If you worry that there are not enough health-care providers to meet health needs, you are not alone. Seventy per cent of Canadians worry about access to care. One factor affecting health-care access is a global nursing shortage.
The increasing demand for nursing services in Canada far exceeds the current supply. Statistics Canada reported in 2021-22 nursing had higher job vacancies than any other occupation, and nurses worked over 26 million hours of overtime.
In honour of National Nursing Week 2024 (May 6-12), we ask all Canadians to consider asking a nurse they know about the realities of the nurses’ working lives.
A short-staffed health system
Forecasting models predicted a shortage of 60,000 nurses nationwide by 2022, and further predicted that would almost double to more than 117,000 by 2030.
Responding to shortages has led to changes in staffing models, with fewer registered nurses, more licensed practical nurses and substantially more health-care aides. But even with these, there is a significant shortage, making it essential to retain existing nurses who have the required education and expertise.
In 2024 the Canadian Federation of Nursing Unions (CFNU), conducted a survey of 5,595 nurses. Thirty per cent reported dissatisfaction with their career and 40 per cent intend to leave nursing or retire.
Early career nurses were even more unhappy with 35 per cent reporting dissatisfaction. This is due to occupational disappointment, which is a feeling of disheartenment with career choice.
Job dissatisfaction in nursing
The majority of CFNU survey respondents attributed this disappointment to high workload and insufficient staffing. One cause of increased workload is caring for more patients than the bed capacity is funded or staffed for. Seventy per cent of nurses reported their workplace regularly operated over capacity.
Even when care areas are understaffed, patient needs do not change and fewer nurses must meet these needs. Nurses are also influenced by shortages in other health professions such as physiotherapy by picking up extra duties to meet patient needs.
Insufficient staffing increases nurse workload to above normal demands and can threaten patient safety. When there is insufficient staff, nurses from other areas may be displaced to cover. For example, a nurse scheduled on an orthopedic unit might be displaced to neurology.
Forty two per cent of nurses in the CFNU survey were displaced within the last year and 40 per cent of them felt inadequately trained for the care area they were sent to.
Insufficient staffing can also lead to missed care where patient needs are unmet. Common examples include delay or failure to answer patient call bells or assist with personal care. Recently neonatal intensive care units highlighted they were functioning at 102 per cent capacity and babies were not able to be fed as frequently.
Nurses’ concerns with substandard care impact job retention as they may experience moral distress. Moral distress is highly correlated with increased intent to leave a job, or the profession.
Safety and safeguards
When short staffed, nurses can be mandated to work beyond their eight- or 12-hour scheduled shifts. Under the Registered Nurse Code of Ethics, the nurse has a duty to provide care to assigned patients until they are transferred to another appropriate care provider. Failure to do so is considered abandonment.
While off duty, nurses can be called in for mandatory overtime. The CFNU policy statement advocates against the use of mandatory overtime except in exceptional circumstances such as disasters. Despite this, in 2023 Manitoba nurses worked over one million hours of mandatory overtime. This is shocking, especially considering Manitoba has legislation limiting mandatory overtime usage.
From a safety perspective however, restricting overtime is not a solution, as it could leave patients at risk and nurses even more overburdened.
Not all overtime is mandatory. Many nurses receive frequent calls to pick up extra hours, which leaves them unable to properly recover between shifts. Declining overtime can cause guilt or a sense of letting colleagues down. In the CNFU survey, 62 per cent of respondents worked overtime in the last month out of obligation.
The impact of the nurse shortage
Work hour factors impact patient safety. The CFNU study “Safe hours saves lives” reported extended shifts led to deficits in patient care with nurses reporting decreased physical strength, focus, and ability to be compassionate. Fatigue contributes to medication errors.
Fatigue is correlated with drowsiness and difficulty staying awake both on shift and when driving home. This presents a danger to patients, nurses, and all Canadians on the roads.
Persistent fatigue has been found to impact nurses health. This influences work attendance which further worsens the shortage. Canadian nurses missed an average of 19 days of work for illness or leave in 2022, up from 14.7 days in 2021. This is more than double the sick time taken by government and private sector employees.
Many factors identified in this article contribute to nurse burnout. Canadian nurses have increasing rates of burnout. Ninety three percent of CFNU survey respondents reported symptoms of burnout. Burnout has been linked with depression, anxiety, and post-traumatic stress disorder.
Why a shortage of nurses matters
All Canadians ought to worry about the nursing shortage. Without addressing it, Canadian’s ability to access safe, compassionate care will be compromised. When looking at the complex ways that the shortage impacts nurses and their work demands, it is no wonder why they experience occupational disappointment.
Work is underway by nurses alongside Canada’s Chief Nursing Officer. The Nurse Retention Toolbox provides guidance. The work to address nursing retention cannot be done by nurses alone. All Canadians need to advocate for conditions that support the well-being of nurses and other health care providers. This is essential for a safe, sustainable health system for us all.
By Lisa McKendrick Calder, associate professor, Department of Nursing Practice; Leanne Topola, assistant professor, Department of Health Systems and Sustainability; and Tanya Heuver, assistant professor, Department of Nursing Practice.