Tag Archives: Blythe

Guide supports internationally-trained nurses transition to Canada

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Hamilton, ON (Nov 7, 2011) — Almost 300 foreign-trained nurses arrive in Canada each year, most settling in Ontario and many lacking the language, technological and nursing skills required to practice here.

To counteract what is called a “brain waste”, researchers in McMaster University’s Nursing Health Services Research Unit (NHSRU) developed a unique web-based guide designed to help hospitals and health care facilities overcome barriers faced by internationally educated nurses (IENs) from the time they enter Canada.

The NHSRU’s guide, Internationally Educated Nurses: An Employer’s Guide, is timely as the Ontario government continues to further open the doors of the province to increasing numbers of international professionals.

“With an aging (nursing) workforce and the threat of nursing shortages, effective management and retention of internationally educated nurses (IENs) is a priority,” said Andrea Baumann, scientific director, NHSRU, who led the development of the web-based guide with Jennifer Blythe, a senior researcher in the unit.

Baumann said the result of an initiative like this is “not only effective use of human resources but a more ethnically diverse health care workforce that better reflects the Ontario population and enhances the quality of health care delivery.”

The guide, which is also available in a print version, provides easily accessible information that targets, among other things, workforce diversity, cultural competence, recruitment strategies, screening processes and hiring practices, bridging programs, settlement support and managers and educators responsibilities.

Web-based resources are listed, with additional resources on migration, settlement, recruitment and integration, personal stories of internationally-trained nurses and video clips of interviews with a number of healthcare organizations.

Maria Rosalie Rival, who received her basic nursing education in the Philippines, discusses how she is completing a degree in nursing under special funding for internationally educated nurses at York University. After arriving in Toronto in 2007, she discovered her credentials in the Philippines were not equivalent to the baccalaureate degree in Ontario.

To illustrate how some health care organizations welcome nurses from abroad, the guide describes an initiative by the Saskatchewan Health Region (SHR), selected as one of the Best Employers of New Canadians in 2010. The SHR team developed guidelines for ethical recruitment and worked with three recruitment agencies and the Philippine government, hiring 100 internationally-trained nurses and staggering their arrival to provide enhanced settlement support.

The website will be launched on Nov. 7 at HealthAchieve 2011 in Toronto, a health care conference anticipating attendance of 9,000 health care and business leaders from around the world.

The NHSRU developed the guide in collaboration with the Ontario Hospital Association (OHA) with funding from the Ontario Ministry of Citizenship and Immigration.

 

For further information and to arrange interviews, please contact:

Laurie Kennedy

NHSRU

905-525-9140, ext. 22206

kennedyl@mcmaster.ca

Innovative Web-Based Guide for Employers of Internationally Educated Nurses

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Internationally Educated Nurses: An Employer’s Guide (www.oha.com/ien) is a unique web-based guide designed to help hospitals and health care facilities overcome barriers faced by internationally educated nurses (IENs) from the time they enter Canada. This new web-based resource launched at HealthAchieve 2011, is produced by The Ontario Hospital Association (OHA) in partnership with the Nursing Health Services Research Unit (NHSRU) McMaster site and is funded by the Government of Ontario.

Workforce Integration of New Nurses: Exploring Employment Goals, Expectations, and Intent to Migrate of Nursing Graduates in a Canadian Border City

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Research Team-   Michelle Freeman, MSN, RN, Andrea Baumann, PhD, RN, Jennifer Blythe, PhD, Anita Fisher, PhD, RN, Noori Akhtar-Danesh, PhD, Camille Kolotylo, PhD, RN

The purpose of this study is to describe the pre-employment profile, employment goals, and intent to migrate of a class of 281 nursing students who graduated from a university in a Canadian border community in 2011. It also explores the job factors these nurses value and their perception of whether their first job will fulfill their expectations

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The Definition of Underserviced: Policies, Issues, and Relevance

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Authors: Blythe, J., & Baumann, A.

Executive Summary:The paper begins by clarifying two terms: shortage and underserviced. Provincial and federal programs for underserviced areas in Ontario are then described and considered in terms of their relevance to nursing. Policies to address issues of shortage and underserviced areas are discussed, followed by recommendations for the future.

The terms shortage and underserviced are two perspectives on the same phenomenon. Shortage denotes inadequate numbers and is used when the supply of human resources is insufficient to meet demand (Unruh & Fottler, 2005). It refers to deficits at macro (national) and micro (organizational) levels and is used by the media to discuss shortfalls in nursing supply, particularly in hospitals. Underserviced (or underserved) denotes locations with perceived disparities in access to health care services (Barer, Wood, & Schneider, 1999). It is used to describe deficits in physician services based on physician-to-patient ratios. Communities are not considered underserviced for nurses because, unlike family physicians, most nurses do not provide services as independent practitioners. There are practical and methodological problems associated with measuring shortages and designating underserviced areas.

Most programs for underserviced areas in Ontario are for physicians, but the Ministry of Health and Long-Term Care (MOHLTC) also provides incentives for medical specialists and rehabilitation professionals. Other Initiatives by the Ontario government are aimed at improving access to primary care in underserviced areas through involvement of a range of professions and better integration of physician services into the community. Family Health Teams and increased investment in nurse practitioner (NP) educational programs are examples of such strategies.

Since regulated in 1998, NPs have had an established role in underserviced areas. It is vital to know whether they are being effectively recruited, retained, and utilized. Many NPs currently work in non-NP roles. However, anecdotal evidence suggests there are as many as a 100 vacancies for NPs in programs funded by the MOHLTC. Details of these vacancies are difficult to establish because aggregated vacancy data from these programs is unavailable. It is important to establish the exact number of vacancies and the reasons for their persistence.

Shortages within professions tend to be generalized rather than discussed in context. This means that the supply problems of smaller sectors (e.g., home care, public health) are not differentiated from those of larger sectors (e.g., acute care), and shortages in rural areas are not differentiated from those in urban centres. Differential shortages by specialty are acknowledged The Definition of Underserviced: Policies, Issues, and Relevance 3 but not well studied. The advantage of the term underserviced is that it directs attention to local variation. Focus on family physicians makes it difficult to assess health care delivery in underserviced areas. Information about local shortages among all health care workers is required.

Problems associated with underserviced areas include intractable physician shortages and overemphasis on a single type of health care service provider. Primary care characterized by independent physician practice leaves many without access to services. Implementing Family Health Teams may improve this situation, but other interventions may be needed.

Recommendations

Recommendations for health human resource planning for underserviced areas are:
• Broaden the scope of underserviced to include a range of health care services (e.g., longterm care, home care, public health) rather than restricting it to the services of selected health care professions (e.g., physicians).

• Expand the concept of shortage to identify regional, local, and specialist nursing shortages.

• Take a systemic rather than discipline-based approach to local health care.
For example:

o Create or expand collaborative organizations and networks (e.g., Family Health Teams, community health centres) for health care delivery in underserviced areas.

o Maximize the contribution of all professions with relevant competencies who are available to deliver health care services in local communities.

o Collect and organize statistical data on health professions and health services to facilitate planning health care delivery in the new Local Health Integration Networks (LHINs).

o Consolidate data about NP vacancies in a central MOHLTC repository for analysis and action.

• Construct profiles of health care services and delivery within each LHIN, including information on communities and catchment areas, health care organizations, partnerships, and alliances.

• Explore health human resource capacity in the newly established LHINs using the concepts of underserviced and shortage. For example, assess which communities within each LHIN are underserviced based on how easily residents can access health care services and whether health human resource shortages contribute to access problems.

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Educated and Underemployed: The Paradox for Nursing Graduates

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Authors: Baumann, A., Blythe, J., Cleverley, K., Grinspun, D., & Tompkins, C.

Executive Summary:

There are three sources of nursing supply: new graduates, internationally educated nurses, and nurses returning to the workforce. This report focuses on the supply and employment of new nursing graduates in Ontario and their absorption into the workforce during the two-year period covering 2003/4 to 2004/5. Historically, economic cycles have created fluctuations in supply and demand. Between 1993 and 1999, Ontario lost 7275 nurses from the system. This was largely in the hospital sector which lost 9.8% of its nursing workforce. The loss was fi nally recouped by 2003, mainly through growth in the community sector (Alameddine et al., 2006, in press).

There are currently 89,054 registered nurses (RNs) and 24,482 registered practical nurses (RPNs) working in Ontario (College of Nurses of Ontario, 2005). The largest potential employer of new nurses is the hospital sector with 24/7 service and over 31,000 patient beds. Other sectors such as community and public health are much smaller. The uptake of new graduates in Ontario is good. However, some concerns arise from market conditions and the availability of receptor sites (i.e., sites where jobs are available at a given point in time). Job opportunities are unpredictable in areas with few health care institutions. Organizations should have suffi cient annual turnover and a relatively large system to absorb new employees (Baumann, Keatings, Holmes, Oreschina, & Fortier, 2006). Employment opportunities are aff ected by economic booms and turnover resulting from retirement, job change, and workers leaving the profession or moving between sectors. Th e education system functions with relative independence from the employment market. There are no projections of required supply. From 1999 to 2004, the number of graduates in Ontario doubled, but the supply was dramatically reduced by more than half in 2005.

A survey of RN and RPN graduates in Ontario was conducted in 2004 and 2005.
The majority who responded to the surveys indicated they wanted full-time work. However, most of the contract off ers they received were part-time, casual, or temporary. Although there was a 9% increase in employed nurses with full-time status between 2004 and 2005, this may have been due to the small number of students graduating that year rather than the greater availability of fulltime work. The majority of new graduates sought employment in the central region and preferred employment in large teaching hospitals. Fewer favoured the community and public health sectors. Actual employment corresponded with these preferences.

Resurveys at six months and two years after graduation indicated that few graduates had left Ontario for employment, despite their stated intent or willingness to do so. Just over half of those who replied to the two-year follow-up of 2004 graduates had full-time contracts. Over half indicated that their employment had changed since graduation (usually from casual to full-time), suggesting that new graduates experience considerable job mobility in their first years of employment. The government of Ontario has implemented a targeted employer incentive to increase the number of full-time nurses. In addition, on May 8, 2006, a new provincial task force was created to examine the issue of full-time positions for new graduands. Other provinces have strategies to improve uptake and increase retention such as bursaries, loan forgiveness, and mentorship.

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The New Healthcare Worker: Implications of Changing Employment Patterns in Rural and Community Hospitals

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Authors: Andrea Baumann, Mabel Hunsberger, Jennifer Blythe, Mary Crea

Executive Summary:Rural health care is changing. Following restructuring in the 1990s some small hospitals remained independent, while others reorganized as amalgamations and alliances. In 2004, Ontario was divided into 14 Local Health Integration Networks (LHINs) to create accessible, quality health care at a local level. Th is study was designed to gain an understanding of the impact on nursing work and the workforce. It focused on 19 rural hospitals in Local Health Integration Network (LHIN) 2 in South West Ontario, and examined how employment patterns have evolved. Th e study provides critical information to assist policy makers in understanding the rural context of nursing practice and the eff ect of government policies on workforce sustainability.

 

Lack of a standard defi nition of rural is a challenge, and data on rural human resources is limited. Th e only report that provides statistics on registered nurses (RNs) employed in rural Canada is for the years 1996-2000. Th is study, published in 2002 by the Canadian Institute for Health Information (CIHI), is now out of date. From 1994 to 2000, the number of RNs working in rural Ontario decreased by 2.32% and increased in urban areas by 0.22%. Th e rural nurse to population ratio declined from 73 to 70 nurses per 10,000 population, similar to the urban ratio of 69.9 (CIHI, 2002). Only 47% of rural nurses had full-time employment, compared to 54.8% of urban nurses (CIHI, 2002).

The study showed that nurses in rural practice are required to be generalists with a broad range of skills that equip them to stabilize critical patients. Th e transport of critically ill patients to tertiary care centres requires a high proportion of rural nurses to be profi cient in emergency care. Nurses refer to themselves as “being it” because they have few resources on site.

Staffing and scheduling in rural hospitals presents unique challenges because of the changing census and small staff pool. A high proportion of part-time nurses are necessary for scheduling fl exibility. Th e full-time to part-time ratio in this study was 46:54. Availability of nurses to meet contingent staffi ng needs is a problem because some part-time nurses have two or three employers. Nurses are called in when the patient census is high and sent home when it is low. This “just in time” approach to hospital staffi ng causes considerable stress to both nurses and managers.

Numerous strategies are being employed by managers to improve staffi ng and scheduling practices. Cross-training is commonly used, and nurses must have a broad range of skills to care for multiple types of patients. Some managers try to predict patterns of overtime and schedule extra shifts. Th e number of overtime hours worked in one year by RNs and registered practical nurses (RPNs) was 18,452.7 hours, which translates into approximately $750,000.00. Managers also introduced cross-site employment as a way to off er full-time employment and the opportunity for nurses to focus on one specialty area.

From 2002 to 2004, there were 243 nurses hired, but only 27% were new graduates. Of the nurses that left their organization during the same time period, 66 (30%) nurses retired and 153 (70%) resigned. Given the complexities of rural practice, nurses and managers in this study reported that more orientation for new hires was essential. Mentorship is diffi cult due to limited staff availability. Innovative strategies such as rehiring experienced post-career nurses to mentor and coach newly hired nurses are recommended.

Maintaining the competence of all rural nurses is essential owing to the isolation of their practice. Upgrading programs for nurses vary across hospitals. A uniform strategy across amalgamations, alliances and independent hospitals would help to coordinate access to educational resources. Educational requirements could be assessed at the LHIN level, and the use of available resources throughout the network optimized. Th e context of rural work environments should be a consideration in establishing safe working conditions. Concerns about violence and security are foremost in the minds of nurses, patients and the public. Various approaches are currently in use to facilitate nurse protection and police access. However, these systems are not standardized, and some hospitals have more security measures than others. Minimum standards are required for all hospitals. A continued challenge is the fi t between rural needs and government initiatives/policies. Th e study hospitals reported it is diffi cult to access programs such as the new graduate and mentorship initiatives. Obstacles include small staff numbers and limited resources available to apply for and implement the programs. A rural advisory panel is needed to assist the government to address specifi c, customized policies that refl ect rural context.

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Internationally Educated Nurses in Ontario: Maximizing the Brain Gain

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Executive Summary:

The three sources of nursing supply in Canada are new graduates, internationally educated nurses (IENs) and nurses returning to the workforce. This report focuses on IENs. Globalization has led to high rates of migration of professionals to economically vibrant countries such as Canada. Because many skilled and educated migrants do not always realize their full potential in their new country, policies to maximize brain gain are imperative. The lack of comprehensive and reliable information on migration flow makes it impossible to obtain an accurate picture of migration globally or nationally (Bordt, 2002). We do not know how many IENs currently reside in Canada or Ontario. However, the Ontario workforce has the second highest percentage of internationally educated RNs in Canada (11.9%, 10,684/89,429) (CIHI, 2006a). In 2005, 34.1% (1114) of new RN members were educated abroad and an additional 13.5% (441) in other provinces. Only 52.4% (1715) of the new RN entrants to the provincial workforce had graduated from nursing programs in Ontario (CIHI, 2006a). While IENs make an important contribution to nursing supply, there is worrisome evidence that many suffer delays in obtaining professional licences. An estimated 40% of IENs who apply to the College of Nurses of Ontario (CNO) fail to complete the registration process and do not enter the workforce. In contrast, on average, between 1995 and 2003, only 2% of RNs educated in Ontario failed to complete the application process (CNO, 2005). A study was conducted to describe and analyze issues relevant to nurse migration to Ontario and investigate the experiences of IENs, including barriers and facilitators to integration in the Ontario health care system. The research team interviewed IENs and other stakeholders such as educators, employers and members of nursing and migrant support organizations. Challenges were evident at all stages in the process of entering Canada and gaining employment as a professional nurse. Lack of information from the Canadian authorities prior to migration was an impediment to migrants with limited knowledge about nursing in Canada. After settlement in Ontario, difficulties and delays occurred while completing the application process for licensure. Many IENs must make considerable investment in upgrading and further education to become eligible to take the professional nursing examinations. A number of nurses found the examinations difficult due to lack of familiarity with Canadian nursing culture and/or inexperience with the examination format. As a result, the pass rate for IENs was much lower than for nurses educated in Ontario. Finally, some IENs had difficulties when they entered the workplace. Because of their unfamiliarity with the Canadian health care system, they often required more mentoring and longer orientation than nurses educated in Canada.

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Research Team

Andrea Baumann
Jennifer Blythe
Anne Rheaume
Karen McIntosh

Better Data: Better Performance – Community Health Nursing in Ontario

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 Executive Summary:

Understanding the supply and utilization of nurses is critical to maintaining an effective community health system. There has to be sufficient staff and a work environment that builds on the existing strengths of community health nursing to meet emerging needs. This report provides a demographic profile of community health nurses (CHNs) in Ontario and identifies enablers that support optimal practice of their competencies.

In 2004, the CHN population represented 15.5% of the Ontario nursing workforce. Most CHNs are registered nurses (RNs), with only 16.7% being registered practical nurses (RPNs). The CHNs were distributed across various organizations, including 29% in home care agencies, 20% in public health, 18% in physician offices, 14% in Community Care Access Centres (CCACs), 12% in community agencies, 6% in Community Health Centres (CHCs) and 3% in community mental health. Between 1999 and 2004, there was a significant increase in the number of nurses in CCACs and the mental health sector. This study highlights the need to replace the aging community health workforce and emphasizes the importance of increasing the proportion of full-time CHNs. About half of the community health workforce (50.2%) was employed in full-time positions in 2004.

Community health nurses are well positioned to respond to evolving community health challenges and changes in health care organization. Management and CHNs in 17 focus groups, representing 8 community health sectors, identified that the optimal use of CHN competencies was associated with professional confidence, effective team functioning, good workplace environments and a supportive community context. Over 3,000 CHNs and senior management in community health answered questionnaires based on the attributes identified by the focus groups. The ability of CHNs to use their competencies effectively could be enhanced by improved interdisciplinary team functioning, management training and improved communication between management and staff nurses. Better coordination among community services would be beneficial.

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Research Team

Andrea Baumann
Jane Underwood
Jennifer Blythe
Donna Ciliska
Anne Ehrlich
Noori Akhtar-Danesh
Mohamad Alameddine
Audrey Laporte
Raisa Deber
Alina Dragan

Supply of Internationally Educated Nurses in Ontario: Recent Developments and Future Scenarios

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Authors: Jennifer Blythe & Andrea Baumann

Executive Summary:

Ontario does not educate sufficient nurses to avoid a serious shortage in the future. Therefore, it is essential that planners understand the importance of internationally educated nurses (IENs) as a supply source. This report builds on Report Number 3 in the Health Human Resource series (Baumann, Blythe, Rheaume, & McIntosh, 2006) and answers three questions: What are the characteristics of the Ontario IEN workforce? What factors are likely to influence IEN supply in the future? What are the implications of IEN migration for policy making and workforce planning?

Characteristics of the IEN Workforce

Over half of all IENs in Canada work in Ontario and comprise 10.78% of the provincial nursing workforce (College of Nurses of Ontario, 2007c.) Among nurses working in Toronto, about a quarter was educated abroad. Most internationally educated registered nurses (RNs) in Ontario come from 10 countries, with about one-third from the Philippines. The workforce profiles of IENs from these countries differ from each other and from Ontario educated nurses. Few IENs are under 30 years of age, but their age composition varies by country. Nurses from the UK are the oldest contingent and Romanian nurses are the youngest. Groups from the USSR and Yugoslavia include proportionately more men. Nurses from the Philippines, Eastern Europe and India have the highest rates of full-time work; nurses from the UK have the lowest. Most IENs work in direct practice and the majority work in hospitals. However, frequencies vary by country. For example, one-third of the nurses from China and Yugoslavia work in long-term care, proportionally more than from the other groups.

Numbers of IENs entering the workforce decreased in the 1990s, increased dramatically in 2004/5 as IENs made efforts to obtain licenses before regulations for entry to practice changed, then fell abruptly in 2006. Eastern European countries ceased to be among the top 10 IEN groups entering the workforce that year. In contrast, numbers of registered practical nurses (RPNs) entering the workforce doubled between 2005 and 2006. Rates of attrition have varied among IENs during the past decade, but overall gains have been relatively small. There were only 824 more IENs in the workforce in 2006 than in 1997.

Influences on IEN Supply

Migration usually occurs from poorer to richer nations. Global forces, push-pull factors and policy decisions all influence migration. While the worldwide nursing shortage has affected nurse migration, individual nurses have multiple motives for leaving their countries. The International Council of Nurses encourages countries to be self-sufficient but upholds the freedom of nurses to migrate. Policy decisions affect the volume of migration. The US has been assertive in attracting IENs and provides National Council Licensure Examination (NCLEX) RN testing worldwide. Canadian provinces vary in their overseas recruitment efforts.

Internationally educated nurses come from source countries with different economic characteristics. These include populous developing countries such as the Philippines and India that educate nurses for export, politically or economically unstable countries (e.g., Iran and the former USSR) and developed countries such as the UK, which acts as a conduit for nurses intending to settle in the US or Canada. Rates of migration from Africa are low, but the loss of even a few nurses negatively affects small workforces in the continent.

Implications for Policy

Without IENs, the nursing shortage in Ontario would be more severe. However, fewer IENs may enter the Ontario workforce as RNs in the future. Encouraging IENs to prepare for RPN examinations may be a useful strategy, but international competition for nurses is increasing and additional strategies (e.g., allowing nurses to take licensing examinations before migration to Canada) may be warranted.

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The Production of Critical Care Nurses: A Collaborative Evaluation of Critical Care Nursing Education in Ontario

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Authors: Fisher, A., Baumann, A., Hunsberger, M., Blythe, J., & Fitzpatrick, L.

Executive Summary:The Ministry of Health and Long-Term Care (MOHLTC), through the Critical Care and Nursing Secretariats, is committed to providing system supports to improve critical care education for nurses and assisting hospitals in meeting their human resource needs for safe and accessible care. Commissioning and supporting the development of new Critical Care Nursing Standards (CCNS) by the Nursing Subcommittee of the Critical Care Expert Panel was the first step in achieving this vision. In order to determine the extent to which these standards have been incorporated into college and hospital-based critical care nursing education programs in Ontario, the Nursing Health Services Research Unit at McMaster University was asked to conduct a collaborative evaluation of selected programs in the province.

 

The CCNS were positively received by critical care nurses in this study as a basis for improving basic critical care nursing education and specialty orientation in the province. Although there were some suggestions for minor changes, the standards were generally seen as “very thorough and well-framed with inherent specific outcomes.” However, concerns were raised about the professional ownership of and ultimate accountability for consistent implementation across the province.

Collaborative evaluation of 24 critical care nursing education programs against the CCNS demonstrated great variation within and among college and hospital-based curricula in Ontario. Mean compliance with the standards varied from 25% to 75%. These outcomes underscored the need for a standardized core curriculum for beginning practitioners in the specialty. If basic preparation in the specialization is to be portable from one hospital to another, all beginning critical care nurses should receive the same educational preparation. Further to this, nurses have consistently identified the lack of formal recognition for the education required to begin work in their specialty area. If educational preparation for the beginning critical care nurse is based on a standardized core curriculum, there should be some consideration for formal credit, either towards a baccalaureate in nursing or a critical care nursing certificate. The standardized critical care nursing curriculum should be presented in partnership with educational institutions in the province. For this to be viable and have provincial impact, strong partnerships between the educational and hospital sector and structures such as the Local Health Integration Networks (LHINs) are required. Ongoing collaborative planning at the governmental, regional and local level will be essential in making this a reality.

Precedence has been set at both the undergraduate and postgraduate level with nursing specializations such as oncology, neonatology and primary health care. These programs provide a standard approach that can be adopted across educational institutions. It may be timely to consider such an approach with critical care nurse specialization.

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