OANHSS Comments on Ensuring the Care Will be
There: Report on Nursing Recruitment and Retention in Ontario
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We commend the Registered Nurses
Association of Ontario and the Registered Practical Nurses Association of
Ontario for their leadership in the development of the this report. It is
comprehensive and presents many challenges that must be addressed urgently to
ensure the continuance of health services not only at current levels but to meet
the needs of the future. We support action that stresses quality improvement in
health care and quality worklife for nurses.
As an Association that represents a significant component of the health care system, we endorse the report and offer our leadership in implementing the action plan as it relates to long term care service providers. Long term care is eager to be party to actions that will change the recognition and value placed on nursing and the contribution our sector makes to health care. We anticipate our unique contributions will be recognized and supported. We have shared the report with many of our members and encouraged them to review it and determine the roles they can play in response.
On the next few pages we will offer comments and suggestions regarding the specific strategies, but prior to doing that, we have a few additional recommendations.
We now provide our comments on the specific strategies.
Specific Comments on Plan of Action Strategies
Recommendation 1
a)
We encourage the JPNC to identify methods of obtaining input on an
ongoing basis from sectors not represented by JPPC. Without such action, key
concerns or implications of action could be missed.
b)
In addition to new models, we suggest that existing models be examined
and that attention needs to be paid to interpreting the models.
c)
We fully support the establishment of the Provincial Chief Nursing
Officer position and a supporting secretariat. We are already seeing the
increased visibility and attention to nursing in our dealings with the Ministry
of Health and Long-Term Care.
d)
While the establishment of nursing advisor positions in all major
divisions of the Ministry could be valuable, we would recommend that there be a
specific link to existing nursing positions such as compliance advisors in long
term care so as to strengthen the existing roles.
e) We concur that data collection is critical to evaluating human resource utilization. To date, our experience indicates that the Ministry’s data collection and analysis is lacking. We urge caution in the development of data collection approaches. Data collection must be timely, consistent and comparable. We should be able to break out information by sector. It will be critical to overcome current definitional problems often related to carrying employer sites and collective agreements.
f), g)
We support the idea of nursing internships in public policy making and
incorporating public policy analysis in nursing curriculums. Recognition of the
importance of public policy in shaping our society and health care system is
critical to influencing the future.
h) In order to promote attendance at public policy workshops, attempts should be made to site these events in the employer settings and providing incentives such as some salary replacement support. It might also be valuable to develop models for such education and distribute this to employers for incorporation into staff development activities.
i) The distribution of policy-related material would build on the suggestions made under h) above. Employer organizations who are active on the public policy front could be allies in the provision and distribution of such materials.
Recommendation 2
a) Funding is a critical issue in the sustainability of health services. It is clearly a shared responsibility of the federal and provincial governments. However, there needs to be fundamental rethinking of how and what is funded. There needs to be a broadening of the Canada Health Act inclusions to support non-acute/non-physician services in tertiary care institutions and the community. Equally important is the need to shift the focus of policy and funding beyond just health services to addressing the broader health determinants. Only by recognizing and addressing the factors that will influence the demand for health services in the future will an affordable health system be sustainable.
b)
No comment
c)
We support the need for increasing the professional nursing levels in
long term care and the importance of residents of all long term care facilities
having access to registered nursing support 24 hours a day. Work is needed to
develop staffing benchmarks that incorporate nursing on which funding is based.
Salary variances funding need to be incorporated into funding mechanisms. The
real need is for funding to be based on the needs of the person not the setting
in which the service/care is provided. In other words, we need a continuum of
care approach which supports fair and equitable treatment of clients based on
their changing needs. The leads for the action on this recommendation should
include long term care facilities.
d)
We fully concur with the need for exploration and establishment of
longer-term and more stable funding mechanisms for all parts of the health care
delivery system.
e)
While we can understand the value that nurse/population ratios might
provide for comparisons and funding determinations, geographical variances
should also be considered. We fully support a funding system that is based on
needs of clients to overcome the current inequities between sectors.
f) In addressing inequities in remuneration, benefits and working condition, it is important to examine the differences not only between sectors, but within sectors as well. For example, within the long term care facility sector there is a wide variance in pay equity funding available to facilities depending on the method of pay equity and the timing of settlements. While it would be ideal that changes are accomplished through collective bargaining, the system barriers need to be addressed first and funding commitments given up front. The Ministry of Labour needs to be included with the leads for this strategy.
Recommendation 3
a)
We fully support client centred care and nurses being a front line leader
in achieving this goal.
b)
To promote support and collaboration on this strategy, we suggest that
employers be added to the leads.
c) Long term care providers are leaders in nurse involvement in decision making due to the flatter organizational structures. However, a major inhibition to some day-to-day leadership participation is the nurse’s inability to be released for front line care for this purpose. Although part of the solution is funding enhancements to add staff, there also is a need to look at methods to involve nurses where they work at the unit or client care level. Technology and creative collaboration methods need to be exploited to maximize the participation opportunities.
d) The issue of nurses being the front line manager is one which is of less significance to long term care providers as long term care facilities are required to have a nurse manager in charge of the nursing services. Also at the unit level, nurses are the leaders and care team coordinators.
Recommendation 4
a),
b) We support the RN (EC) role as essential
to primary care reform. However, the emphasis in the strategies for this
recommendation is on primary care settings or hospitals. We would like to see
the addition of a strategy to recognize this role in long term care facilities.
While we appreciate that support has been provided by the government for
piloting the role in facilities, this is the only setting where nurse
practitioners have been introduced with the proviso of the pilot test. There is
a need for a commitment to long term support.
c)
No comment.
d)
We also support action to effect regulatory changes that will allow acute
care NPs to obtain their RN (EC) designation. Given that these practitioners are
already graduate prepared nurses with a clinical nurse specialty, the lack of RN
(EC) designation is inhibiting their practice. Some of these nurses practice in
long term care settings with specialty training in geriatrics. Recognition for
this advanced training would enhance the value they add to these settings and
could lead to greater incorporation of the role within our sector.
e)
No comment
f) No comment
Recommendation 5
a)
Caution is needed to ensure the Guide not be too generic. The more specific to the employment setting the more useful
it will be. Also, this strategy could be strengthened by the addition of the
Ministry to the list of leads.
b)
The strategy needs to be linked to strategy 1(e) above and our comments.
The methodology needs to be sector specific.
c)
We concur with this strategy as two key reasons for casualization in long
term care and community settings is inadequate and unstable funding.
d)
This is another strategy that is closely linked to those under
recommendation 2 so we defer to our comments under that section. We suggest that
the sector associations be included
as leads working in consultation with the JPNC.
e)
Again this seems similar to strategy recommendation 2f and is a strategy
that will be critical to progress in the non-hospital sectors.
f)
While this strategy is laudable, focus on leadership development for the
basic registered nurse is also critical for long term care settings where there
is limited access to advanced practice nurses. Such work needs ongoing financial
support beyond what is committed here.
g)
We support mechanisms for recognizing and developing clinical expertise.
However there needs to be a focus on clinical ladders which are
sector-specific. Current models are designed for acute care.
h)
This survey would be a valuable undertaking on which we would welcome
participating as long as we receive some funding to offset costs. It will be
important to incorporate employer input in the design of the survey so as to
balance the design with union considerations.
i) Exit interviews should already be a component of human resource policy of organizations so this strategy will reinforce it.
Recommendation 6
In general, we support the strategies related to this recommendation. The comments we have are in relation to three strategies.
b)
We would add geriatrics so as not to focus on just healthy aging.
The reality is nurses need to understand the issues of morbidity
associated with aging. The emphasis on technology is also critical.
e)
Employer-sponsored nursing student loan programs may be unrealistic in
light of the limitations and constraints facing many employers. An alternative
may be a sector of employers joining forces to institute such a program perhaps
with matching support from the university/college and/or professional
associations.
f) To make this strategy workable there must be union buy-in so that collective agreements are supportive. Many agreements do not permit these types of arrangements and flexibility.
We fully support the strategies. With regard to enhancing telehealth capacity, careful costing will be required so that adequate cost effective data is available to support any funding demands which could be extensive.
Recommendation
8
This is an essential
recommendation if the future availability of nurses is to be assured. We need to
profile the scope and depth of nursing practice in all settings in a way that is
exciting and positive. The glamour images perpetuated by the media for the ER
type of scenarios must be offset.
Recommendation 9
Again, we support the strategies attached to this
recommendation with the proviso that evaluation incorporates data on the outcomes and impact of the actions.
For example, do we know if the Career Fairs were successful and whether
all sectors benefited? Were the fairs and career lines
accessible to all employers and nurses or were the costs incurred
unaffordable for some sectors?
Recommendation 10
The strategies are all laudable. Obviously we need to influence student career choices and education at the secondary school level is essential. We wonder though about the impact of targeting material to elementary students when choices come so many several years later?
Also, as noted, important in the public profiling of the profession and in educational/recruitment actions, it is critical that the full scope, breadth and depth of the profession is explored along with the continuing advanced educational opportunities. Too often the public and young people think of nursing as the people giving care in hospital emergency rooms, operating rooms or ICUs. We have to break this narrow view and show that nursing leads to extensive opportunities in many different settings in Canada and around the world. The military has used this approach in its recruitment activities with some success.
OANHSS again congratulates the authors of the Ensuring the Care Will Be There report for its comprehensiveness and practical approaches to addressing the current and emerging nursing retention and recruitment issues. We look forward to working with all players in the health and education sectors to ensure that the strategies contained in the report are acted upon immediately. We cannot afford to delay in addressing the key factors that are affecting the sustainability of a professional nursing workforce in Ontario.
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OANHSS members include not-for-profit providers of long term care, services and
housing for seniors in Ontario.
Members include municipal and charitable long term care homes, non-profit
nursing homes,
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service agencies.
