nurse burnout and shortages: attention turns to mental health and skill development programs
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kulvir moudgil, left, a recipient of two canadian nurse foundation scholarships, came to canada from india in when she was just 18 to become a nurse.
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throughout the pandemic, sherri kensall worked in the hemodialysis unit at vancouver general hospital, helping patients with kidney disease keep to their dialysis schedule – all while being “hypervigilant” about infection protocols.
she’s been in healthcare for over 30 years, first as a sexual assault nurse, then moving to nursing in acute care, and then specializing as a renal care nurse for treating people with kidney failure.
“getting to know patients over years and years, working with them, helping them to be healthy or helping them to be a little better than they were before, that’s really rewarding. the whole process around end-of-life care, too, i personally find very rewarding,” kensall says.
her commitment to the job kept her going through the uncertainties of covid-19 when frontline workers were expected to stay calm and power through.
“during those early days, our staff was really quite worried. people were concerned that they were going to catch covid themselves, or worse, they were going to give it to families. that was a big concern from many perspectives.”
patients on dialysis are immunocompromised, so strict adherence to policies was a priority. family members who would usually accompany patients for treatment three times a week weren’t allowed in.
“we lost that connection to the families that we worked so closely with. that was tough,” kensall admits, adding the pressure to take on more mounted as colleagues became ill.
“if you don’t come into work that has a huge impact on your coworkers and your patients as well. so we were feeling the need to come in, but at the same time knowing very likely you’re going to be short staffed, working longer and really struggling to get your breaks. it feels like you’re going a hundred miles an hour for the entire day, and it’s just exhausting.”
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emergency departments and intensive care were both heavily hit with nurses leaving positions and leaving the profession during the pandemic and its aftermath. icu nurses would light a candle for patients when life support was withdrawn, kensall says.
“i remember they told me, ‘that candle has been going for months and never went off because we lost that many people.’ with the heartbreak of that, we found a lot of our icu nurses just left. they went to other areas of nursing with public health or anywhere where they could get away from that overwhelming sense of loss because it hits you and you feel so futile.”
the result playing out now in facilities across the country is a lack of experienced nurses and a higher proportion of novice nurses who face constant stress.
“the feeling is that no matter what, you have to put up with everything that’s thrown at you. it’s a tough way to approach work,” kensall says of new nurses on the job and veteran nurses who are left scrambling to cope. she’s also seen an influx of care aides and others with little-to-no training to help fill in the gaps for non-nursing duties, which ultimately means nurses are coordinating larger teams.
not only are nurses having challenges with the demands, but patient care itself is undermined, kensall adds, with nurses on patient floors who are not able to bathe patients every day, even though that helps patients feel better, for instance.
“you can’t get to it because you have meds to give, you’ve got dressings to change, all these things that are quite critical. in dialysis, we often have someone who wants to get up to go to the bathroom, but meanwhile you’ve got someone who’s experiencing a low blood pressure and you’re having to deal with that, so they’re having to wait longer than they’re comfortable. i find that really tough.”
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the canadian nurses foundation (cnf) and its funding partners are working to make positive changes to stem the tide of nurses leaving the profession or moving away from critical care roles. the charity, known for its scholarships and bursaries for nursing students, has now made mental health support and skill development programs a priority. its annual fundraiser, the night shift: lighting up the night for nurses, was held on nov. 2 in ottawa in an effort to highlight these initiatives.
in ontario, for example, the majority of nurses say they have experienced a breaking point related to their job this year and 89 per cent reveal their mental health is suffering because of workplace conditions, according to the annual survey by the registered practical nurses association of ontario.
staffing levels in canadian hospitals have been affected with statistics canada reporting that job vacancies in healthcare and social assistance reached an all-time high of 136,800 in the first quarter of 2022, spiking almost 91 per cent compared to the first quarter of 2020. and health economists predict a shortfall of 117,600 nurses in canada by 2030.
“when i speak with nurses, i know it has been difficult. i don’t think there’s a person in canada who would argue the value of nurses and the importance of their leading-edge compassionate care to canadians,” says rob gottschalk, cnf ceo.
he points to the stress on nurses in the crisis of the pandemic as a wake-up call for everyone to recognize the role of nurses as driving patient care. nurses are the interface between patients, their families and healthcare services, dealing with things that may be beyond their control like wait times and access to surgical suites, he explains. they are also leading rehabilitation programs and recruitment for clinical trials. “they’re providing more care and more services than the general public is aware of.”
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cnf has partnered with the mental health commission of canada to fund programs that have been accredited by the canadian nurses association and are targeted to support the well-being of nurses.
adding mental health and career development to the cnf mandate have led to deeper discussions with donors around where people want to impact care. “it’s more than writing a cheque for a scholarship,” says gottschalk. “people care, people want strong nurses. and we want to provide nurses with the support of donor-funded and community-identified programs.”
kensall sees mental health support as a win for nurses, but it will take a shift in thinking. “we’re working with patients who are struggling, whether it’s a clear mental health problem or whether they’re stressed or going through difficult experiences. so we’re used to supporting people through that. we’re not used to looking at ourselves and going, ‘oh, i’m the one who needs support.’ caring for ourselves is a little different.”
like gottschalk, she also stresses that there is a need for wider recognition of the breadth of expertise of nurses. one of the things that drew her to the profession was the opportunity to pursue different specialties throughout her career.
“i think people need to know that many nurses are working in quite specialized areas. it’s important that we acknowledge their expertise and shape our system so that we’re building on that,” she says.
one person out front on the issue is judy duchscher, an associate professor of nursing at thompson rivers university in kamloops, b.c., who started her nursing career over 40 years ago. she is the catalyst behind nursing the future, a mentorship and support program funded by cnf for newly graduated nurses to improve their transition into the workforce and boost retention.
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reports indicate that as many as 57 per cent of new graduate nurses leave the profession in their second year of practice. scientific literature has even called the transition period for new graduate nurses as “traumatic,” according to the canadian journal of nursing research.
duchscher’s term for it, rooted in her research theory, is “transition shock.”
“what happens is when new graduates get out there, if they don’t have the support of other senior nurses then they are essentially thrown into a very chaotic, highly unpredictable, tumultuous environment. they’re expected to keep their head above water. and a lot of them are drowning,” she says.
“you have to give them an opportunity to understand what is normal and how to deal with general situations before they’re dealing with crisis after crisis after crisis [in acute care]. so they really are at a significant disadvantage. and emotionally they are not confident. they see themselves as the reason why the situation is going south, like blood pressure falling.”
duchscher is advocating for graduates to practice alongside a more senior nurse to help them understand why something is happening, what steps to try, and to experience a satisfying patient outcome. if they don’t have those positive outcomes initially, then they draw a direct relationship between practice and failure, “and that is emotionally and morally damaging,” she says.
what often follows is burnout. they blame themselves because they can’t cope and leave the profession.
“the mental health of nurses in general is rapidly deteriorating. we’ve had struggles in practice for so long, but i think we’re seeing a real exit of nurses because of it. and the pressure on the newly graduated nurse becomes ever apparent,” duchscher notes.
the intent of nursing the future is providing new graduates who have been in practice for one year with training in crisis management and chaos intervention so they can support and work in a peer relationship with the new graduates just coming out who may be struggling. the initiative will develop the leadership of new nurses and build capacity into the system.
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“new nurses are out there on their own, essentially because a lot of the senior nurses have left as a result of workplace issues and shortages and whatnot. it’s one of those vicious cycles where we have lost our seasoned intellectual and practice elders.”
australia has been using duchscher’s research and theory to frame its own graduate transition program where senior nurses who have left are returning to the workplace – not to take a patient load, but to mentor novice nurses.
now health canada is funding research that duchscher is leading to launch a national nurse residency program in canada, administered in partnership with the canadian association of schools of nursing. senior nurses will be working with new graduates in a shared workload, addressing the challenges that new nurses face to help them better transition into practice.
“if we can chip away at some of the issues that new nurses are struggling with, where people don’t understand what they’re going through and aren’t supporting them during the initial four months of practice, if we could change that, i think we could make a real impact,” she says.
so, what does it take to succeed in nursing for those graduating in 2024?
kulvir moudgil, a recipient of two cnf scholarships, came to canada from india in 2014 when she was just 18, leaving her culture, her family and friends, to become a nurse in a country where she saw more opportunity and independence for women. as a child, she and her siblings experienced the trauma of their mom becoming bedridden after having her uterus removed and suffering complications.
moudgil took over household duties while her dad worked, and this ultimately inspired her to go into nursing. “i want to be the person who can be there for someone when they need it. that was it, i thought ‘i’m going to study biology, i’m going to go for it. i’m going to be there for people who need me.’”
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she’s in her final year of nursing at thompson rivers university while raising her baby boy ayan and enjoying life in kamloops with her husband. she doesn’t have any reservations about her chosen path or what comes next.
for kensall, looking back at her career and the challenges ahead, she says that nursing has brought her personal and professional growth and fulfillment: “being able to influence care is so important. you can be doing projects like i do where i’m training teams to talk to patients about dialysis at home as an alternative, or it can be those individual interactions. i’ve had some amazing conversations with patients. being able to work with patients who are going through a difficult time so that they can maintain their dignity and feel cared for is such an amazing feeling.”
karen hawthorne is a toronto-based writer.
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