Executive summary: Nursing retention toolkit

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Nursing is the largest group of regulated health professionals in Canada. Pressure on the nursing workforce has been building over time due to long-standing health systems issues such as an aging and growing population, lack of appropriate health workforce data, and inadequate recruitment and retention of healthcare providers. The growing demand for care is outpacing the supply of available nurses, putting pressure on health systems to rapidly address care gaps across federal, provincial, and territorial jurisdictions.

In recognition of the acute nursing shortages across the country and internationally, the nursing retention toolkit: Improving the working lives of nurses in Canada has been developed to support nursing retention. As a resource created 'by nurses, for nurses', the toolkit draws on the expertise of the nursing community, evidence-based practice, and current lived experiences of front-line nurses.

The toolkit:

Themes and initiatives

The toolkit focuses on eight core themes that impact a nurses' day-to-day working life. Each of the core themes are underpinned by the values of respect, transparency, anti-racism and anti-oppression, and accountability. Each theme has a goal, and accompanying initiatives that can be used as a guide for employers and organizations to implement as strategies that target retention. The order in which the eight themes appear do not indicate priority or sequence. Each theme may have greater or lesser relevance depending on the local context of the specific employers, organizations, or health systems.

The themes include:

  1. Inspired leadership
  2. Flexible and balanced ways of working
  3. Organizational mental health and wellness supports
  4. Professional development and mentorship
  5. Reduced administrative burden
  6. Strong management and communication
  7. Clinical governance and infrastructure
  8. Safe staffing practices

The image that follows depicts the eight core themes in a circle surrounded by the underpinning values, all with the goal of supporting nurses in Canada by optimizing their working conditions.

Figure 1. Core themes and underpinning values to enable professionally supported and fulfilled nurses

Text description

This image depicts the eight core themes in a circle surrounded by the underpinning values. Inside the circle are figures holding hands and the text professionally supported and fulfilled nurses.

The eight core themes are:

  • Inspired leadership
  • Flexible and balanced ways of working
  • Organizational mental health and wellness supports
  • Professional development and mentorship
  • Reduced administrative burden
  • Strong management and communication
  • Clinical governance and infrastructure
  • Safe staffing practices

The underpinning values:

  • Respect
  • Transparency
  • Anti-racism and anti-oppression
  • Accountability

The table below outlines each of the eight core themes and their respective goal, followed by initiatives that align with each of the themes.

Theme Goal Initiative
Inspired leadership Empower nurses of all levels, roles, and settings to experience fulfilment in their work and become leaders within their organizations.
  • Cultural change
  • Leadership competencies
  • Emerging nursing leaders
Flexible and balanced ways of working Promote nurse autonomy and flexibility in scheduling and career progression.
  • Flexible work design
  • Scheduling systems
  • Workplace resources and amenities
Organizational mental health and wellness supports Increase timely and fulsome access to appropriate and effective preventative and acute health and wellness supports, with an urgency and focus on mental health supports.
  • Zero-tolerance for violence, bullying, and racism
  • Moral distress and injury care
  • Best practices for vacation and time off
Professional development and mentorship Provide nurses across the entire career span options to enhance their skills and pursue their career goals.
  • Transition programs
  • Mentorship programs
  • Career pathways and bridginf programs
Reduced administrative burden Free up nurses to focus on the tasks and care that they are uniquely skilled to provide.
  • Work re-design
  • Digital preparedness
  • Documentation requirements
Strong management and communication Promote cultures of transparent leadership and mutual respect between management and point-of-care nurses.
  • Nursing management competencies
  • Supporting nursing leaders
  • Nurse engagement and listening
Clinical governance and infrastructure Ensure that supportive clinical governance and infrastructure is in place to ensure that nurses have a core role in decision-making and are at the forefront of driving the development of a sustainable health system.
  • Structured participatory governance
  • Nursing shared governance
  • Nurse-led models of care, initiatives, and practice standards
Safe staffing practices Support physically safe and psychologically brave workplaces by implementing staffing practices (e.g., nurse-patient ratios) that reflect factors like patient acuity, nurse experience, and work-life balance.
  • Clinical supports
  • Safe staffing framework and tools

Implementation and next steps

Implementation of retention strategies is fundamental to assist in bolstering the nursing workforce in Canada. There are many initiatives underway across Canada to support nursing retention. The toolkit provides a framework that can be utilized as a key resource for employers and organizations to enhance the current working conditions of nurses and outlines many of the initiatives.

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