Getting it Right: Planning for Nursing Resources Based on Needs of People

International Seminar of PROFAE

Salvador, Brazil, July 25, 2006

Dr. Gail Tomblin Murphy

Dalhousie University

Halifax, Nova Scotia

Canada

Nursing in Canada

• Nursing workforce in Canada includes three occupational groups

• 250,000 Registered Nurses;

• 6,000 Registered Psychiatric Nurses;

• 60,000 Licensed Practical Nurses• To obtain a license to practice nursing,

individuals must demonstrate theoretical knowledge, clinical practice skills, as well as pass a national exam

Acknowledgements

Team: • Dr. Linda O’Brien-Pallas, Dr. Stephen Birch, Dr

George Kephart, research team (health services researchers and policy makers) in ten jurisdictions.

Funders: • Health Canada, HRSDC,CHSRF, CIHR,

NSHRF, OMHLTC, Saskatchewan Innovation and Science Fund, and Capital District Health Authority.

General Features of Work:

Collaborative• Multi-jurisdictional

• Education and Health ministries

• HHR researchers and government planning officials

Innovative• Population health needs-based

• Testing effectiveness of planning/policy scenarios

• Readily adaptable to new data/assumptions/commitments

Traditional HHR Planning

Most HHR planning has been:

• poorly conceptualized

• intermittent

• varying in quality

• supply-driven

• profession-specific

• made without consideration of changes in health care needs and service provision

• made without vision or data

Challenges

InfrastructureEvidenceCapacityFunding

Opportunities

Partnerships

Needs based and context based planning

Data investment

Population HealthNeeds

Health System and Health Human Resources Planning Conceptual Framework1

Efficient Mix of Resources(Human & Non-Human)

Social

Political

Technologica

l

Economic

Geographical

Production

(education and training)

Health Outcomes

Provider Outcomes

System Outcomes

PLANNING & FORECASTING

ResourceDeployment

andUtilization

Supply

1O’Brien-Pallas, Tomblin Murphy, Birch, 2005 (adapted from 1O’Brien-Pallas, Tomblin Murphy, Birch, & Baumann , 2001, and O’Brien-Pallas & Baumann, 1997)

Management organization & delivery of services across sectors

Financial Resources

System Design

Analytical Framework (Birch, Tomblin Murphy, Kephart, O’Brien-Pallas, MacKenzie, 2005)

Estimates the health services required to meet the needs of the population that is then translated into the required health providers to deliver this service.

Provider Supply• ‘How many providers are (or will be) available to deliver

health care services to the population?’

Provider Requirements• ‘How many providers are required to ensure sufficient

‘flow’ of health care services to meet the needs of the population?’

Some Profession Specific Simulation Results

LPNs RNs

Effects of Individual Policy Changes on LPN Gap by Future Year, Needs Follow Observed Trends, Atlantic Canada, 2002.

-2500

-2000

-1500

-1000

-500

0

500

1000

0 5 10 15 20 25 30 35 40

Future Years

LP

N G

ap

Make No Changes (1) Increase Training Seats by 20% (From 407 to 488) (2) Decrease Program Attrition by 10% (From 11% to 10%) (3) Decrease Grad Out-Migration by 20% (From 10% to 8%) (4) Increase In-Migration by 10% (5) Decrease LPN Exit Rates by 10% (6) Shift 20% of Part-time LPNs to Full-Time (7) Increase Productivity by 0.5% per Year (Compounded) (8)

(6)

(7)

(8)

(3)

(4)

(5)

(1)

(2)

Effects of Cumulative Policy Changes on LPN Gap by Future Year, Needs Follow Observed Trends, Atlantic

Canada, 2002

-2500

-2000

-1500

-1000

-500

0

500

1000

1500

2000

2500

3000

0 5 10 15 20 25 30 35 40

Future Years

LP

N G

ap

Make No Changes (1) Increase Training Seats by 20% (From 407 to 488) (2) … AND Decrease Program Attrition by 10% (From 11% to 10%) (3) … AND Decrease Grad Out-Migration by 20% (From 10% to 8%) (4) … AND Increase In-Migration by 10% (5) … AND Decrease Exit Rates by 10% (6) … AND Shift 20% of Part-Time LPNs to Full-Time (7) … AND Increase Productivity by 0.5% per Year (Compounded) (8)

(5) (6)

(4)

(3)

(7)

(2)

(8)

(1)

Effects of Individual Policy Changes on RN Gap by Future Year, Needs Follow Observed Trends, Atlantic Canada, 2002

-14,000

-12,000

-10,000

-8,000

-6,000

-4,000

-2,000

0

0 5 10 15 20 25 30 35 40

Future Years

RN

Gap

Increase Productivity by 0.5% per Year (Compounded) (8)Decrease Exit Rates by 10% (6)Shift 20% of Part-time RNs to Full-Time (7)Increase In-Migration by 10% (5)Decrease Grad Out-Migration by 20% (From 35% to 28%) (4)Decrease Program Attrition by 10% (From 20% to 18%) (3)Increase Training Seats by 20% (From 977 to 1172) (2)Status Quo (1)

(1) (2)

(3)

(4)

(6)

(5)

(7)

(8)

Effects of Cumulative Policy Changes on RN Gap by Future Year, Needs Follow Observed Trends, Atlantic Canada, 2002

-14,000

-12,000

-10,000

-8,000

-6,000

-4,000

-2,000

0

0 5 10 15 20 25 30 35 40

Future Years

RN

Gap

Make No Changes (1)Increase Training Seats by 20% (From 977 to 1172) (2)… AND Decrease Program Attrition by 10% (from 20% to 18%) (3)… AND Decrease Grad Out-Migration by 20% (From 35% to 28%) (4)… AND Increase In-Migration by 10% (5)… AND Decrease Exit Rates by 10% (6)… AND Shift 20% of Part-Time RNs to Full-Time (7)… AND Increase Productivity by 0.5% Per Year (Compounded) (8)

(1)

(2) (3)

(4)

(6)

(5)

(7)

(8)

Recommendations

Need based Planning

Data Investment

Partnerships

Recommendations

Needs-Based Planning• Considering changes needs of people across

age, gender, and social groups.

• Considering social, economic, cultural, technological, political, geographic factors

Recommendations

Data Investment• Ongoing investment in accessible,

comparable, and comprehensive data for HHR planning is critical.

• Ongoing data collection on the variables needed for the supply, training, work and productivity and needs modules

• Learning from best practices

Recommendations:

•Partnerships • Policy community (both the Ministries of

Education and Health), the education community, regional health authorities, communities, NGOs, the research community and others are essential.

• Need to commit to sharing tools, best practices, frameworks, data, analytical models, data, etc

Collaborative Pan Canadian Framework: Implications for Nursing

Relevance to the Nursing Sector in Canada

Building the Strategy for Nursing Human Resources in Canada. http://www.buildingthefuture.ca/

An extensive consultation process designed to seek the views and opinions of a wide range of nursing stakeholders in Canada on about nursing

Building the Strategy for Nursing Human Resources in Canada.

5 years study with 2 phases and examined the nursing workforce for all three regulated nursing professions in Canada.

• Phase I: 15 research reports on areas such as nursing mobility, the international labour market, nursing education in Canada, and many others.

• Phase II: Pan-Canadian HHR strategy in consultation with government and non-government stakeholders.

Summary of Recommendations Create a stable supply of nurses. Develop a pan-Canadian approach to nursing education in

collaboration with the provincial, territorial and federal governments to prepare the number of qualified graduates needed to meet workforce needs.

Enhance data collection to improve HHRP. Use a HHRP Framework based on population health

needs to plan for nurse resources. Use evidence-based practices to inform staffing decisions

including retention and recruitment decisions.

Summary of Recommendations Implement effective and efficient mechanisms

to address workload issues and improve patient, nurse, and system outcomes.

Create work environments that maximize patient, nurse and system outcomes.

Improve and maintain the health and safety of nurses.

Develop innovative approaches to expand clinical experiences in nursing education.

Maximize the ability of nurses to work in their full scope of practice.

Three Priority Pan-Canadian Strategies to deal with Nursing HR Challenges

Optimize use of nurses' knowledge and skills - Allow nurses to practice to their level of competency in all clinical settings.

Link planning with other health professions - Develop a pan-Canadian interprofessional health human resource strategy.

Ensure a future supply of nurses - Provide funding to increase the capacity of nursing education programs in Canada.

• Need to devote adequate funding to increase the supply of nurses by increasing the capacity of nursing education programs in Canada.

Workplace Priorities Compile “Best Practices” that outline effective workplace

strategies that create effective working environments, and maximize nurse and system outcomes.

Create a coordinated pan-Canadian strategy to inform health system managers and policy-makers regarding the relationship between workload and quality of patient care and nurse health.

Address issues related to workplace health and safety and working environments to ameliorate the effects of overwork and burnout.

Pan-Canadian Strategies to Create a Stable Supply of Nurses

Broaden the HHR planning framework to be inclusive of other health professions

Develop an integrated health profession HHR strategy

Standardize and streamline the regulation and licensure of nurses among jurisdictions in Canada to facilitate mobility

Pan-Canadian Strategies to Create a Stable Supply of Nurses (Cont’d)

Develop national standards to assess the competencies of internationally educated nurses

Establish supports to facilitate the integration of such nurses into Canadian society

Work to identify and minimize barriers to the immigration of nurses while establishing policies to prohibit unethical “poaching” of nurses

Pan-Canadian Strategies for Nursing Education

Establish a national strategy to recruit First Nation, Inuit and Métis

Develop consistent pan-Canadian standards for nursing education

Devote adequate funding to increase the supply of nurses by increasing the capacity of nursing education programs in Canada

Pan-Canadian Strategies for Nursing Education (Cont’d)

Provide funding assistance in the form of scholarships and bursaries, tax incentives for nurses who re-enter the profession and programs to address tuition debt relief for nurses

Promote education for nurses at the Masters and PhD level

Develop a long-term strategy to educate and recruit nursing faculty

Pan-Canadian Strategies to Expand Clinical Experiences in Nursing Education

Explore full potential of technology to enhance learning opportunities for nurses in Canada; e.g.: • Web-based learning, telehealth, simulation labs

Increase simulated learning experience Develop innovative opportunities to integrate

student placements across sectors Fund clinical experiences in a variety of

geographical areas Explore the development of pan-Canadian

clinical learning experiences

Pan-Canadian Strategies to Expand Clinical Experiences in Nursing Education (Cont’d)

Fund clinical experiences in a variety of geographical areas

Appropriately recognize and compensate the role of preceptor/mentor in clinical education

Provide adequate funding for ongoing continuing education.

Pan-Canadian Strategies to Enhance Data Collection for HHR Planning

Develop frameworks and tools to needs based HHR planning

Develop a unique identifier for students and registrants in nursing groups to permit long-term follow-up

Standardized criteria for data collection to support HHR planning

Develop a national database for nursing HHR Coordinate the activities of nursing research units

to share results and develop common research agendas

Pan-Canadian Strategies for Evidence-Based Staffing Decisions

Tools to accurately assess workloads of nurses in various settings

Standards to regulate nurse staffing mix, nursing workloads and maximum hours of work allowed

Policies that will enable older nurses to play a mentorship / expert role for younger nurses

Share “Best Practices” related to retention and recruitment of nurses

Pan-Canadian Strategies to Maximize Ability to Work to Full Scope of Practice

Ensure organizational policy eliminates non-nursing duties for nurses

Conduct and support further research that supports nurses working to their full scope of practice

Disseminate knowledge of existing research