Last April, 975 new nurses passed their entrance exam to practice and others will join the care teams after their exam in December. In addition, the Order of Nurses of Quebec (OIIQ) issued, for the year 2020-2021, 3629 new permits to practice. In a context of scarcity of resources, it would be tempting to entrust this successor with a workload and responsibilities that exceed their abilities. However, several questions arise to better protect these precious resources and welcome this succession in the health network.
Posted at 11:00 a.m.
How can we offer them working conditions that guarantee a real quality of life so that they like the profession and want to stay there? How can they maximize the use of their skills in their care offering so that the population of Quebec can finally benefit from their expertise? How to motivate them, not only to participate, but also to contribute actively to the innovations and research that health care and services so badly need? How to make them want to invest in the development of a career in nursing? These are some of the many elements of the reflection for which the nursing care directorates of the establishments and the national directorate of nursing care and services should not only be stakeholders, but also have “the power” to implement the best practices facilitating integration and retention at work?
It is not only a question of manpower and human resources, but of nurses who must be treated as full professionals and be part of the solutions with their management of medical care.
In presenting the health plan, Minister Christian Dubé had the wisdom to recognize that the solutions are known, but that they are not applied and that we must take advantage of past experience, expert reports and the best practice. However, remember that for decades, nursing care experts, clinicians, managers and researchers have participated in numerous committees, working groups and pilot projects, mandated by the Ministry of Health. These experts have produced analyzes and numerous recommendations in the face of the network’s glaring problems, in particular with regard to nursing staff planning, work organization, work-family balance, attraction and retention of these professionals.
Beyond the scarcity argument
These works, which have been expensive, have been little disseminated, most often shelved, watered down or placed under embargo, thus leaving aside solutions that have already been necessary for too long. For example, the shortage argument persists even though the real problem is related to the retention and attraction of nurses. This so-called scarcity then becomes a justification for prioritizing short-term solutions and holding back any appropriate innovation or change. Recently, the mixed success of the incentive program aimed at recruiting nurses still reflects the fact that the incentives do not take into account the known expectations of nurses or the available research data relating to attraction and work-family balance. .
How to explain that practices known and recognized as effective by the scientific community in nursing sciences find so little echo among decision-makers and that so much resistance persists? There seems to be great difficulty in recognizing the complementarity of two areas of expertise, on the one hand that of workforce management and on the other that of the administration of nursing services and organization of work in a specific context of professional nursing practice. Recognizing and taking advantage of this complementarity of fields of expertise must be part of a change in organizational culture desired in the Health Plan.
The changes that are beginning in the self-management of schedules are a step in the right direction to restore more autonomy and power to nurses, but this is not enough, we must go much further.
In fact, nurses represent 49% of all nursing staff and the nursing and cardiorespiratory care teams (nurses, nursing assistants, attendants) making up the nursing teams make up 29% of all health network staff. . The current crisis clearly indicates that it is necessary to review the governance structure to allow the directors of nursing as well as the national director to assume their responsibilities and exercise strategic leadership in matters of planning, organization and evaluation of nursing resources. In addition, we believe that to fully ensure this leadership, the position of the national director of nursing care and services at the Ministry of Health should be reviewed and raised to the level of an assistant general manager.
Studies show that the organizational structure has significant impacts on the quality of the work environment of managers, impacts which have repercussions on the evolution of professional practices, retention at work and the quality of care. The current crisis, which has been brewing for a long time, is proof that the centralizing managerial model, which offers little power to nursing care managers and nurses, is not suited to human and complex organizations. This model has rather negative effects on motivation at work, the feeling of belonging and respect; nor does it allow for the full use of nurses’ skills.
In short, several actions must be undertaken in the short term, several of which are urgent and could be done by drawing inspiration from best practices in a climate of cooperation and complementarity.