The `dark age' of nursing is over
May 10, 2008
Mike Funston
STAFF REPORTER
Emmet O'Reilly's experience as a registered nursing graduate seven years ago provides a dramatic contrast to the severe job shortage nurses faced just a few years earlier.
After graduating from the University of Toronto, O'Reilly had no trouble finding full-time work in the emergency department at St. Michael's Hospital and then at Mount Sinai.
After six years at the hospitals, having gained a wealth of experience, he took on a new challenge, testing a broader range of his knowledge and skills, as a clinical nurse co-ordinator at South Riverdale Community Health Centre, including independent assessment of patients, wellness and disease prevention.
Brimming with confidence and enthusiasm, he's already planning the next phase of his career.
"I'm taking a nurse practitioner program next fall," he says.
Nurse practitioners have the authority to prescribe medications and order blood work, CT scans, colonoscopies and other diagnostic tests. Their role in the health-care system is expected to increase in response to Ontario's doctor shortage.
"I love being a nurse," O'Reilly says. "I don't think there's a more varied profession in the world. I've gone from helping people with heart attacks to patients with runny noses and more complex health issues.
"Tomorrow, I can do something else. It's 1,000 careers in one. If you play your cards right, all of them can be very exciting."
He did concede that the recent news of a plan by Rouge Valley Health System to cut 72 nursing positions over three years sent a shiver through the nursing profession.
But there is no doubt that nurses have more opportunities today than in the 1990s – "the dark age" of nursing, as Doris Grinspun describes it. She is executive director of the Registered Nurses' Association of Ontario (RNAO), the professional body for nurses.
Back in the 1990s, the profession was reeling under the impact of provincial funding cuts that led to layoffs and thousands of nurses being forcedto leave the province or country to find full-time jobs.
By 1998, the number of full-time nurses in the workforce, compared with casual and part-time, had dropped to 50 per cent from 60 per cent in the late 1980s.
Increasing workloads, stress and burnout also took their toll. Rare, back then, would have been the king of optimism and ringing endorsement for the profession as expressed today by O'Reilly.
While a job shortage was the big issue in the '90s, today it's a shortage of nurses and how to develop strategies to attract more young people to the profession, as well as keeping older nurses in it.
"That's something all the stakeholders – government, employers and educational institutions – have to address," says RNAO president Wendy Fucile, acting nursing director at Trent/Fleming nursing school.
"The best recruitment strategy is providing the range of employment models (full-time and part-time) that nurses want."
A looming problem concerns the aging workforce.
Of the 91,000 nurses in Ontario, 22,000 are 55 or older. Efforts are being made to keep them in the workforce longer, with measures such as the 80-20 policy introduced by the provincial government two years ago.
It provides funding for nurses 55 and up to devote one day a week to lighter physical duties, educational functions or mentoring young nurses, primarily in the acute-care sector.
About 2,000 nurses have been involved in the program to date, says Ontario's chief nursing officer Vanessa Burkoski, who advises the government on health and public policy issues from a nursing perspective.
"They have told us that the program has made them feel valued, supported and respected for their knowledge. We are very, very pleased with that," Burkoski says.
"It's an important initiative for our late-career nurses and we're very hopeful that will be part of our strategy for the future. We have every intention of building on that."
However, not every health-care facility can introduce the policy because of nursing shortages and other issues.
Although the shortage is great news for nurses seeing jobs, it's contributing to "crushing workloads," says Vicki McKenna, first vice-president of the Ontario Nurses' Association, the union representing 54,000 front-line nurses and allied health-care workers.
"It also has to do with the overcrowding in hospitals that are running at 100 per cent capacity or more for in-patient beds, leaving some patients in the hallways. That's a terrible way to practise as a nurse, as well as being terrible for the patients," McKenna says.
"And we don't have the additional staff to deal with the overcrowding."
The province has been working diligently to attract and retain more nurses, and has set a goal of getting 70 per cent of Ontario's nurses working full-time, Burkoski says.
That's the magic number the government believes will allow nurses "to deliver comprehensive care to patients, work well with inter-professional teams, get to know their colleagues and produce positive outcomes for patients," she says.
There's no specific target date to achieve this goal.
"It's something we'll chip away at," she says. "We're trying to make Ontario the place to be for the nursing profession. That's our vision."
The province previously announced it will spend $500 million to add 9,000 more nurses to the system by 2011/12.
Another provincial initiative that has enjoyed success is the guarantee of a full-time job for 7- 1/2 months for all new graduates.
So far, 2,600 nurses have taken advantage of the program and, of these, more than 80 per cent have retained full-time jobs, Burkoski says.
According to Grinspun, "new grads aren't workload-ready," and the 7- 1/2 months serves as a critical orientation period.
"The government has just extended this policy for another year. We want it to be a multi-year strategy until the nursing shortage is gone," she says.
Grinspun notes that the 80-20 policy for late-career nurses and the new-grad initiative work well together.
"The influx of new grads can get the (mentoring) support necessary while the mature nurses feel extremely valued."
Mid-career nurses, those with 10-plus years experience, also need to be considered, Grinspun says, by offering them more professional development opportunities.
"We lose important numbers of them. We have to pay more attention to them."
In the '90s, the number of middle nursing managers was cut by 30 per cent, she says.
"Nurse managers used to have one unit. Then it became two, three and even five units. Imagine the frustration of those middle managers not being able to connect with their staff, not being able to supervise them well or inspire and engage them," Grinspun says.
"Their numbers must increase, maybe not to the days of one unit per manager but two would be good.
"This will create opportunities for mid-career nurses to develop administrative skills and knowledge. Otherwise, the vacuum in nursing administration leadership in a decade will probably be insurmountable."
McKenna notes that nurses are among the "sickest and most injured" in the workforce, so health and safety issues, such as security and proper equipment, must be put in place to protect them.
The older nurse and new grad policies are positive steps, McKenna says, but more needs to be done to improve the conditions for nurses in Ontario.
"This is a competitive province as far as wages go in the hospital sector, but we've got a lot of catch-up work to do in the long-term-health and public-health sectors."
Toronto Star