Virtually no one goes through life untouched by nurses. They are there to
cradle us at birth, to offer us comfort at death, and to provide care for us
at every stage of life in between. Yet nursing has long been not only an
invisible profession, but a silent one.
Today, that silence is being shattered. The so-called quiet crisis in
nursing is now near the top of the health-care agenda because the potential
ramifications are so vast.
Hospital and home-care administrators struggle every day with staff
shortages. Entire wards are closed, elective surgeries are routinely
cancelled, emergency backlogs are growing and thousands of Canadians are on
waiting lists for home care because of chronic shortages.
The human-resources challenge is not confined to nursing. After years of
cutbacks and poor planning, there are shortages of physicians, radiologists,
laboratory technicians and homemakers too, but the problem is particularly
visible in nursing because 75 per cent of health professionals are nurses.
There are 263,000 registered nurses in Canada.
According to a study by the Canadian Nurses' Association, within a decade
there could be a shortfall of 113,000 nurses. A report by the Registered
Nurses Association of Ontario paints an even bleaker picture, saying the
shortfall could reach 90,000 in Ontario alone.
So why can we not attract and, more important, retain qualified women and
men in the profession?
The short answer is the work environment. In researching my book, Critical
Care: Canadian Nurses Speak for Change,I spent a lot of time on-the-job with
nurses. Many of them, though they loved delivering care, described their
workplaces as "toxic."
It is a tragic irony that health-care providers toil in remarkably unhealthy
environments. Ultimately, patients will pay for disdainful and short-sighted
policy decisions.
Nurses have borne the brunt of cutbacks. They have been hit by massive
layoffs, increased workloads and much higher patient-nurse ratios. The No. 1
complaint of nurses is that they don't have time to spend with their
patients anymore. How can they get job satisfaction -- and how can patients
get proper care -- when nurses are systematically deprived of the ability to
do the core of their work?
Casualization -- the loss of full-time, permanent jobs with benefits -- is
also a huge issue. Fifty-one per cent of nurses in Canada now work
part-time. It is not unusual for nurses to juggle jobs in three or four
institutions.
Because of shortages, many nurses work large amounts of overtime -- three to
four extra shifts monthly is not unusual -- and are unable to take holidays.
The work is physically and mentally demanding. Forty per cent of nurses have
chronic back problems. They burn out in the prime of their careers.
Given the increasing demands and specialization, the pay is not great. The
top wage for a nurse in Canada is $30.25 an hour, less than a plumber. Some
home-care nurses earn as little as $12 an hour. The average salary has
fallen steadily for a decade to $31,200.
Nurses must constantly upgrade their education to remain current. Yet most
employers do not pay for courses, nor do they provide the time for studies
(Paid education, not salary, is the principal attraction for Canadian nurses
who go to the United States).
All these workplace issues have to be considered in the demographic context.
The average age of nurses in Canada is 45 and rising. The average retirement
age is 55 and falling.
Under current conditions, within the decade, the majority of Canada's
263,000 registered nurses will have to be replaced. There are fewer than
8,000 graduates from nursing schools annually. Within one year of
graduation, one-third of new recruits are lost. About 10 per cent opt for
full-time, better paying jobs in the U.S., which is also stepping up
recruitment efforts. A more worrisome aspect of the brain drain is the 20
per cent of new nurses who leave the profession altogether, joining
thousands upon thousands of their older counterparts. Therein lies the
solution. There are almost as many qualified nurses in Canada working
outside the profession as there are working as nurses. Improving the work
environment could entice many of them back, stave off early retirements and
attract young women and men to nursing.
Nurses are the backbone of our public health-care system, the front-line
workers in hospitals and the community, the primary providers of programs,
from prevention to acute care.
If there are shortages of nurses, there will be severe shortages of
services. There will be suffering and there will be deaths. What is now a
labour market shortfall, could quickly mutate into public-safety issue.
We are already experiencing the beginnings of this bleak scenario in
emergency rooms, surgical wards and home-care programs, and unless action is
taken, the problem will escalate.
This is a critical time for nurses and nursing.
It is a critical time for care.
Adapted from Critical Care: Canadian Nurses Speak for Change
(HarperCollins). An excerpt from the book will run in tomorrow's Health
section.

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