The Changing Tide - Nursing Shortages and Promoting Nurse-Led Innovation in Healthcare

I attended a union meeting the other day. It was filled with talk of problems that nurses in British Columbia (and across the country) have been facing for many years. The problems that were discussed in the meeting were the same as those discussed when I attended my first union meeting more than a decade ago. Issues like the shortage of nursing are new to nurses who are entering the profession today. But these issues are not new to the profession of nursing. In a 1967 issue of Macleans magazine Alan Edmonds wrote about the shortages in nursing. Again, in 1980 Ian Pearson wrote an article about the shortage of nurses in Canada. In 1997 Sharon Doyle Driedger wrote about the issue of nurses burning out by the increasing stressors of the Canadian healthcare system. And again in 2008 Kate Lanau wrote about nursing shortages leading to patient safety issues like medication errors. The shortage of nurses in Canada has been an ongoing issue since World War II. In the early part of the 20th century, shifts to a hospital system in which structured healthcare services became centralized with resources focused on treating acute issues led to physicians requiring highly trained nurses. And so, in 2021 when the issue of a nursing shortage is again brought to the public and presented as a result of the COVID-19 pandemic for nurses who have worked in this profession for many years it is clear that this is not a new issue. 

The issues that have come up over and over again in nursing are also issues that are faced by the Canadian healthcare system. Similarly, many of the issues that nurses in Canada face are global nursing issues and stem from global healthcare issues. 

The Future of Health Services and Systems 

The hospital system was a useful system in the context of it's time. It allowed resources like diagnostic tools (including diagnostic imaging) to be centralized. From the hospital system standards of practice and consistency of service emerged as well as centrlized locations that provided reliable and evidence-based education for healthcare practitioners. But, with advances in healthcare overall like water sanitation systems, mass vaccination programs, access to public healthcare, and increases in public knowledge of wellness including diet and exercise the context of Canada has changed. We need to re-think a system in which most resource are spent on the highest level of care without consideration of how health services can be better organized and delivered within communities. The 2002 report Building on Values: The Future of Healthcare in Canada outlined recommendations to ensure the sustainability of the Canadian healthcare system. Here are almost 20 years later. We need to think about how to action these changes. 

One strategy that can be helpful in changing our healthcare system to a change in focus away from the hospital system. It is time to move past a model in which the majority of nurses are educated to be leaders and innovators but find themselves largely employed at the bedside in acute care centres. Many nurses start their careers at the bedside, but the days in which a nursing career consists of staying at the bedside in the same job at the same unit for the duration of a nurses career are gone. Those romantic notions of a life-long bedside job need to be let go of because the healthcare industry is changing. Career options for women have changed drastically since the profession of nursing gained popularity in the first half of the 20th century. Gone are the days when nursing was only open to unwed women who were under the age of 30. And so, we need to let go of those old and outdated ideas. 

Nurses are the healthcare leaders of today. They have been leaders in healthcare for the past century, though this may not have been the popular narrative. Stereotypes persist about physicians as the leaders of healthcare. We need to let that go because the hierarchies in healthcare are not benefitting the healthcare system, and in turn they are not benefitting the public. 

Love,

Michelle D.