Solutions to Alberta's nurse staffing crisis

As the prime minister and premiers continue negotiations for new health care funding agreements, United Nurses of Alberta is focused on making sure the priorities of front-line nurses are part of the solution to the current nurse staffing crisis.

UNA has proposed a list of solutions and has shared them in a letter to Health Minister Jason Copping. Copping responded to UNA in a letter acknowledging he received the proposed solutions but he has not yet taken up our offer to engage with him on implementing these solutions.

The measures outlined in the letter are focused on the first two Rs of the 3Rs of fixing health care: retention and recruitment.

These solutions are based on the practical experience of front-line nurses and they can be implemented immediately to improve the retention and recruitment of nurses currently working in Alberta’s public health care system.

Retain nurses

• Eliminate vacancy management. Under AHS’ current vacancy management program, each vacancy is reviewed by several levels of senior leadership prior to posting to a job listing. This prevents local management from hiring new staff in a timely manner and centralizes all decision making. This simple change would give front line staff at worksites more stability to fill shifts and decrease the number of temporary postings in order to attract more nurses, especially to worksites in rural Alberta. An increase in regular scheduled staff would allow a decrease in the current level of overtime hours.

• Take immediate action to begin dismantling Operational Best Practices (OBP). The AHS Performance Review prepared by EY in December 2019 determined that “[c]linical staffing decisions are typically based on historical staffing levels and OBP worked hours targets, rather than evidence-based assessments of patient acuity.” While OBP can have a positive impact in some stable health care settings, it has caused trouble for nurses and health care staff working in emergency and intensive care units, where patient care needs can change multiple times each shift. Instead of focusing on operational financial best practices, the priority should be on patient care best practices.

• Creating more publicly-delivered Long Term Care (LTC) beds and hiring the nursing staff to deliver care to the patients in those beds. Successive governments have made the decision to not create more Long Term Care beds, leaving Alberta in a situation where 30 per cent of patients in acute care beds are waiting to go to LTC. These beds need to be matched to patient needs. It is an opportunity to fix what previous governments did wrong by failing to increase the number of LTC beds.

• Offer financial incentives to nurses at rural and remote worksites. Providing additional financial incentives will help retain nurses already working in rural and remote communities. Additional financial incentives should be provided to nurses who have already chosen to work in remote communities in the province, which have traditionally been some of the most challenging to staff.

• Ensure appropriate staffing so nurses are not doing non-nursing work. Many nurses are being asked to carry out non-nursing activities such as housekeeping and unit clerk duties. Appropriate staffing is needed for every level of health care, especially so nurses can focus on direct patient care. This means having an appropriate number of housekeeping and unit clerk staff.

• Begin collecting and sharing workforce data. Data collection and sharing will help identify where and how workforce challenges and staff deficits are impacting different worksites across the province. In order to retain nurses we need to understand why many of them are choosing new careers outside nursing or taking early retirement. AHS and other employers should be required to provide monthly reports to Alberta Health and concerned stakeholder groups detailing worked, paid and overtime hours for each category of nursing by shift and day of the week for each program or unit. This information is readily available in employers' payroll systems and would provide insights about which sites are successful in retaining nurses and where overtime data identifies the need for more regular full-time and part-time positions. Collecting and transparently sharing this data would provide a basis for consensus-based staffing allocation decisions based on Alberta patient and population needs.

• Improve access to ambulatory and urgent care. This will relieve the pressure and overcrowding in emergency departments.

• Improve home care and access to mental health services as soon as possible.

Recruit nurses

• Increased supports for new nurses. Transitional graduate initiatives and mentorship programs will help support recently graduated nurses as they enter the workforce. Letter of Understanding #7 in the UNA Provincial Collective Agreement allows for senior nurses to split their full-time equivalent hours for the purpose of mentoring. This will require financial support from the employer to become a reality.

• Facilitate transition into the workplace for Internationally Educated Nurses (IEN). Nurses recruited from other countries to work in Alberta as Registered Nurses and Registered Psychiatric Nurses need transition support into their new workplaces and the support to meet any additional credential requirements put upon them by their employer or professional college.

• Increase the number of students in nursing schools. Increasing the number of seats in nursing schools and funding for these programs at colleges and universities will educate the next generation of nurses in Alberta. There should also be improved access to bridging programs for Licensed Practical Nurses who want to become Registered Nurses.

• Provide scholarships and financial supports for nursing students to encourage them to work in rural communities. The government can create new scholarships and bursaries or match already existing incentives in rural Alberta aimed at nursing students.

• Expand the Locum initiative across the province. This initiative is currently only available to nurses working the AHS North Zone. A Locum for worksites in the Central and South Zone would provide financial incentive for nurses to work in these communities.

UNA understands there are already efforts to improve the transition of internationally recruited nurses into the system and increase the number of nursing seats in Alberta. We support these efforts and look forward to working closely with the government and our coworkers from other health care unions on these issues.

UNA also looks forward to feedback from its members and additional ideas about how to address retention and recruitment of nurses.