can provide. Meanwhile, nursing vacancies have more than tripled (+219.8%) in the last five years, according to Statistics Canada’s July 2022 Labour Force Survey.”

This is the opening paragraph written by Linda Silas, president of the Canadian Federation of Nurses Unions, in a research report released in Dec. 2022, explaining the crisis facing the nursing profession in Canada.

BC is now years into an acute shortage of nurses as part of the broader crisis in an overwhelmed health system. The province took steps this year to fast-track foreign nurses and incentivize retired nurses to return.

But nurses and nurse educators say the problem in the field goes beyond—and much further back than—departures from pandemic burnout.

On March 14, 2023, a joint news release from the Canadian Medical Association, the Canadian Nurses Association and the College of Family Physicians of Canada, all of whom contributed to a federal parliamentary report, offered this proviso:

“… the primary focus of federal, provincial, and territorial government investment is creating a workable and effective system for everyone rather than bringing more workers into a system that is in need of significant repair …”

Here in Victoria, Susan Duncan couldn’t agree more.

A nurse, nursing professor and nurse researcher with the UVic School of Nursing, Duncan was also previously the school director for five years (two of which were pandemic years), she now teaches graduate courses in policy and leadership.

“We’re in a time we’ve never been in before,” she said. “So, it’s critical we’re clear about the problems we’re trying to solve. And that we have the data and evaluation systems to support what we are doing.”

Nursing shortages, for example, were a concern long before the pandemic, but with distinctly different demographics. Previous years had an exodus of pre-retirement nurses, but nurses today are leaving their profession early and in mid-career.

Susan Duncan, a professor with UVic’s School of Nursing. Photo: UVic

UVic announced in its 2023 budget plan and framework that it is already working on the expansion of its nursing programs, which Duncan says she is happy to see. But adding more seats alone won’t address the problem.

“The focus should be placed on retention of nurses across the system,” she says, asking, “How else are we going to keep those nurses engaged and supported in their work so they stay?”

“We know what the problems are,” says Duncan, “and we know how to fix them.”

Education, says Duncan, must play a fundamental role in addressing the prevailing issues driving nurses to leave their profession, which boil down to organizational and management structure and the lack of nurse mentorship.

“Resources for nursing education, having sufficient faculty to support practice, is as important,” Duncan says.

Having worked through the pandemic and the call for ‘all hands-on deck’—Duncan collaborated with Island Health and the Red Cross to arrange for nursing students to work at vaccine clinics across Greater Victoria and the south island region—she feels now is an ideal time to introduce change.

“Our graduates tell us they need support within the workplace in the form of leadership and mentorship. This has become an urgent need because we are losing nurses daily.”

Duncan believes the province and health authorities need to make deep changes at their systems and leadership levels with a mandate to support nurse leadership.

Allie Slemon agrees. A PhD graduate of UBC’s School of Nursing, and now an assistant professor at UVic’s School of Nursing, Slemon completed her doctoral dissertation on “how nurses promote social justice” in emergency departments.

“Nurses want to provide excellent care and are educated with that intent. But if we are told to prioritize cost-cutting, to treat more patients per hour, and to be dependent on digital tools, then we can’t do the work that we were fundamentally trained to do.”

Allie Slemon, an assistant professor at UVic’s School of Nursing Photo: Geoff Howe

Efficiency demands clash with nurses’ needs and training

Slemon longs for employers to enhance their understanding of how management, administrative structures and systems (operational, digital, hierarchical) can conflict with nurse education.

“For health authorities to achieve success in retaining the nurses they hire,” says Slemon, “better understanding is needed around what they are putting their nurses through in today’s workplace.”

As an example, she points to the new grad placed on a ward and required to attend to as many as 20 acute care patients without a senior nurse to provide direct support.

“That nurse is not likely to cope, to find the resilience, to be successful in her work,” says Slemon, adding, “No one understands these pressures better than the nurse leaders requesting such efficiencies.”

“These are big challenges and they are a major factor within a big, systemic management structure,” says Slemon, noting the pressures leaders face managing tight budgets while increasing efficiencies.

The BC Nurses Union makes the same case in a position statement on nursing leadership, saying “structural changes in health services have resulted in a significant loss of nursing leadership.”

“The current shortage of nurses will create a shortage of nursing leadership at a time when the demand for services is increasing. Most nurses do not receive enough support from existing management structures and in some cases this is because their managers are non-nurses and lack clinical skills,” the union’s statement reads. “Nurses report feelings of dissatisfaction with the amount of control and responsibility in their job.”

How things got to this point

Slemon points to an opinion piece recently published by a colleague that taps into the source she believes is a primary problem within health leadership today.

Who dismantled nursing mentorship systems and how do we get them back? asked Sally Thorne, nursing teacher and past nursing school director with UBC, in her essay published March 27, 2023, in Nursing Inquiry.

Thorne put the issues into context, claiming “the disruption of nursing mentorship systems is a serious threat to societal health writ large.” She reflected on the structures that were in place in the 1970s to support nurses throughout their career and how they added to the value of nursing.

“I always had a head nurse, often a nursing team leader, and, when guidance was needed beyond that, I had access to a charge nurse or even a director of nursing. It felt like I was supported within a web of nursing expertise and authority that was at close range should anything go wrong.”

That changed, wrote Thorne, along with the budget cutting and new efficiencies introduced in the 1980s onward, the catalyst for steadily decreasing job satisfaction across the nursing profession.

In other words, it’s taken 50 years and a pandemic to reach the current crisis status.

“The evolving fashions in health administration have systematically disadvantaged the kinds of workplaces and care settings within which organic nursing leadership and mentorship systems used to thrive,” Thorne concluded.

New models can reintroduce what was valuable in the old ones

In order to get on the right path, Duncan says nurses can lead systems change while contributing to nursing care sustainability by introducing new models—principle-based approaches to care—into areas like long term care, primary care, and home care.

“We’ve been talking about these new care models for decades,” she says, referring to the research and innovation in planning and policy that has been conducted over the past 10 years yet remain to be applied.

For example, in 2011 an expert commission released a report on the role of nurses in the health care system with a shift to more community-based and public health models of primary care that, had they been implemented, would have enabled access to primary care teams.

“Nurses are not always invited to the tables where their perspectives are needed,” Duncan explains, a concern she would like to see addressed by government, health authorities, unions and educators. “Nurses want both voice and influence in their workplace. There is considerable evidence that shows how this helps with retention. We need to pay attention to that data, for starters.”

Both Duncan and Slemon foresee a cultural change, too, where nurses are guided through their work life by employers who focus on mentorship, advancement and who encourage discourse and equity-promoting practices that hone leadership skills.

“We put great effort into building these education programs and we see such promise in our students as they are excited to work, to make a difference,” says Duncan. “Then we hear from our graduates that they are frustrated and disillusioned with work.”

Help is finally on the way in BC

On April 4, 2023, Adrian Dix, BC’s Minister of Health, announced patient-to-nurse ratios will be introduced as part of a new nurse staffing model to enable more manageable workloads. An investment of $750 million is included, allocated over three years.

BC Nurses Union interim CEO Jim Gould told My PG Now on April 10, 2023 that the announcement showed government was “taking these matters seriously and respecting nurses,” in spite of the long wait.

“This is something we have been asking for for a very long time,” Gould said, “about 25 years.”

Even so, BC remains the first province in Canada to introduce this new approach, currently up and running in California and Australia.

BC’s Ministry of Health is expected to make further announcements soon on supports for nurse retention.

Kate Hildebrandt is a UVic retiree as of May 2022. She worked as a communications officer for UVic’s Faculty of Human and Social Development for more than seven years. This faculty is home to seven schools, one of which is the School of Nursing.