https://www.infirmiere-canadienne.com/blogs/ic-contenu/2025/02/18/infirmier-penurie-raisons-sous-jacentes
Second of two responses to October article: “How nurses may be impeding recruitment and retention”
By Kate Shelest
February 18, 2025
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Nurses are resilient, highly educated professionals. They possess varying levels of resilience and may find satisfaction in providing care in challenging situations.
Kathy Arseneau’s October 1, 2024, Canadian Nurse article, “How nurses may be impeding recruitment and retention,” triggered deep reflection and requires a thoughtful response.
The issue
The potential for a nursing shortage was apparent many years ago. I have witnessed the fight to maintain nursing professional standards and adhere to the CNA Code of Ethics (2017). Nurses’ burnout, leading to moral distress and illness, should not be a surprise. Please see these Canadian-based studies listed in my references:
- Havaei, MacPhee, and Dahinten (2016), “Emotional Exhaustion and Intention to Leave”
- Havaei, MacPhee, Ma, Gear, and Sorensen (2020a), A Provincial Study of Nurses’ COVID -19 Experiences and Psychological Health and Safety in British Columbia, Canada: Final Report
- Havaei, MacPhee, Ma, Gear, and Sorensen (2020b), A Provincial Study of Nurses’ Psychological Health and Safety in British Columbia, Canada: Final Report
Courtesy of Kate Shelest
“It’s been my experience that nurses have an innate drive (even a professional core value) to be problem solvers, helpers and healers. When these core values are challenged or blocked from being actualized, nurses can experience moral distress and compassion fatigue,” Kate Shelest says.
In these provincial studies of acute care, community care and long-term care, nurses reported “worsening mental health…and lower quality of nursing care” (Havaei et al., 2020a, p. 14).
It’s been my experience that nurses have an innate drive (even a professional core value) to be problem solvers, helpers and healers. When these core values are challenged or blocked from being actualized, nurses can experience moral distress and compassion fatigue.
The response
To my disappointment, this article in Canadian Nurse strongly suggests that nurses are a root cause of the nursing shortage through their negative behaviours toward aspiring colleagues and students. I’m not denying that varying forms and levels of these behaviours may exist. But time should be taken to understand where these behaviours might be coming from.
In his article “Reductionism + Nursing Devaluation Syndrome: The Triggers Behind the Mass Exodus of Nurses,” Ali Fakher (2024, p. 1) discusses how traditional reductionist approaches in healthcare focus on isolated symptoms rather than the holistic needs of patients. This perspective reduces nursing to a series of tasks rather than recognizing it as a complex interplay of emotional, physical, and social factors. It strips the profession of its depth and fails to utilize the critical thinking, innovation, and leadership nurses bring to patient care.
This perspective is also supported by MacPhee, Dahinten, and Havaei (2017), who discuss how, through the impact of mechanistic approaches to practice, “nurses suffer from emotional and moral distress,” leading to outcomes that include “emotional exhaustion/burnout, job dissatisfaction and eventual exit from the profession” (p. 3).
This, combined with shortages of all health-care staff, high acuity of clients and recovery from a global pandemic (let’s not forget that one), absolutely stomps on nursing core values, strains resilience and exhausts the energy required to hold compassionate inquiry.
Stress from various sources is linked with “changes in cognitive, behavioural, and emotional function that can compromise professional caring” (Dyess, Prestia, Marquit, and Newman, 2018, p. 79). It is recognized that the impact of nurses’ burnout and personal and vicarious trauma can also spill out into their personal lives. A lack of control over the weaknesses in the current Canadian health-care system also adds to the moral distress.
Considering all of this, of course nurses might experience times when they want to discourage others from joining the profession. Nurses are innately caregivers and protectors. Why encourage anyone to run into a burning building?
The solution
Nurses are bound by their professional standards and the CNA Code of Ethics to support their own health and maintain fitness to practice. The Code of Ethics endorses the World Health Organization’s (WHO) definition of health: “a state of complete physical, mental (spiritual), and social well-being, not merely the absence of disease” (CNA, 2017, p. 23). This is an acknowledgment that the interactive relationship between all dimensions of the human experience is holistic; therefore, holistic self-care is a valid resource to support the health of nurses.
Instead of publishing a provocative article that doesn’t look at the whole picture of the current reality of nursing and the profession’s history and challenges, I respectfully suggest that compassionate and practical solutions be considered.
As stated, nursing professional standards, the Code of Ethics and the WHO’s definition of health reflect the importance of a holistic approach to health and well-being. Positive approaches to support nurses, such as the following suggestions, should be duly presented and considered:
- At the very least, integrate a holistically based curriculum that supports the practices of holistic self-care at the student level. At least then nursing graduates will be better prepared to deal with the professional challenges that (I believe) will not be solved anytime soon.
- Implement holistic supports for nurses who are currently practising.
- Offer holistic supports to burned-out nurses who have left the profession.
I would like to emphasize here that nurses are resilient, highly educated professionals. They possess varying levels of resilience and may find satisfaction in providing care in challenging situations. Rushton, Batcheller, Schroeder, and Donohue (2015) suggest that the creation and implementation of holistic self-care practices by nurses may strengthen and sustain that resilience from a whole-person perspective, supporting health and fitness to practice.
In closing, I acknowledge that I’ve only scratched the surface of the peer-reviewed literature describing the state of burnout and the impact of current working conditions on nursing practice. I am in full support of the integration of holistic theory into existing nursing programs and workplace program implementation. Nursing as a profession needs to heal holistically from the inside out, with self-compassion and compassion for our colleagues — because I don’t see the system shifting for us any time soon.
References
Canadian Nurses Association. (2017). Code of ethics for registered nurses. Retrieved from https://www.cna-aiic.ca/en/nursing/regulated-nursing-incanada/nursing-ethics
Dyess, S., Prestia, A., Marquit, D., & Newman, D. (2018). Self-care for nurse leaders in acute care environment reduces perceived stress: A mixed-methods pilot study merits further investigation. Journal of Holistic Nursing, 36(1), 79–91. doi:10.1177/0898010116685655
Fakher, A. (2024). Reductionism + nursing devaluation syndrome: The triggers behind the mass exodus of nurses. Linkedin. Retrieved from https://www.linkedin.com/pulse/reductionism-nursing-devaluation-syndrome-triggers-fakher-bsn-rn--dyh3f/
Havaei, F., MacPhee, M., & Dahinten, V. (2016). RNs and LPNs: Emotional exhaustion and intention to leave. Journal of Nursing Management, 24(3), 393–399. doi:10.1111/jonm.12334
Havaei, F., MacPhee, M., Ma, A., Gear, A., & Sorensen, C. (2020a). A provincial study of nurses’ COVID-19 experiences and psychological health and safety in British Columbia, Canada: Final report. doi:10.14288/1.0394563
Havaei, F., MacPhee, M., McLeod, C., Ma, A., Gear, A., & Sorensen, C. (2020b). A provincial study of nurses’ psychological health and safety in British Columbia, Canada: Final report. doi:10.14288/1.0391985
MacPhee, M., Dahinten, S., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(7), 1–17. doi:10.3390/admsci7010007
Rushton, C., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Association of Critical Care, 24(5), 412–421. doi:10.4037/ajcc2015291
World Health Organization. (2019, June). WHO global report on traditional and complimentary medicine 2019. Retrieved from https://www.who.int/publications/i/item/978924151536
Kate Shelest, RN, BSN, MA Integral Health, is a CIINDE-certified holistic nurse coach/consultant and student advisor. She is also a current board member and past president of the Canadian Holistic Nurses Association.
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