Lorna Rothery spoke to Dr Leigh Chapman, Canada’s Chief Nursing Officer, about the current challenges faced by nurses and how she hopes the implementation of the Nursing Retention Toolkit will help to bring about positive change
Can you tell me a bit about the Nursing Retention Toolkit? Why was it created, and what are its key goals and themes?
When I started as the Chief Nursing Officer of Canada in August 2022, it was evident that a lot of effort was being put into recruiting both domestically trained nursing graduates and internationally educated nurses. Many organizations were struggling with severe health workforce shortages, which were exacerbated by the pandemic and led to service delivery disruptions, such as the closure of emergency departments and increased surgical wait times. In Canada, healthcare is funded federally, while the administration, organization, and delivery of healthcare are the responsibility of the provinces and territories. The development of the Nursing Retention Toolkit was not a solitary endeavour. It was a collaborative effort, with the federal government playing a pivotal role in convening the nursing community to develop a resource that supports nursing retention.
An advisory group was formed in February of last year, and they worked collaboratively on the development of a pan-Canadian forum on nursing retention. Recent research has shown that nurses now have different needs, particularly regarding flexible staffing and scheduling, a finding not previously observed in research on nursing retention. This approach ensured that the toolkit truly addressed the needs and aspirations of the nursing community and new evidence on nursing retention.
Many nurses across the country are feeling burnt out, and while efforts are being made to recruit new nurses, experienced nurses are feeling demoralized and overlooked. This has led to a strong need to focus on nursing retention. We organized a large pan-Canadian nursing retention forum in June with the goal of developing a nursing retention toolkit through a co- development process that involved members of the nursing community. We released the executive summary of the toolkit last fall to seek endorsement from federal, provincial and territorial ministers. The toolkit has been well received since its launch in March 2024, and aligns with the work of the International Council of Nurses (ICN) on the economic power of nurses. This alignment reassures us of the toolkit’s effectiveness and its potential to bring about positive change in the nursing profession. It emphasizes the need for strategic investment in nurses, highlighting their ability to drive societal change. The toolkit addresses current needs, such as the focus on anti-racism, anti-oppression, equity, diversity, and inclusion, which nurses across the country are demanding to see implemented in every organization, making them feel valued and respected. Overall, the toolkit reflects the sentiments that nurses have been expressing.
As a nurse with over 20 years of experience, I believe the Nursing Retention Toolkit is a significant resource. It provides a strategic reset for organizations to reevaluate their health human resource plans and retention strategies by exploring themes such as management competencies, professional development, and mentorship. This endorsement reassures us that the toolkit provides comprehensive and effective initiatives to address the challenge of nursing retention. We need to consider what is not currently on our radar and where we can improve, even in the context of limited resources. It’s clear that not investing in nurses has consequences, and patient outcomes suffer when there’s a lack of quality or continuity of nursing care. This is a critical point in time for a strategic reset, and the real test will be in the implementation. We’re currently tracking progress to see what initiatives are making a difference and if they are truly impactful.
What challenges do nurses face in their work that the public may not be aware of?
I believe the public may not fully understand the inherent hierarchies that exist in healthcare. On the one hand, nurses are hailed as heroes and celebrated during the pandemic, but on the other hand, they often face abuse as they are the closest to patient care. This abuse is not directed at them as professionals but rather at the overall health system in which they work. There is a misconception that nurses are not autonomous and are solely collaborative when, in reality, they can make critical, life-or-death decisions and interventions, especially in rural and remote settings where they are often the sole healthcare provider. The public’s understanding of these hierarchies is crucial as it dispels the misconception that only doctors can make all the decisions. While physicians have a broader scope of practice, it’s the nurses who often implement these decisions and make autonomous choices that directly impact patient outcomes. There is a traditional or paternalistic perception of the nursing role that perpetuates the notion that nurses are just altruistic caregivers rather than educated, competent, skilled, and knowledgeable health professionals in their own right.
Can you provide examples of best practices in terms of support measures that are in place for the welfare of nurses?
I believe that as regulated health professionals, nurses should prioritize their own wellbeing. I don’t usually address burnout directly because it’s largely an individual issue. Instead, I focus on distress and moral injury – when nurses are unable to provide the care they desire, it affects their sense of professionalism. It can have serious consequences for both the patient and the nurse over time. The toolkit focuses on making structural changes at an organizational level rather than an individual level. However, individuals also have a responsibility to show up in a certain way; I believe that every day, we have a choice in how we present ourselves. We can dwell on negative news, or we can focus on the positive impact we have on people’s lives, which is truly significant and can leave a lasting legacy. We often tend to pay attention to negative headlines instead of recognizing the amazing things that occur every day, often due to the skills and contributions of nurses. For example, providing exceptional wound care that prevents the need for IV antibiotics is remarkable. Vaccine campaigns that keep people healthy and out of hospitals, as well as safely assisting in the delivery of a baby, are extraordinary accomplishments. We need to recognize the privilege of working in this field and being part of this profession.
How can future policy measures best support nursing students?
The national nurse residency program is a great example of supporting the transition of nursing students to professional practice. We need to consider recruiting and retaining nursing students nationwide, as well as promoting the role of nurses through a positive communication campaign. The strained healthcare systems affect the learning environment and consequently impact retention and attrition rates among nursing students. We need better support for new graduates transitioning into practice, as they often face challenges in finding adequate mentorship and support. While nursing isn’t the only profession facing retention challenges, it’s crucial to focus on nursing due to the significant impact nurses have on healthcare systems and patient outcomes. Therefore, a concerted effort is needed to address nursing retention, along with broader applicability to other professions in the health and social services sectors.
What are the next steps for the Nursing Retention Toolkit?
We are gathering examples of early successes to share at the upcoming Health Ministers Meeting this fall. Additionally, we are conducting an analysis focusing on the adoption and implementation of the toolkit to determine the impact of our efforts. We are also interested in learning about challenges – for example, if organizations or health authorities haven’t adopted initiatives from the toolkit, we want to understand why. It’s important to recognize different approaches to addressing nursing retention in Canada.
