Flexible and balanced ways of working: Nursing retention toolkit
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- Goal statement
- Initiative – Flexible work design: Explore and enable flexible work opportunities that account for work preferences
- Initiative – Scheduling systems: Modernize scheduling systems to improve staff's ability to modify their schedules, provide transparency, and timely responses to meet staffing needs
- Initiative – Workplace resources and amenities: Establish and promote workplace resources and amenities that can support nurses while working on-site
Goal statement
Promote nurse autonomy and flexibility in scheduling and career progression.
Initiative – Flexible work design: Explore and enable flexible work opportunities that account for work preferences.
Intended outcome
- Increased nurse satisfaction, which may include improved work-life balance and increased autonomy.
- Decreased sick time, increased fill rates, improved patient outcomes, and net positive cost benefit for employers.
- Flexibility for nurses to contribute to unit-based quality improvement (QI) initiatives.
- Nurses are supported in career progression and education by being able to "earn to learn."
- Seasoned nurses can maintain a role in the community (e.g., mentorship-focused roles).
Description
This initiative involves exploring, identifying, and implementing an alternate, flexible work design – beyond traditional full-time shifts –to support nurses' needs and their continued career progression. Addressing the rigidity and constraints of full-time roles is anticipated to help align nursing opportunities to work preferences, including younger nurses' desire for greater work-life balance, mid-career nurses' desire for continued learning and career progression into leadership roles, and late career nurses' preference for less strenuous and more mentorship-focused roles.
Types of flexible work design may include:
- Part-time roles: Part-time work arrangements that are stable (e.g., 0.7 and always on the same unit) can provide team stability, a stable schedule for nurses, while still offering work-life flexibility.
- Job sharing: Work arrangements where two (or more) individuals share the responsibilities, hours, duties of a single full-time position, similar to the flexibility offered through line sharing. Each nurse typically works part-time.
- Provincial float pool: Work arrangements where nurses are hired on a temporary basis to work at various health care facilities particularly in rural and remote areas, and the labour union acts as the intermediary between float nurses and their employers.
- Dual roles: Nurses who express interest in dual roles are cross-trained to work in multiple units and nursing teams within or across nursing organizations to help balance workload and diversify day-to-day experience.
- Weekend workers: Work arrangements where individuals can work exclusively or primarily on weekends.
- Casual positions: Work arrangements where nurses work on an as-needed basis, providing flexible staffing support to cover shifts when regular staff members are unavailable.
Planning considerations:
- Incentives: Benefits packages for part-time positions and premiums for less attractive shifts (e.g., night shifts, weekends) may be considered. In union environments, contract negotiations with unions would be required.
- Maintaining stability: A balance between flexibility and stability of the team environment. The right ratio between casual positions and permanent positions within teams will vary by unit and nursing workplaces but should be carefully considered. Trust between team members can be compromised when there is lack of consistency and stability in staffing, and new or unfamiliar environments can be taxing to work in. Additionally, regular assessment of patient acuity and nurse-patient ratios should be conducted.
- Float team: Float teams, involving nurses who are not assigned to a particular team, unit or setting and who are assigned to work where there is a need due to volume, acuity or vacancies, may be more suitable for nurses with more seniority or who are in progressive retirement. Explore ways to encourage nurses to stay in the public health system by improving retention. For example, facilitating the process of transitioning between facilities, and in turn, reducing administrative burden, could be a benefit over working with a private agency.
- Supporting leaders: Consider how flexible work design can support nursing leaders to be present in clinical areas where care delivery occurs, which can enhance their credibility with point-of-care nurses they support.
- Mitigating conflicts: Conflict mitigation strategies should be developed to address potential conflicts among point-of-care nurses or between point-of-care nurses and individuals responsible for shift scheduling.
- Voluntary redeployment: The regularization of cross-training across teams and units may bring positive outcomes.
Note: forced redeployment should be avoided at all times as it does not promote nursing retention.
Target nursing population
All (Student, New Grad, Mid-Career, Late-Career, Managers and Faculty, etc.)
Stakeholder involvement and role of nurses
- Responsible: Clinical managers.
- Accountable: Employer leadership team.
- Consulted: Point-of-care nurses to provide perspective and insights on flexible work design options, co-design shift options, and contribute to the selection of shift options, and support ongoing implementation of new flexible work design, Clinical Managers, Union Representatives to ensure scheduling complies with collective agreements and labour regulations, and reflect negotiated terms such as shift length, breaks, and overtime rules, while also accommodating individual nurse preferences within those parameters.
- Informed: All levels of nursing staff.
Reference resources and examples (See appendix for links)
- Manitoba Weekend Premium and Full-Time Incentive for Nurses (through Shared Health Manitoba): Through the Health Human Resource Action Plan, the Manitoba Government introduced a weekend premium where employees receive an $8 premium for each eligible hour worked, a full-time incentive of $10,000 per year for nurses who work in qualifying full-time equivalent positions with a rotation pattern, of either days/evenings or days/nights or straight evening or nights.
- Manitoba Provincial Nursing Float Pool (through Shared Health Manitoba): A provincial nursing float pool was negotiated between Shared Health and the Manitoba Nurses Union; the collective agreement provides nurses a premium wherein they agree to an assignment away from their home site to support staffing needs across Manitoba.
- British Columbia Nurses Union (BCNU) Job Sharing and Full-Time Incentive: In BCNU's collective agreement language related to job sharing, procedures for requesting and approving job sharing agreements are outlined. BCNU also has a full-time incentive where nurses receive a premium of up to an additional $2 per hour.
- Saskatchewan Union of Nurses (SUN) Job Sharing and Weekend Worker: The SUN collective agreement includes job sharing arrangements and weekend worker positions.
Initiative – Scheduling systems: Modernize scheduling systems to improve staff's ability to modify their schedules, provide transparency, and timely responses to meet staffing needs.
Intended outcome
- Nurses have greater control over their schedules and flexibility that addresses their individual needs and preferences.
- Increased nurse satisfaction, improved work-life balance, and increased autonomy.
- Employers may see decreased sick time, improved patient outcomes, and net positive cost benefit.
- Improved decision-making and transparent, equitable shift distribution with real-time access to information on available shifts and staffing needs.
Description
This initiative addresses modernized scheduling systems, including evaluating, selecting, and implementing a digital, user-friendly scheduling system. Modernizing scheduling systems may help to increase nurses' autonomy and flexibility, enabling nurses to conveniently select and change shifts based on their availability, preferences, and skills, ultimately promoting a better work-life balance.
Planning considerations include:
- Use and optimize existing scheduling tools: Organizations are encouraged to conduct a needs assessment to understand nurses' scheduling concerns and existing tools used to support scheduling (e.g., private Facebook groups for shift swaps). Where possible, new scheduling systems should reflect existing, proven processes, and strive to make scheduling easier for nurses, not more complicated.
- Effective skill mix: Identifying effective skill mix should remain top of mind throughout any scheduling modernization processes and supports for nursing leaders to do so effectively should be provided. See "Safe Staffing Framework and Tools" for more.
- Create organization-specific self-scheduling guidelines: Develop guidelines to support a standard approach to implementing the scheduling system. Individual units and other nursing workplaces can tailor guidelines to their needs, based on the patient care demands. Include mandatory requirements for compliance with labour laws and union agreements in self-scheduling guidelines.
- Engage unions as partners: Actively partner with local nursing unions to develop scheduling systems and associated guidelines. Consider implementing a pilot as a proof-of-concept for subsequent contract renegotiation.
- Develop scheduling principles that support team-based models and continuity of care: Shift swaps should be made in accordance with local policies. For example, restricting shift swaps to be within units or nursing teams where a nurse has been trained can maintain a connection between team members. Fairness, flexibility, and patient care priorities are additional principles to consider.
- Communication about balancing individual versus team needs: Success of self-scheduling approaches requires participating nurses to be sensitive to the balance of individual versus team needs. While self-scheduling introduces greater flexibility for individuals, the needs of the team should not be compromised. Aims of self-scheduling should be clearly communicated and upheld by leadership.
- Clarify roles and responsibilities for scheduling: Where possible, dedicated scheduling staff should be trained to use the software and be available to support scheduling. Clarifying roles and responsibilities can help prevent scheduling from falling onto nursing managers. Conflict resolution approaches, including escalation paths, should also be developed.
- Define baseline criteria: Organizations should set baseline criteria for their scheduling needs. These may include a user-friendly interface, customization to support a variety of shift types and rotation patterns, mobile accessibility to allow staff to manage their schedules on-the-go. Additional features that may support nursing leaders include reporting and analytics capabilities to support decision-making about staffing levels, and accurate forecasting of staffing needs.
- Leadership support and responsibilities: Leadership support to test the system and processes can be critical to developing impactful solutions. Leadership has responsibility to manage scheduling conflicts with effective conflict mitigation strategies.
Target nursing population
All (Student, New Grad, Mid-Career, Late-Career, Managers and Faculty, etc.)
Stakeholder involvement and role of nurses
- Responsible: Project Manager, IT team, point-of-care nurses to understand self-scheduling requirements for supporting needs of the nursing workplace.
- Accountable: Employer leadership team.
- Consulted: Point-of-care nurses to voice concerns, co-design scheduling system, and implementation of the schedule system; Clinical Managers; Union Representatives to ensure scheduling complies with collective agreements.
- Informed: All levels of nursing staff.
Reference resources and examples (See appendix for links)
- Newfoundland and Labrador Provincial Self-Scheduling Guidelines: Guidelines support employers and point-of-care nurses when organizations deploy self-scheduling services.
- Vancouver Coastal Health's My Schedule program: This program includes scheduling functionality and shift swapping.
- Living Lab Charlevoix: Self-Scheduling Solution by the "Living Lab" in Quebec.
- Horizon Health Flexible Scheduling Project: A toolkit has been created for nursing units interested in developing a self-scheduling option. Lessons learned include the importance of having in-house self-scheduling expertise and engagement with collective bargaining representatives.
- Manitoba Nursing Union (MNU) collective agreements: The MNU collective agreements include specific language about self-scheduling for organizations to reference.
Initiative – Workplace resources and amenities: Establish and promote workplace resources and amenities that can support nurses while working on-site.
Intended outcome
- Increased nurse satisfaction, which may include improved work-life balance, increased autonomy, increased perceived respect and value of nurses from the community.
- Decreased sick time, increased fill rates, improved patient outcomes, and net positive cost-benefit for employers.
- Nurses may have increased capacity to contribute to unit-based and workplace QI initiatives and engage in personal or professional development.
Description
This initiative aims to establish and promote a range of essential resources and amenities to support nurses while working on-site. These offerings are aimed at enhancing employee well-being, promoting work-life balance, creating a supportive work environment, and fostering a culture of continuous growth and development.
These resources and amenities may include:
- Childcare: Developing childcare supports to meet the needs of the nursing population, especially those who work 12 hour shifts or irregular hours outside the usual Monday to Friday from 9 to 5.
- Making getting to work easier: Supporting conveniently accessible transit options, including options that promote environmentally-friendly transit decisions.
- Supports for nutrition and rest: Providing organizational supports to meet nurses' foundational needs, including getting the nutrition and rest they need to stay healthy.
- Housing: While housing affordability is much broader than health systems, organizations could consider advocating for housing assistance specifically for nurses. Organizations may provide temporary, subsidized or pro-rated housing, particularly in rural and remote areas where it is difficult to recruit and retain nurses.
Planning considerations include:
- Childcare accessibility: Ideally, on-site childcare is offered at a reasonable cost, and nurses who work shifts and need childcare services outside of "regular" work hours are not charged a premium. Also, consider childcare supports for unplanned childcare needs. Some organizations have adjusted shift change times to align with childcare hours (e.g., shift change time modified to 8 a.m. to accommodate childcare drop offs).
- Leveraging programs: Seek information on provincial programs, local programs, and availability of childcare subsidies to support nurses.
- Transportation: Consider how to support multiple modes of transportation (i.e., subsidized parking spaces and public transit, carpooling services, shuttles from key parking lots in the area). Additional considerations for rural areas include kilometer reimbursements and gas allowance. For all modes of transport, consider accessibility throughout the day and night, and transit safety.
- Rest spaces: On-site rest spaces for nurses should be both private and secure.
- Nutrition: Expand times when nutritious meals are available on-site, ensure water is easily accessible as well as access to coffee and snacks, and support access to fitness facilities (e.g., gym facility or membership, explore discounts available from professional organizations and unions).
- Nursing students: Where possible, extend workplace resources and amenities to nursing students.
- Union collaboration: Work collaboratively with unions while respecting collective agreements in the development of new workplace resources.
- Housing support: Organizations may provide temporary, subsidized or pro-rated housing.
Target nursing population
All (Student, New Grad, Mid-Career, Late-Career, Managers and Faculty, etc.)
Stakeholder involvement and role of nurses
- Responsible: Employer-supported project teams and nurses to support ongoing implementation.
- Accountable: Employers and nurses.
- Consulted: Point-of-care nurses to provide insight on, prioritize and co-design high priority resources and amenities; Clinical Managers; Ministry; Industry partners.
- Informed: All levels of nursing staff.
Reference resources and examples (See appendix for links)
- Churchill Health Centre Amenities: Churchill Health Centre in Manitoba provides a variety of amenities to support the retention of health care staff in northern, rural, and remote communities.
- Jewish General Hospital and McGill University Health Centre Relaxation Booths: Relaxation booths have been introduced for staff to rest and recharge. Sessions are booked through an app.
- Jewish General Hospital Subsidized Daycare: This daycare centre offers 80 spaces and gives priority to CIUSSS employees.
- Sunnybrook Daycare: This workplace daycare offers 71 spaces for children and has subsidized options for families.
- Salt Spring Community Housing for Nurses: Hospital foundation and community on Salt Spring Island have come together to build apartment units to house their nurses.
- SickKids Housing for Staff: SickKids in Ontario offers rental housing accommodations for nurses and other types of employees coming from across Canada and abroad.
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