Introduction: Nursing retention toolkit

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• Message from the Chief Nursing Officer (CNO) of Canada
• A message from the advisory committee
• Patient testimony
• Message from Indigenous Elder
• Purpose
• Guiding principles

Message from the Chief Nursing Officer (CNO) of Canada

I am pleased to introduce the nursing retention toolkit: Improving the working lives of nurses in Canada.

Since I was appointed to the CNO role, I have prioritized engagement with the nursing community from coast to coast to coast. During these visits with nurses, students, faculty and administrative leaders, it has been clear to me that the retention of nurses is a significant challenge. We must focus on solutions in order to improve nurses, work environment. I am inspired by the vitality of nurses across Canada, and I know that when we work together, we can create solutions that will drive meaningful change in the health care system.

The toolkit was developed to support nursing retention. It is the result of a pan-Canadian collaborative effort in partnership with the Canadian nursing community and with nurses who are committed to improving the working lives of nurses in Canada, now and in the future. As a resource created by nurses, for nurses, it draws on evidence-based practice, lived and living experiences of point-of-care nurses, and insights from nursing professionals at all career stages, including nursing students.

It is my hope that the toolkit will spark change in how we think about and value the nursing profession and build on the work others have done to improve nurses' working conditions in Canada. The toolkit provides an opportunity for employers and health authorities to work together to develop standardized programs across health care organizations and systems in Canada. It also provides an opportunity to focus on collaboration, working together to find economies of scale by identifying initiatives that can be scaled up and spread to different organizations and jurisdictions. Recognizing that nurses work in varied settings, the toolkit was not designed to be applicable to a specific workplace. Nursing workplaces have different realities and factors that influence how the initiatives in the toolkit can be implemented. As such, the initiatives provide a range of approaches for nurses and employers to work together to implement strategies that best suit the circumstances of their nursing workplace.

I want to personally thank all the nurses from various sectors of the health care system from across Canada who contributed to the development of the toolkit. It was developed in collaboration with an expert advisory committee comprised of esteemed members of the nursing community and validated through many sessions with the broader nursing community from every province and territory in Canada. I am so proud of nurses in Canada and am committed to working with all nurses to make nursing a profession of choice in Canada. I commend all nurses for the dedication you have shown and continue to show towards the nursing profession. Canada is fortunate to have individuals with such great knowledge, expertise and professionalism in the health system.

Canada's nurses are an integral part of our health system; even with the complex and ever-changing environment we work in, nurses respond with humanity, composure, expertise, competence, and professionalism. Ensuring a robust and sustainable workforce is foundational to increasing wellness in the profession and respect for the work that nurses do every day. More must be done to improve the working lives of nurses in Canada, and the Nursing Retention Toolkit is a great starting point to initiate lasting positive change.

Leigh Chapman, RN, PhD
Chief Nursing Officer
Health Canada

A message from the advisory committee

Every minute, day or night, in every corner of the country, nurses work to ensure the health of patients^{Footnote 1}, families, and communities. The work of nurses forms the base of health care, and the working conditions of our workforce are of vital importance to sustaining our publicly funded system in Canada. However, over the last several decades, the working lives and conditions of nurses have declined, leading to the national nursing retention crisis we are witnessing today. As a country and a society, it is past time to address the root causes of the nursing shortage with a commitment to nursing retention.

The nursing retention toolkit is designed to support our commitment towards improving the retention of nursing staff. The first of its kind, it is built on the knowledge and experiences of nurses from every province and territory, united in articulating what we need to do to support nurses in their ongoing work. What we offer you are feasible retention initiatives that can be implemented immediately. Each initiative has been carefully validated with nurses in a wide range of roles and in diverse care settings, constituting a compendium of bold and innovative solutions for nurses, by nurses.

There is flexibility in the implementation of the initiatives in this toolkit. Each initiative can stand alone, and each grow stronger when taken up together. While directed towards retaining nurses caring for patients directly, each initiative can also be considered in other domains of nursing work, such as leadership, policy, research, and education. Every initiative can and should be explored, regardless of the shortage of nurses in any given practice setting. All require political will and a genuine commitment to involve nurses in change.

The toolkit offers a reminder that nurses are human beings, requiring what any other human needs: rest, nourishment, work-life balance, and fulfilment at work. It is also a reminder that nurses are not heroes who selflessly care despite the context. Nurses are professionals with knowledge, skills, and expertise that make a difference for people in Canada. Nurses know how important their work is to the health of all people. Nurses also know what we need to continue the critical work of sustaining health care for all. We ask that you use this toolkit to aid nurses in helping you protect the health care system in this country. We cannot act alone; we need all levels of health care governance to join us in this effort. This toolkit is an action plan, and we ask that you take action with us today.

Cynthia Baker, RN, PhD
Canadian Association of Schools of Nursing

Liliana Canadic, RN, BScN
Ministry of Health, Government of Saskatchewan

Tim Guest, RN, BScN, MBA
Canadian Nurses Association

Cynthia Johansen, MSc, MAL
BC College of Nurses & Midwives

Toni Leamon, BA, BScN, RN
Patient Advocate

Linda McGillis Hall, RN, PhD
University of Toronto

Ovie Onagbeboma, RN
Canadian Black Nurses Alliance

Linda Silas, RN, BscN
Canadian Federation of Nurses Unions

Natalie Stake-Doucet, RN, PhD
Université de Montréal/Quebec Nurses Association

Angela Wignall, RN, BSN, BA, MA
Nurses and Nurse Practitioners of British Columbia

Eyasu Yakob, Nursing Student
Canadian Nursing Students' Association

Patient testimony

This toolkit needs to do exactly what the title says – improve the working lives of nurses in Canada. As patients, we have watched nurses care for us on our worst days, support us through the worst outcomes, and help us feel our very best under the worst of circumstances. But right now, nurses are having their worst days every day they go to work. They are experiencing the worst outcomes and circumstances, where they have so much care and support to give, but never enough time or resources to do it. Patients see you and support you. Nurses are the backbone of the health care system and without their passion, health care would be a scary place. I hope that, with the support of the initiatives in this toolkit, we can begin to show nurses the kindness, attention, and priority that nurses have always shown to us.

Toni Leamon, BA, BScN, RN
Past Patient Voice Chair (2020-2023), Canadian Medical Association

Message from Indigenous Elder

Nurses are the ones who are always there for us, looking after us when we need it most. We must recognize that nurses deserve to be thanked, appreciated and that their wellbeing is critical. We must ensure that all nurses are taken care of as well. In a sense, they are mentors of care and wellbeing. We must ensure that there is place, space and time for them to be balanced in mind, body and spirit. These three pillars of life are essential for all and 'we' should ensure and provide support for nurses in whatever capacity we can in pursuing this life balance.

Elder Cat (Mark) Criger, Cayugan
Traditional Indigenous Philosopher

Purpose

The nursing retention toolkit: Improving the working lives of nurses in Canada ("the toolkit") was co-created by a uniprofessional group of Canadian nursing community members brought together in 2023 in a Nursing Retention Forum by Canada's Chief Nursing Officer. The group is comprised of nursing experts, point-of-care nurses, nurse-employers, decision-makers, nursing regulators, union representatives and others who advise and support pan-Canadian efforts to address Canadian nursing retention.

The aim of the toolkit is to provide Canadian nurse-employers and health care organizations with practical strategies and tools to improve the retention of nurses. As a resource created by nurses, for nurses, it will draw on evidence-based practice, lived and living experiences of point-of-care nurses, and insights from nursing professionals at all career stages. The intended audience of the toolkit includes employers, organizations, health systems, as well as health systems administrators (e.g., Human Resource professionals).

The toolkit focuses on eight core themes (listed below) that impact nurses'^{Footnote 2} day-to-day working life in the domain of clinical care and provides corresponding tools that Canadian employers can implement to support nursing retention. It was created in the context of interdisciplinary team-based care environments. The order in which the eight themes appear do not indicate priority or sequence. As each theme may have greater or lesser relevance depending on the local context of the specific employers, organizations, or health systems, it is anticipated that not all themes will be pursued by all audiences. Each of the core themes are underpinned by the values of respect, anti-racism and anti-oppression, transparency and accountability.

Text description

Themes include:

1. Inspired leadership
2. Flexible and balanced ways of working
3. Organizational mental health and wellness supports
4. Professional development and mentorship
5. Reduced administrative burden
6. Strong management and communication
7. Clinical governance and infrastructure
8. Safe staffing practices

The target nursing population for the toolkit spans the various phases and stages of a nurse's career lifecycle, such as: student, new grad, mid-career, late-career, managers, nursing leader or executive, and nursing educational faculty. Initiatives outlined may impact only one or all of these phases and positions.

Guiding principles

The toolkit is comprised of tangible initiatives and actions that can be implemented by Canadian nursing employers and organizations to improve the working lives of nurses. Several guiding principles were utilized when selecting the tools, including the following:

• Actionable: Tools must be within the scope of nurse-employers, implementable in the short term and yield benefits immediately or in the near term.
• Values-based: Tools are underpinned by the values of respect, anti-racism and anti-oppression, transparency and accountability.
• High-impact: Tools address systemic challenges at the organizational level faced by nurses in their career phases and positions
• Organization-focused: Tools should be developed at the organization and health-system level for implementation rather than for the individual nurse to adopt.
• Future-focused: Where appropriate, tools should leverage and advance the use of technology to improve nurses' experience

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