https://www.infirmiere-canadienne.com/blogs/ic-contenu/2025/02/10/ne-sont-pas-blamer-penurie-personnel-infirmier
First of two responses to October article: “How nurses may be impeding recruitment and retention”
By Anne Marie Lauf
February 10, 2025
istockphoto.com/LaylaBird
Retention and recruitment challenges have been longstanding within Canadian nursing. The nursing shortage cannot be remedied without examining why it exists.
Kathy Arseneau’s October 1, 2024, Canadian Nurse article, “How nurses may be impeding recruitment and retention,” was highly thought-provoking. I found, however, that it did not address the myriad factors contributing to the challenges surrounding retention and recruitment, and it lay the blame for a continued nursing shortage at the feet of nurses.
Courtesy of Anne Marie Lauf
“Systemic changes must be made first, in order that we can retain the nurses we currently have. We need senior nurses to mentor new staff, and the new staff need a healthy practice environment, which will, in turn, encourage their retention,” says Anne Marie Lauf.
Retention and recruitment challenges have been longstanding within Canadian nursing. The nursing shortage cannot be remedied without examining why it exists. Contrary to Arseneau’s insistence that adding more nurses to the workforce is the solution to the current nursing landscape, this is only one part of the solution, and in isolation would serve as a stop-gap measure at best.
A systemic problem
To attempt to remedy the retention and recruitment challenges nursing currently faces, we need to begin with the understanding that this is not the fault of nurses expressing their discontent; rather, it is a systemic problem. A non-exhaustive list of contributors to the nursing shortage includes the following:
Unrealistic/unsafe staff–patient ratios
A unit could be fully staffed, yet still have unrealistic or unsafe workloads. This situation could be remedied only by management’s advocating for the staff and patients, and the employer’s acknowledging the need for improved workload ratios and willingness to create more positions for those providing direct care.
This approach would require larger budgets and the eschewing of the pervasive notion that nurses should do more with less. B.C. is implementing minimum staff–patient ratios, but in Alberta, where I practise, this is not a reality; ratios in my practice setting are 2 to almost 3.5 times higher than those of B.C.
The expectation that nurses provide free work every shift
There is an expectation that nurses arrive at work early, in order that they review their patient assignments and plan their day. I’ve known nurses to arrive up to an hour early for their shifts; this is not a phenomenon limited to new graduates. At the end of your shift, most units allow 10–15 minutes for report.
In 35 years, I can attest that report almost always goes beyond this time frame, owing to the vast amount of information to be relayed in order to have safe and effective continuation of care. This time is not remunerated.
Refusal of legitimate overtime by management/employers
Unfortunately, it is commonplace for nurses to miss breaks or have their breaks interrupted. Despite the often-stated misbelief of some managers, this practice does not reflect a lack of organizational prowess; it reflects an unreasonable workload.
Much of this overtime is refused by management/the employer and demonstrates another way in which nurses provide free labour. Often, nurses simply stop attempting to claim this overtime, which management then views as confirmation that workloads are appropriate.
Mandated overtime
As the term suggests, this is overtime that staff must work, if the employer deems it an emergency. This practice gained notoriety at the height of the pandemic, but it has always existed in times of inadequate staffing.
It raises the question, “When does inadequate staffing constitute an emergency, and when is it representative of poor managerial planning or purposeful understaffing by the employer?” This is an abusive practice that leads to burnout, moral distress, and workplace dissatisfaction. Additionally, it puts at risk the licence of every nurse forced to work beyond their scheduled shift.
Overall underemployment
Since the early 1990s, there has been a movement in many health-care authorities to abolish 1.0 full-time equivalents (FTEs). This practice was implemented as a cost-saving measure, as only nurses working a 1.0 FTE are entitled to a day off with pay for each statutory holiday. In a large organization, this would result in savings of millions of dollars per year.
Underemployment of new graduates
Speak to new graduates and you will quickly learn that if they are fortunate enough to have been hired by a larger health region, most hold two or three casual positions to make ends meet.
Many graduates tell me they’ve had to wait five or more years before getting a part-time position with benefits. It’s discouraging to enter a profession that claims shortages yet you know that you will be underemployed.
Wage freezes or increases not commensurate with the cost of living
This situation, in the context of increases to co-pay portions of benefits and parking increases, results in less take-home pay.
Too few university spots in nursing faculties
When I entered my BScN program in the mid-1980s, one needed a 70% GPA for admission, with early admission granted if you had a 75% GPA. When my two daughters entered their BN program in 2016, they needed GPAs in the high 80s/low 90s for admission.
Across many Canadian universities (for example, the University of Alberta, MacEwan University, and Queen’s University), nursing faculties have one of the highest, if not the highest, GPA entrance requirements.
This high GPA requirement is driven by competition for available seats. It supports the notion that there is not a recruitment shortage, but rather a shortage of university seats, and a resultant shortfall in graduates required to meet the demand.
With a four-year turnaround from admission to a baccalaureate program to graduation, any increase in seats will not result in an increased workforce for four years. Accelerated degree programs graduate fewer nurses, but do so in two years.
The underlying problem of poor retention and recruitment
A commonality among these contributors to poor retention and recruitment in nursing is a lack of respect — for nurses, for the profession of nursing, and for our patients.
If we were to remedy the nursing shortage tomorrow by adding more nurses, we would be unlikely to retain them without remedying the aforementioned factors. Of my clinical group that graduated in 2020, 28.6% have already left the profession.
Systemic changes must be made first, in order that we can retain the nurses we currently have. We need senior nurses to mentor new staff, and the new staff need a healthy practice environment, which will, in turn, encourage their retention.
Per Arseneau, those who express their discontent with the profession tarnish the professional image of nursing. I disagree. It is only through acknowledging our discontent that we can act collectively to effectuate change.
Advocacy has always been part of our role as nurses. To remain silent in one’s discontent, with the misplaced notion that silence will actually serve the profession in any way, is misguided. To believe that any nurse can prevent someone from entering nursing simply because they say so, imbues that nurse with far more power than they possess and connotes an innate weakness in the listener.
To commit a lie of omission regarding the current nursing landscape, when speaking with someone considering entering the profession, is unethical. Would such omission serve the individual or the profession? Ultimately, it would serve neither.
Arseneau states that nursing is one of the most respected professions in the world. The aforementioned contributors to poor retention and recruitment would suggest otherwise. Published alongside her article regarding retention and recruitment is another Canadian Nurse article stating, “I have been punched, I have been kicked, I have been screamed at and spat on.”
I would challenge Arseneau’s assertion that nursing is respected. Although I share in the desire for nursing to be respected as a profession, to claim that we are respected, in the face of glaring evidence to the contrary, silences the voices of victims and only allows such abuses to continue.
There are significant concerns regarding nursing retention and recruitment in Canada. Most, if not all, of the contributors to poor retention and recruitment existed prior to the pandemic. The stress of the pandemic, including the noted abhorrent treatment of many nurses by their employers, some members of the public, and the government, served as the proverbial straw that broke the camel’s back. Nurses said, “I’m done,” and meant it.
Those nurses who remain are battle weary and less tolerant of the disrespect. New graduates entering the profession are dedicated, hard-working individuals, who are self-possessed in their understanding that they deserve to be treated with respect. They will establish boundaries to protect themselves, as is their right.
Pointing an undeserved finger at the nurses who are still practising at the bedside will serve only to alienate them further and will do nothing to encourage them to stay, or to encourage others to join the profession.
To remedy the current climate, we need to place the responsibility where it lies—with the system—and demand solutions there. The time has come for nurses to stop internalizing the blame for systemic problems.
Anne Marie Lauf, RN, BScN, is a staff nurse at Agape Hospice in Calgary. She has worked in hematology and palliative home care and was a clinical instructor in oncology.
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