nursing shortage impacts patient care: how do we solve it?
10 minute read
domino puson decided to become a nurse when, at age 17, he spent time caring for his mom with cancer, inspired by the nurses at her hospital visits.
supplied
stay up to date on this topic
at a time when the population is growing and aging, requiring more complex care, canada’s nursing shortage and high turnover are serious concerns.
the numbers on nursing show there’s work to be done to attract and retain people in a challenging career that many consider the backbone of health care: 40 out of 100 nurses leave the job before age 35, says a study by the montreal economic institute. a 2024 survey conducted by the canadian federation of nurses unions among 5,595 nurses practicing in canada revealed that nine in 10 nurses reported some level of burnout.
statistics canada has reported high levels of stress among health-care workers, with nurses consistently ranking among the most emotionally exhausted professionals.
yes, there’s burnout in every profession and challenges with attracting and retaining talent, but when it’s something like health care that touches almost everyone, you’re going to hear more about the outcomes. there are longer wait times for care, reduced access to services and growing patient dissatisfaction. if you live in a rural area, these issues can be even more difficult. when early intervention for so many conditions is critical, people rely on health-care facilities to deliver the care they need.
a pan-canadian collaboration of nurses contributed to a nursing retention toolkit, supported by the federal government, outlining initiatives that include work-life balance and flexibility, safe practices and nursing leadership. while insights to solving shortages vary, a common theme is supporting and valuing the expertise that nurses bring to the table.
domino puson, a registered nurse in ontario, studied nursing in his home country of the philippines. he was always a champion of education and career development, working as a nurse instructor in a hospital operating room and becoming dean of nursing at a university. he decided to become a nurse when, at age 17, he spent time caring for his mom with cancer, inspired by the nurses at her hospital visits. she died within three months of her diagnosis.
advertisement
“when we were in the hospital, i saw nurses there and they were so kind and very compassionate. and i could see the difference between other health professions. no judgment, but nurses are just exemplary in terms of their explanation [of his mom’s health and treatment]. they made it very simple for me. i was amazed,” he says of the medical knowledge and care.
“because of that experience, i look at every patient and see my mom. it drives me to give them the absolute best care possible, knowing that it would make my mom proud of me.”
he came to canada for a new path in his life and career but wasn’t able to practice because of legislation changes and requirements at the time, he says. a friend, however, who works at trillium health partners hospital network (thp) helped puson apply and find work at thp through the network’s support of newcomers to canada. he pursued schooling that bridged his international education and experience to later transition into nursing at thp in areas like the clinical resource team that ensures quality patient care and manages health-care resources.
mentorship app supports nurses in new roles
when he heard about a new initiative to provide mentoring to nurses from more experienced nurses, he immediately saw the value and applied to become project coordinator. the game-changer initiative is an app called wementor+ that started as a pilot and showed great results, helping the hospital network reduce turnover among nurses by almost half from 2023 to 2024. workforce projections estimate that ontario could face a shortage of more than 33,000 nurses and personal support workers by the end of the decade.
“wementor+ resonates with me, because it was mentorship that diverted me back to my track. without the mentorship of my friend, i could have gone into marketing because i had started my marketing education.”
sponsored by:
alberta primary care clinic owners association
advertisement
when a new nurse joins the team, they go into their work email and the app is already set up for them. they fill in a few answers to questions and the algorithm suggests a mentor or a mentee within thp. the mentorship relationship is guided by goals and meeting prompts in the app, helping to keep the virtual meetings on track. puson, who is now project manager of wementor+, calls it “mentorship on demand” because nurses can also access the app through their work phones when they need support or advice at the patient’s bedside with any team mentor who is available.
the reality of staffing shortages forces remaining nurses to work double shifts, increasing workforce burnout and a heavy emotional burden on the staff, he says.
“without a stable, supportive team, early career nurses frequently experience isolation. they feel isolated in silos. they have self-doubts and they have moral distress, which could potentially drive them to leave the profession.”
the big win is that the app has sparked a culture of mentorship in the organization. originally designed for nurses, the app has since grown to 705 active users and is expanding across all health disciplines at thp. with a new hospital in the plans, thp will increase its workforce by 30 per cent over the next six years, making staff retention a priority, puson adds.
internationally educated nurses a talent pipeline
another focus for meeting nurse shortages across canada is supporting internationally educated nurses (iens). in 2022, they made up 12 per cent of newly licensed nurses, with over 5,000 entering the profession, mostly concentrated in the larger provinces of ontario, followed by british columbia, alberta and quebec. estimates suggest the annual inflow is more than 5,000 and expected to grow along with our domestic staffing needs.
advertisement
as the canadian institute for health information (cihi) reports, credential recognition initiatives and support programs are in place to help with integration into the health-care system. the care centre for internationally educated nurses, for example, has comprehensive services for before and after arrival in canada that are funded by immigration, refugees and citizenship canada.
dr. lyle oberg, a physician and former alberta cabinet minister, is an advisor with speedstaff health-care staffing, a canadian recruiter that has established a unique ien program. he says the nursing shortage reflects an additional retention challenge: iens who find job placements don’t always stay at those jobs. they might decide they want to move from a rural community to a larger city or experience another part of canada.
major urban centres typically attract more nursing graduates and returning professionals, while smaller cities and rural or remote areas struggle with gaps in recruitment and retention. cihi’s broader workforce data shows that supply per population has expanded only modestly for many care roles, which can worsen regional disparities in staff stability and care access.
“sometimes when you see problems, they’re going to occur five or 10 years down the road. but that’s not what this is,” says dr. oberg.
“the problem is today, the problem is tomorrow, next week and next month. so there needs to be some immediate solution. if you increase the number of nurses that are being trained, wonderful, everyone agrees with that. but that’s four years down the road and probably more than that.”
he says bringing in nurses from other countries is the immediate solution, well underway with many nurses coming from the philippines, for instance.
speedstaff has made inroads with another country, vietnam, where dr. oberg says nurses graduate with “superior credentials” from four-year degree programs—and an interest in relocating for career and family opportunities.
advertisement
dr. oberg also highlights the work ethic and commitment of vietnamese people that make them “outstanding members of the community,” he says, adding that vietnam has a population of more than 100 million and graduates 16,000 to 20,000 nurses a year. an average nurse in vietnam gets paid $10,000 to $12,000 a year. “so they want an opportunity to go elsewhere to bring their skills to other countries.”
in the speedstaff program, nurses will be placed as registered practical nurses and licensed practical nurses (the same role, but different terminology depending on the region in canada). after relocating, they can take the regulatory nursing exam to become more advanced registered nurses. these individuals start as temporary foreign workers in a specific place and job, as outlined in their work permits, and can apply to become permanent residents.
as quebec immigration lawyer colin r. singer writes, “temporary foreign workers are playing a critical role in keeping canada’s health-care system running. they are stepping into difficult roles at a time when staffing shortages are at a crisis point. many are staying in canada long-term and continuing to support patients and families in hospitals, care homes and private residences.”
he also notes, “as demand continues to rise, these workers deserve recognition, support and clear pathways to permanent residence. they are not just filling gaps—they are becoming the backbone of canada’s care system.”
dr. oberg adds that iens lead to workforce stability. “and, you know, for rural alberta, for geraldton, ont., you’re going to have people that want to stay there because they’ve been there for the last one or two years. they come with the expectation that they’re bringing their family, and they want to be members of the community. this is a good solution for everyone.”
advertisement
recognizing nurse specialties and expertise
when it comes to workforce staffing and sustainability, there’s also a case to be made for recognizing nurses for their specializations and experience. dr. kimberly leblanc, president of the canadian nurses association, has a doctorate degree in philosophy in nursing and advanced practice credentialing for wound, ostomy and continence nursing. with 29 years of practice, she says she considered leaving the profession in her early career.
“i’m a nurse from the ’90s. and when i started working, there was something called bumping. so they were cutting nursing positions. they’re probably shooting themselves in the foot now because there’s such a shortage of nurses my age because they cut so many positions. nurses were fleeing the profession like crazy, but as well, in a two-year period, i worked in eight different departments. that meant every few months i was being bumped,” she says, explaining she was a young nurse with under two years’ experience.
“every six months, there was a huge learning curve, going from general surgery to medicine, and then to neurology and then to emergency and then to an outpatient clinic. it was exhausting. so, i either went back to school and specialized and figured something out, or i was going to leave the profession.” her daughter has a master’s degree in nursing and works in emergency at montreal general hospital, well-equipped to respond to the complexity of er cases.
there’s still a perception in the health-care system today that nurses are interchangeable, where “a nurse is a nurse is a nurse,” and as such they can be shuffled into any area of need, dr. leblanc says, although that’s not the case.
“you do not want me dealing with patients in an icu or an emergency department. people would die, hands down. so, i think that we need to re-envision nursing and to understand nursing specialty.”
advertisement
practical nurses typically manage stable and predictable patients. registered nurses, registered psychiatric nurses and also nurse practitioners (who have graduate-level education and advanced clinical knowledge and experience) can manage unstable, unpredictable patients, she says of the differentiation.
dr. leblanc is a consultant in long-term care, using it as an example of how teams can be structured effectively. she has seen how patients are discharged much sooner from the hospital with complex needs that have to be addressed in long-term care settings or at home. hospitals need the beds and staff for incoming patients.
“in long-term care, you normally have one to two registered nurses in a building. and then the rest are practical nurses simply because 90 per cent of the patients are stable and predictable. so, everybody has a role to play and we work very closely in collaboration.” in the facilities she works with, she’ll come in when needed to help with complex patients.
if you have a practical nurse who has additional certification in gerontology, they may be better positioned on a care team than a registered nurse who doesn’t have gerontology certification or experience.
find the right staff mix for your team
“so, you have to look at your staff. the nursing world understands this and we work well together [with physicians and other health-care professionals]. unfortunately, in the health-care world, they see it as a practical nurse is cheaper than a registered nurse or a registered psychiatric nurse. so, ‘we’re going to go with the lower paid individual’ rather than looking at ‘let’s get the right staff mix.’”
in some cases, a practical nurse has the knowledge and skill to do the job that you need them to do. in other cases, you need a different blend of professionals. then in some situations, you only want a doctoral prepared nurse or a master’s prepared nurse.
advertisement
as dr. leblance says, “it’s no different than would you want a family physician doing cardiac surgery? a better analogy is probably a family physician who delivers babies. if it’s a stable, non-complex situation, you could have a midwife, you could have a family physician or a nurse practitioner delivering those babies. but when you have a really high-risk complex case, you want an obstetrician.”
solving the nursing shortage has to include strong retention by building effective teams with nurses working at their full scope of practice, she emphasizes.
“if we want to have better access to care and reduce inefficiencies and to really strengthen the sustainability of our system, we have to optimize our workforce. so part of it is looking at we don’t need to just add more bodies. we need to better utilize the bodies we have.”
share story
