Poor work conditions worsen nurse shortage
Canadian report offers 49 recommendations
High stress, low morale, and heavy workloads are leading to increased absenteeism and injury among nurses, according to a report by a Canadian research institute.
A poor work environment is contributing to the nursing shortage as older nurses leave the profession and younger workers shun it, according to the study, which was commissioned by the Canadian Health Services Research Foundation in Ottawa, Ontario.
"In studies we’ve done, work intensity has increased," says Andrea Baumann, RN, PhD, associate dean of the faculty of health science at McMaster University in Hamilton, Ontario. "The patients are sicker . . . and there’s fewer registered personnel. Therefore, you get higher rates of stress-related illnesses."
A multidisciplinary team, including specialists in anthropology, sociology, and business, reviewed existing literature, including unpublished reports and manuscripts, and conducted focus groups and telephone interviews. They found, for example, that absenteeism among nurses rose steadily from 1986 to 1999, to a rate of 8.5%.1
Although Canada typically has had better nurse-patient ratios than in the United States, the gap has narrowed due to cost cutting, Baumann says.
In fact, other countries, such as Great Britain, are experiencing shortages, a circumstance that forces hospitals to compete for labor on a global basis, she explains. "Now it’s a worldwide shortage in the industrialized world."
The shortage is forcing a paradigm shift in the way employers view their work force, Baumann says. "There is a lot of new literature coming out talking about human capital. We hypothesize that if you approach it in that way, trying to make your work force as healthy as you can, you will have higher rates of productivity.
"If I [were] an individual employer, I’d be very focused on my workplace and I’d be looking at my employees as my most important asset," she says.
Add staff instead of overtime
The report, Commitment and Care: The Benefits of a Healthy Workplace for Nurses, Their Patients, and the System, offers 49 recommendations for improvements. It urges employers to reassess their staffing, hiring sufficient nurses and adding permanent full-time or part-time positions to reduce the use of agency personnel and overtime.
At Hamilton Health Sciences, a four-hospital system affiliated with McMasters University, administrators are considering creating a permanent float team. The nurses would be oriented to work on several units and would be available to move according to the patient care needs.
"We’re looking at some kind of coordinated approach, a resource center that would facilitate deploying staff to different areas when they’re needed," explains Margaret Keatings, RN, MHSC, vice president of professional affairs and chief nursing officer.
Keatings says she is well aware of the effects of overwork on an aging work force. In her previous job, she was chief nursing officer of the Workplace Safety and Insurance Board, a workers’ compensation insurer in Ontario.
Long shifts, high patient acuity, and understaffing lead to physical strain, she says. "What we’re starting to recognize are the effects of chronic back strain," she says. "That becomes more of an issue with an aging work force."
Job restructuring is one way to ensure that nurses have the support they need, Keatings says. She is developing a yearlong mentoring program for new graduates, which will give older nurses a new role while ensuring new nurses have the leadership and role models they need.
"If you role model the right behavior from the beginning, there’s going to be more teamwork and camaraderie," Keatings says.
In fact, while some of the recommendations of the Canadian report would clearly increase costs, others, such as allowing more latitude in decision making and creative design of jobs, would not, Baumann says.
"It’s not all about paying people more money," she says. "I think there’s an assumption that you just need to have more money. The studies show it’s not about money; it’s [working] conditions."
Flexible policies will become ever more important as the nursing population continues to age, she notes.
"Some of the older workers want redesigned work assignments to allow them to practice in a more effective way," she says.
Reference
1. Baumann A, O’Brien-Pallas L, Armstrong-Stassen M, et al. Commitment and Care: The Benefits of a Healthy Workplace for Nurses, Their Patients, and the System. Ottawa, Ontario: Canadian Health Sciences Research Foundation and The Change Foundation; 2001. Web site: www.chsrf.ca.
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