As I write this reflection in late autumn 2022, the topic of the Canadian nursing workforce is on my mind. In the context of my consulting work I am often engaged in discussions on recruitment and retention of nurses in Indigenous communities. We look for ideas from many sources and consider strategies that will be most effective in the local context on Vancouver Island.
National organizations have issued statements and reports this month that highlight the urgency of human resources in the Canadian health system. In conjunction with a meeting of provincial and territorial ministers of health with the federal health minister, many organizations held meetings and issued briefing notes. The Canadian Medical Association (CMA), Canadian Nurses Association (CNA) and HealthCareCAN issued a “prescription for hope” that received media attention at that time. A follow-up letter to the Council of the Federation Chair of was issued on November 22 by the Canadian Federation of Nurses Unions (CFNU), CNA and CMA requesting an “urgent meeting” on finding solutions the health care crisis. I follow all these organizations on social media and appreciate seeing frequent updates and timely media releases. The media release and link to the letter are available here: Nurses and doctors engage Council of the Federation around solutions to Canada’s health crisis (cna-aiic.ca)
On November 17, the Canadian Health Workforce Network and the CFNU released a comprehensive report: Sustaining Nursing in Canada. I recommend working your way through the entire document when time permits as I’m doing at present. For a quick overview, I suggest the “Strategic Priority Actions” on page 9 followed by the Executive Summary. The “multi-layered solutions” offered are most welcome. We do need to think of steps and layers in a coordinated way and not a piecemeal approach. See also page 23 for a figure summarizing key points around retaining, returning and recruiting nurses.
Workforce planning is a strong theme of Sustaining Nursing in Canada with three steps identified on page 14: 1) Embed nursing workforce planning, 2) Enhance nursing data to support inter-professional workforce planning and 3) Enable nursing workforce partners access to evidence. In terms of priority actions, some are directed at employers and governments. I see a cluster of proposed actions that would help in nursing education and in mentoring students and new graduates as well as attention to supporting nurses over the course of a career. It’s intriguing to consider the idea of the national health workforce agency (pages 52-53) and I think that we may hear more about implementing something similar in Canada.
It is both a worrying and hopeful time as we reflect on media stories and personal experiences. I do hope that governments are paying attention at long last and that we will see solutions become a reality.
I end this post with images from earlier this fall when I visited the beautiful provinces of Nova Scotia and Newfoundland. I carry these memories with me with optimism for improvements in health care for people and communities in all parts of our country.
Last year I signed up for updates from the Institute for Healthcare Improvement (IHI), the organization known for the Triple Aim framework. I have been learning about IHI’s impressive work and have appreciated the resources available on the organization’s website. This week I participated in an excellent webinar featuring Dr. Don Berwick, IHI President Emeritus and Senior Fellow, and Dr. Jessica Berwick, Internist, Beth Israel Deaconess Medical Center, discussing the topic Morality Matters: How to Reset the Mission of Quality Improvement.
Their starting point was a keynote presentation by Don Berwick given at IHI’s National Forum last December in which he had raised concerns about the tensions experienced in healthcare today arising from two eras: professional dominance in era one followed by a move to accountability, measurement and greater scrutiny in era two. He proposed steps to a third era – the focus of the February 18 webinar – with a plea to decrease excessive measurement among other steps (See slide 8 in the webinar slides). To move into a moral era, he outlined the need to recommit to the science of improvement, protect civility within healthcare and focus on the patient (“Listen, really listen”). Jessica Berwick offered commentary and examples from her current experience as a new internist and hospitalist in Boston. It was interesting to hear from this dynamic father and daughter team as they talked about what really matters and explored ways to overcome the challenges imposed by corporate entities and external systems. They stimulated my thinking about the importance of values to the quest of improving health and healthcare delivery.
As a keen observer of global health trends, I have been following recent discussion about the formal conclusion of the United Nations Millennium Development Goals (MDGs) this year and the launch of a new era framed by Sustainable Development Goals. National governments, international agencies, the private sector and civil society organizations have participated in drafting the new goals in advance of the UN Summit in September 2015.
Schoolchildren in Punjab, India
Known as the Post-2015 Development Agenda, it will be a single development framework to encompass three dimensions: social, economic and environmental goals. This proposed new Agenda with 17 goals builds on important work over the past decade on climate change, global financing for development and social determinants of health, among many other major issues. See the UN Sustainable Development Knowledge Platform for background documents and media releases.
Commentaries by some organizations and individuals have highlighted concerns about gaps in the framework and lack of implementation strategies; however, it’s anticipated that this final draft will be endorsed after years of political negotiations to arrive at this stage. It’s worth noting that a technical review of the 169 targets is underway by teams of experts.
All 17 goals relate to better health in the broadest sense; there are also specific health goals and targets worth a close review. The push for universal health coverage–the topic of recent global health systems efforts–is a major focus in the new framework.
In this final year of the MDGs, the World Health Organization issued a fact sheet in May 2015 with an overview of results on each of the health-related goals and targets. The fact sheet highlights achievements in specific targets for reducing child mortality; improving maternal health; combating HIV/AIDS, malaria and other diseases; improving access to safe drinking water and sanitation; and provision of access to affordable essential medicines in developing countries.
The final draft document developed in preparation for the September Summit is entitled Transforming our World: The 2030 Agenda for Global Action:
People often ask what I’m doing these days and what projects I have on the go. When I’m not in the garden—the Russian sage is performing beautifully this year–I’m managing the work of the Association of Registered Nurses of BC (see my July 22 Memorable Moments post below). My role includes working closely with the Board of Directors in overall coordination of our activities to develop a new professional nursing association in British Columbia.
As some of you know, I have remained interested in and connected to a project in India. The University of British Columbia School of Nursing and the Canada-India Education Society (CIES) have had a longstanding relationship with health care and nursing education initiatives in Punjab state through the Guru Nanak Mission Medical and Educational Trust. From 2001 to 2005, I worked as a consultant on a primary health care project that focused on community-based activities in villages near the Guru Nanak Mission Hospital and its affiliated College of Nursing at Dhahan-Kaleran in Nawanshahr District.
Following a visit to India in February 2011 by a small delegation from CIES and UBC (see my Highlights of 2011 post), a new relationship was begun with Baba Farid University of Health Sciences (BFUHS). All nursing colleges in Punjab state, including the Guru Nanak College, come under the umbrella of this large university located in Faridkot, in western Punjab.
Map of Punjab State and Districts
The overall goal of the new partnership is to provide for an exchange of educational and research opportunities to build capacity bilaterally. Specific objective are to contribute to the professional development of nurse educators, strengthen graduate nursing education and increase research capacity throughout the colleges associated with the BFUHS system. I am pleased to serve on the Baba Farid Partnership Advisory Committee of the UBC School of Nursing and was delighted to meet with two nursing faculty members from BFUHS in June while they were visiting UBC. I look forward to similar exchanges as this partnership develops.