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Houssem Eddine Ben-Ahmed discusses the recruitment and retention of Canadian nurses.

Image courtesy of interviewee. March 22, 2024

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This video video is a transcription of a presentation discussing an article published in a nursing leadership journal, which highlights complex issues facing the nursing and healthcare workforce in Canada, such as staffing shortages, excessive workloads, and toxic workplace environments. These challenges negatively affect nurses' psychological well-being, contribute to burnout, and potentially lead to a decline in the quality of patient care.

The speaker outlines a comprehensive review aimed at identifying evidence-based solutions to these issues. The methodologies employed included a literature review, consultations with experts, and interviews with key stakeholders. The review identified over 1,000 articles, ultimately focusing on 1,176 relevant ones.

Key findings were categorized into reactive and long-term solutions, with emphasis placed on three main approaches: "Retain and Support," "Return and Integrate," and "Recruit and Mentor." Specific suggestions include reducing nursing workloads, creating supportive workplaces, integrating internationally educated nurses, and focusing on local recruitment initiatives.

In conclusion, the presentation stresses the urgent need for coordinated, evidence-based solutions to address the persistent challenges faced by healthcare workers and ensure high-quality care for patients. The speaker calls for immediate action from policymakers and a comprehensive implementation of the proposed solutions to avert a future crisis in the healthcare system.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

00:00.225 --> 00:02.365
We have published it, this,

00:02.365 --> 00:04.885
article on the nursing, leadership journal,

00:05.065 --> 00:09.125
the Canadian Journal, and, one, like nursing

00:09.385 --> 00:12.365
and healthcare workforce, have been facing a number

00:12.385 --> 00:15.805
of complex issues, including staffing shortages, heavy

00:15.865 --> 00:18.405
and excessive workloads, mandatory over time,

00:18.735 --> 00:22.365
toxic workplaces, emic, violence, et cetera, et cetera.

00:22.865 --> 00:25.245
And this, all these issues,

00:25.425 --> 00:27.845
may have a negative impact on the nurses

00:28.265 --> 00:31.085
and the he healthcare workforce, for example,

00:31.155 --> 00:34.165
they may have impact on their, psychological wellbeing,

00:34.665 --> 00:37.285
on their progression, during,

00:37.745 --> 00:39.245
you know, in, in their pathway.

00:39.825 --> 00:43.245
And also many, they may leave the, their positions

00:43.245 --> 00:44.845
and also the profession altogether.

00:45.505 --> 00:48.725
And also, this may have an impact on the, quality

00:48.785 --> 00:51.125
of care and healthcare services offered

00:51.145 --> 00:52.725
to the clients, resident and patients.

00:52.745 --> 00:55.965
For example, we may, we have heard a lot about,

00:55.965 --> 00:57.045
missing nursing care.

00:57.145 --> 01:02.125
We have heard a lot about burnout, like, the people

01:02.155 --> 01:04.485
that can also like die when they don't have,

01:04.555 --> 01:06.245
receive a high quality care.

01:06.985 --> 01:10.005
So in, when nurses don't feel good, don't feel,

01:10.005 --> 01:12.445
or they feel burned out, of course,

01:12.445 --> 01:14.885
this have negative impact on the patients and, and,

01:14.885 --> 01:18.245
and the quality of care to identify the different,

01:18.245 --> 01:20.085
solutions or evidence based solutions

01:20.465 --> 01:22.685
and initiatives that have been implemented in Canada,

01:22.905 --> 01:24.445
or even at the, at the international level,

01:24.865 --> 01:27.165
we have conducted a comprehensive product review.

01:27.505 --> 01:31.085
Uh, so this is a type of, knowledge synthesis,

01:31.295 --> 01:35.565
which is like a designed to offer, policy,

01:35.575 --> 01:39.285
healthcare, or decision makers with rapid informations.

01:39.705 --> 01:42.045
Uh, because you, like, within a time of crisis, we need

01:42.045 --> 01:44.965
to provide psychologists in evidence to,

01:45.075 --> 01:46.405
implement some initiatives.

01:46.405 --> 01:49.605
So this is a feasible in this kind, in this kind of, of,

01:49.665 --> 01:50.965
in, in, in this context.

01:51.465 --> 01:53.605
So for the comprehensive level review,

01:53.705 --> 01:55.285
we have used different methodologies.

01:55.755 --> 01:59.005
Like, we have conducted peer reviewed, literature.

01:59.185 --> 02:00.565
We have consulted the literature,

02:00.945 --> 02:04.845
and also with the asserts of two, librarians from the,

02:04.845 --> 02:06.205
from the University of Ottawa.

02:06.505 --> 02:09.405
And we have identified more than 1000 articles.

02:10.025 --> 02:13.285
And, we have included only 1, 176

02:13.285 --> 02:14.725
articles within this review.

02:15.265 --> 02:17.605
And to do that, we have used the confidence,

02:17.605 --> 02:21.565
which is a platform, to, that supported us

02:21.665 --> 02:23.725
to screen, to extract the data

02:23.825 --> 02:27.805
and synthesize the data, into, different teams.

02:29.075 --> 02:30.845
Also, we have,

02:30.955 --> 02:35.005
used like different databases like Al PubMed midline to look

02:35.025 --> 02:36.645
for the, for this literature

02:37.145 --> 02:40.325
and the second method that we have used to collect data.

02:40.545 --> 02:42.245
We have, used interviews

02:42.305 --> 02:46.125
and group discussions with, 42 stakeholders

02:46.195 --> 02:49.005
that are representatives of unions, representatives of,

02:49.025 --> 02:52.005
of regulated bodies, and other key nursing,

02:52.145 --> 02:54.205
and healthcare organizations to do that.

02:54.665 --> 02:57.405
So for these interviews, we have,

02:57.515 --> 02:58.565
also like we have individual

02:58.565 --> 03:00.365
Interviews and also focus groups.

03:00.545 --> 03:01.685
So for the focus groups.

03:01.745 --> 03:04.765
So we have,

03:04.955 --> 03:08.645
divided the groups into break rooms, breakout rooms,

03:08.825 --> 03:11.565
for the, for the each room, we have targeted three themes.

03:11.855 --> 03:14.965
First team, like the, the are retention, then the return,

03:15.225 --> 03:17.645
and then recruit recruitment of, of nurses.

03:18.265 --> 03:20.565
And for each team, there were like groups.

03:20.745 --> 03:24.965
And these groups have, ranked the different initiative

03:24.965 --> 03:27.845
that we have identified in the re review according

03:27.865 --> 03:28.885
to their importance.

03:29.545 --> 03:33.205
And, here, like we have invited an expert, of x,

03:33.225 --> 03:37.125
of cross lead, cross C, which is like a software that use it

03:37.145 --> 03:41.645
to, to show, the process with the transparency

03:41.865 --> 03:44.765
for these stakeholders, how, what are the most impactful,

03:45.025 --> 03:47.685
initiatives, to implement.

03:48.585 --> 03:51.965
And then we have, conducted the surveys

03:52.935 --> 03:57.545
with the 11 key, negotiators that are members also

03:57.545 --> 04:00.065
to CFNU, the Canadian Federation Officer Unions,

04:00.605 --> 04:02.985
in case if we did not capture all the initiatives.

04:02.985 --> 04:06.265
So this, service have augmented the data.

04:06.845 --> 04:08.745
And, just wanted to be sure

04:08.745 --> 04:10.865
that we have covered all these initiatives.

04:11.285 --> 04:12.985
So those are the different

04:12.985 --> 04:14.465
methodologies that we have conducted.

04:14.525 --> 04:18.225
Uh, for this rapid review, our findings, we have,

04:18.685 --> 04:21.505
so we have like two big parts, themes of the findings.

04:21.725 --> 04:23.985
One theme about reactive solutions,

04:24.295 --> 04:26.385
that solutions should be implemented in the

04:26.385 --> 04:27.465
medium and short term.

04:27.765 --> 04:31.105
And also we have identified, long term solutions.

04:31.895 --> 04:33.585
Like in this article that we have published,

04:33.645 --> 04:35.745
we have focused only on the reactive solutions

04:35.895 --> 04:37.385
that we're gonna talk about today.

04:37.805 --> 04:38.905
For reactive solutions,

04:39.005 --> 04:41.465
we have identified like three Rs, the approach.

04:41.765 --> 04:44.385
So the first r, which is like retain and support.

04:45.085 --> 04:48.065
Uh, we have focused on different, measure folks,

04:48.405 --> 04:50.265
and then there is return and grade.

04:50.485 --> 04:52.625
And the third are recruit and mentor for.

04:52.625 --> 04:55.545
So for the first R we have focused on the issue

04:55.545 --> 04:57.465
that have identified at the beginning.

04:57.525 --> 04:59.985
So, for example, we have focused like on initiative

05:00.045 --> 05:02.905
to reduce nursing workloads, both in acute

05:02.925 --> 05:04.025
and non-acute settings.

05:04.655 --> 05:07.465
Also, we have identified solutions that to create safe

05:07.465 --> 05:10.145
and healthy and more supportive workplaces.

05:10.685 --> 05:12.585
Uh, you know, like, because there is uncivility

05:12.805 --> 05:15.745
and many, many nursing have been facing this kind

05:15.745 --> 05:16.985
of demonizing practices.

05:17.285 --> 05:19.785
And also, we, suggest a solution

05:19.785 --> 05:21.225
to embed mental health days.

05:21.365 --> 05:23.425
So this may let nurses

05:23.565 --> 05:26.305
to energize themselves when they take, one

05:26.305 --> 05:27.825
or two days of, of break.

05:28.535 --> 05:31.625
Also for the to retain nurses, we have implemented target

05:31.645 --> 05:34.225
and retention solutions across their career continuum.

05:34.605 --> 05:38.425
So when nurses, they graduate, they need to,

05:38.645 --> 05:41.585
be supported and also throughout their career, of course,

05:41.715 --> 05:42.985
until their retirement.

05:43.765 --> 05:46.865
For the, for the second R, which is return and integrate.

05:46.865 --> 05:49.945
Here we have focused on how we can return nurses

05:50.165 --> 05:53.065
who have left the profession or the public sector,

05:53.175 --> 05:55.705
because many, they have, they, they went

05:55.805 --> 05:57.965
to the private sector to work

05:57.965 --> 05:59.765
because the conditions are better

05:59.765 --> 06:00.885
than in the, in the public sector.

06:01.555 --> 06:02.565
Also, we have suggested

06:02.565 --> 06:04.565
to develop magnet like working conditions

06:04.565 --> 06:05.645
and organizational culture.

06:06.225 --> 06:08.525
You know, like in USA, they have implemented,

06:09.485 --> 06:13.005
a magnet hospitals, which is one of the gold standard,

06:13.005 --> 06:14.125
for excellence in nursing.

06:14.625 --> 06:17.525
So we, our experts have highlighted

06:17.555 --> 06:21.205
that this is very important to implement it in Canada,

06:21.385 --> 06:24.525
to, improve, work, working conditions

06:24.525 --> 06:25.685
of, of, of healthcare workers.

06:26.425 --> 06:27.565
And also to return

06:27.625 --> 06:30.685
and integrate, this, this workforce.

06:31.265 --> 06:33.445
We suggest facilitating the integration

06:33.445 --> 06:35.485
of internationally educated nurses within Canada.

06:35.865 --> 06:37.925
You know, like we have many international educated nurses

06:37.955 --> 06:39.925
that are in Canada, and they're,

06:39.925 --> 06:42.525
that are unemployed or underutilized.

06:42.595 --> 06:43.645
They don't work here.

06:44.195 --> 06:46.325
Most of them are, struggling

06:46.325 --> 06:47.925
with the registration process.

06:48.425 --> 06:51.245
So we need to streamline the registration process

06:51.825 --> 06:54.605
and to, ate their integration within the healthcare,

06:54.745 --> 06:56.125
the Canadian healthcare workforce,

06:56.785 --> 06:59.085
and the third R, which is recruit and mentor.

06:59.625 --> 07:03.525
And this, we have focused how we can, recruit nurse

07:03.545 --> 07:05.325
and focus on the local recruitment.

07:05.745 --> 07:07.565
And instead of recruiting overseas,

07:07.675 --> 07:09.085
because the shortage is global.

07:09.305 --> 07:12.365
So we need like to focus on nurses that are here in Canada

07:12.985 --> 07:15.405
by fostering pathways into nurse training, through

07:15.405 --> 07:18.165
and tuition free for the following years.

07:18.505 --> 07:22.645
And also, student loan forgiveness programs to, and,

07:22.785 --> 07:24.525
and target trainee diversification.

07:24.785 --> 07:26.885
You know, like we are serving diverse populations.

07:26.885 --> 07:28.845
So we need to focus on,

07:28.845 --> 07:30.805
diversifying this, workforce.

07:31.345 --> 07:34.565
And also, of course, support expansion of training programs

07:34.565 --> 07:36.525
through employer funded secondments

07:36.745 --> 07:39.405
of the clinical nursing faculty in academic institutions.

07:39.785 --> 07:41.565
We have added to the three hours,

07:41.625 --> 07:43.485
we have the fourth hour, which is respect.

07:43.865 --> 07:46.965
Nurses and healthcare workers need to feel respected

07:47.385 --> 07:52.205
by the policy, makers to work within healthcare

07:52.205 --> 07:54.165
and to provide high quality services.

07:54.785 --> 07:59.605
So this generally, what are our, data showed,

07:59.605 --> 08:01.845
after conducting, contacting this, the,

08:01.845 --> 08:04.765
this review here, like what we can take home,

08:05.275 --> 08:07.605
like messages from this rapid review

08:07.605 --> 08:10.965
and from this, research that first, we need

08:10.965 --> 08:13.885
to support nurses because they are the largest group

08:13.885 --> 08:16.765
of healthcare workers, which is the most priority

08:16.765 --> 08:20.285
for health policy decision maker to take action, we need

08:20.285 --> 08:21.885
to take action to support nurses.

08:21.995 --> 08:23.085
This is not a new call.

08:23.595 --> 08:26.565
This nurses have been facing this problem.

08:27.065 --> 08:30.005
Uh, this issues more for more than decades.

08:30.665 --> 08:31.845
Uh, you know, like a report

08:31.845 --> 08:34.045
after report, we are, we are suggesting the same

08:34.045 --> 08:37.125
recommendations, but there is no action, I can say,

08:37.145 --> 08:39.805
or few actions that have been undertaken,

08:39.945 --> 08:43.205
to support healthcare workers, which is important also

08:43.205 --> 08:45.725
that we need to implement evidence-based solutions

08:46.265 --> 08:49.125
to support first the nursing cook force, that the,

08:49.125 --> 08:51.325
that requires urgent reactive solutions

08:51.325 --> 08:54.205
and also proactive solutions in the medium term

08:54.305 --> 08:55.895
to avoid the future crisis.

08:56.675 --> 09:01.215
So, the solution that I have presented,

09:01.285 --> 09:04.015
earlier, there are different solutions,

09:04.115 --> 09:08.295
but we should not pick up, it's not a cafeteria just

09:08.295 --> 09:10.415
to pick up and choose from, from the solution,

09:10.415 --> 09:13.535
but it should be, implemented as a set

09:13.535 --> 09:15.735
of solutions are coordinated planet

09:15.835 --> 09:18.215
and sequenced solutions that all levels

09:18.235 --> 09:20.055
of government governments need to undertake.

09:20.515 --> 09:22.695
So this is what we need,

09:22.835 --> 09:26.415
or watch, the, unit contributions of,

09:26.435 --> 09:29.535
of our review, that all the solutions should be implemented

09:29.595 --> 09:32.415
by, you know, planet.

09:32.835 --> 09:36.775
So that's why we have suggested, such subject plans for

09:37.615 --> 09:40.415
employers, stakeholders, and the federal government.

09:40.675 --> 09:44.845
And I think this is like, like to avoid the future crisis,

09:44.845 --> 09:46.885
you know, like the CVID 19 have,

09:47.215 --> 09:49.725
exacerbate the situation of,

09:49.725 --> 09:50.885
nurses and healthcare workers.

09:51.425 --> 09:53.845
So if you would like to have better services in Canada

09:53.985 --> 09:55.445
and even in other countries,

09:55.445 --> 09:57.565
because the global is crisis, we need

09:57.565 --> 09:58.805
to support healthcare workers.

09:59.745 --> 10:03.965
So this is what we can, take from this, the,

10:04.025 --> 10:05.125
the, this, this review.

10:05.125 --> 10:07.245
But we still need more other researchers

10:07.385 --> 10:09.325
to sustain our healthcare workers.

00:00 - We have published it, this, article on the nursing, leadership journal, the Canadian Journal, and, one, like nursing and healthcare workforce, have been facing a number of complex issues, including staffing shortages, heavy and excessive workloads, mandatory over time,

00:18 - toxic workplaces, emic, violence, et cetera, et cetera. And this, all these issues, may have a negative impact on the nurses and the he healthcare workforce, for example, they may have impact on their, psychological wellbeing, on their progression, during, you know, in, in their pathway. And also many, they may leave the, their positions and also the profession altogether. And also, this may have an impact on the, quality

00:48 - of care and healthcare services offered to the clients, resident and patients. For example, we may, we have heard a lot about, missing nursing care. We have heard a lot about burnout, like, the people that can also like die when they don't have, receive a high quality care. So in, when nurses don't feel good, don't feel, or they feel burned out, of course, this have negative impact on the patients and, and,

01:14 - and the quality of care to identify the different, solutions or evidence based solutions and initiatives that have been implemented in Canada, or even at the, at the international level, we have conducted a comprehensive product review. so this is a type of, knowledge synthesis, which is like a designed to offer, policy, healthcare, or decision makers with rapid informations. because you, like, within a time of crisis, we need to provide psychologists in evidence to,

01:45 - implement some initiatives. So this is a feasible in this kind, in this kind of, of, in, in, in this context. So for the comprehensive level review, we have used different methodologies. Like, we have conducted peer reviewed, literature. We have consulted the literature, and also with the asserts of two, librarians from the, from the University of Ottawa. And we have identified more than 1000 articles.

02:10 - And, we have included only 1, 176 articles within this review. And to do that, we have used the confidence, which is a platform, to, that supported us to screen, to extract the data and synthesize the data, into, different teams. Also, we have, used like different databases like Al PubMed midline to look for the, for this literature and the second method that we have used to collect data.

02:40 - We have, used interviews and group discussions with, 42 stakeholders that are representatives of unions, representatives of, of regulated bodies, and other key nursing, and healthcare organizations to do that. So for these interviews, we have, also like we have individual Interviews and also focus groups. So for the focus groups. So we have,

03:04 - divided the groups into break rooms, breakout rooms, for the, for the each room, we have targeted three themes. First team, like the, the are retention, then the return, and then recruit recruitment of, of nurses. And for each team, there were like groups. And these groups have, ranked the different initiative that we have identified in the re review according to their importance. And, here, like we have invited an expert, of x, of cross lead, cross C, which is like a software that use it

03:37 - to, to show, the process with the transparency for these stakeholders, how, what are the most impactful, initiatives, to implement. And then we have, conducted the surveys with the 11 key, negotiators that are members also to CFNU, the Canadian Federation Officer Unions, in case if we did not capture all the initiatives. So this, service have augmented the data. And, just wanted to be sure that we have covered all these initiatives.

04:11 - So those are the different methodologies that we have conducted. for this rapid review, our findings, we have, so we have like two big parts, themes of the findings. One theme about reactive solutions, that solutions should be implemented in the medium and short term. And also we have identified, long term solutions. Like in this article that we have published, we have focused only on the reactive solutions

04:35 - that we're gonna talk about today. For reactive solutions, we have identified like three Rs, the approach. So the first r, which is like retain and support. we have focused on different, measure folks, and then there is return and grade. And the third are recruit and mentor for. So for the first R we have focused on the issue that have identified at the beginning. So, for example, we have focused like on initiative

05:00 - to reduce nursing workloads, both in acute and non-acute settings. Also, we have identified solutions that to create safe and healthy and more supportive workplaces. you know, like, because there is uncivility and many, many nursing have been facing this kind of demonizing practices. And also, we, suggest a solution to embed mental health days. So this may let nurses

05:23 - to energize themselves when they take, one or two days of, of break. Also for the to retain nurses, we have implemented target and retention solutions across their career continuum. So when nurses, they graduate, they need to, be supported and also throughout their career, of course, until their retirement. For the, for the second R, which is return and integrate. Here we have focused on how we can return nurses who have left the profession or the public sector,

05:53 - because many, they have, they, they went to the private sector to work because the conditions are better than in the, in the public sector. Also, we have suggested to develop magnet like working conditions and organizational culture. You know, like in USA, they have implemented, a magnet hospitals, which is one of the gold standard, for excellence in nursing.

06:14 - So we, our experts have highlighted that this is very important to implement it in Canada, to, improve, work, working conditions of, of, of healthcare workers. And also to return and integrate, this, this workforce. We suggest facilitating the integration of internationally educated nurses within Canada. You know, like we have many international educated nurses that are in Canada, and they're,

06:39 - that are unemployed or underutilized. They don't work here. Most of them are, struggling with the registration process. So we need to streamline the registration process and to, ate their integration within the healthcare, the Canadian healthcare workforce, and the third R, which is recruit and mentor. And this, we have focused how we can, recruit nurse and focus on the local recruitment.

07:05 - And instead of recruiting overseas, because the shortage is global. So we need like to focus on nurses that are here in Canada by fostering pathways into nurse training, through and tuition free for the following years. And also, student loan forgiveness programs to, and, and target trainee diversification. You know, like we are serving diverse populations. So we need to focus on, diversifying this, workforce.

07:31 - And also, of course, support expansion of training programs through employer funded secondments of the clinical nursing faculty in academic institutions. We have added to the three hours, we have the fourth hour, which is respect. Nurses and healthcare workers need to feel respected by the policy, makers to work within healthcare and to provide high quality services. So this generally, what are our, data showed, after conducting, contacting this, the,

08:01 - this review here, like what we can take home, like messages from this rapid review and from this, research that first, we need to support nurses because they are the largest group of healthcare workers, which is the most priority for health policy decision maker to take action, we need to take action to support nurses. This is not a new call. This nurses have been facing this problem. this issues more for more than decades.

08:30 - you know, like a report after report, we are, we are suggesting the same recommendations, but there is no action, I can say, or few actions that have been undertaken, to support healthcare workers, which is important also that we need to implement evidence-based solutions to support first the nursing cook force, that the, that requires urgent reactive solutions and also proactive solutions in the medium term to avoid the future crisis.

08:56 - So, the solution that I have presented, earlier, there are different solutions, but we should not pick up, it's not a cafeteria just to pick up and choose from, from the solution, but it should be, implemented as a set of solutions are coordinated planet and sequenced solutions that all levels of government governments need to undertake. So this is what we need, or watch, the, unit contributions of,

09:26 - of our review, that all the solutions should be implemented by, you know, planet. So that's why we have suggested, such subject plans for employers, stakeholders, and the federal government. And I think this is like, like to avoid the future crisis, you know, like the CVID 19 have, exacerbate the situation of, nurses and healthcare workers. So if you would like to have better services in Canada and even in other countries,

09:55 - because the global is crisis, we need to support healthcare workers. So this is what we can, take from this, the, the, this, this review. But we still need more other researchers to sustain our healthcare workers.

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