• The Issue

    The Nursing shortage is a major problem in Canada. Canada currently also has no regulations regarding staffing levels (Bernat, 2007). Nurses are at the frontline in healthcare and spend the most time with patients across all healthcare professionals. Short staffing of nurses compromises the level of care patients receive, putting both patient safety and nurses' jobs at risk.

    Why You Should Care

    YOU the Nurse:Nurses who work in areas with nursing shortages are more likely to experience job dissatisfaction, fatigue, and burnout (Berry & Curry, 2012). Errors in care are more likely to occur because of this (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). Nurses are legally responsible for their patients and risk job loss and legal charges if patient safety and well being become compromised. Having more nurses will decrease the workload of nurses and decrease the chances of overlooking important aspects of care.

    YOU the Patient:Nurses are the healthcare professional that spends the most time caring for the patient. They give you your medications and various treatments, help you move around, bathe, toilet, and spend time with you and talk when you need it. They help you when you feel scared or alone, and when you are in pain or uncomfortable. They advocate for your needs and rights, and when they are short staffed, they have less time to give you the care you need.

    YOU the Public: Even if you have never been in a hospital, you or a loved one could be there at any time. You have the right to receive the best care possible when needed, and should expect that your loved ones will receive the same when they are in need. When the time comes for someone to need nursing care, they should expect the best care, and helping stop the nursing shortage will help us achieve this.

    Please look through our website for more information, and sign our petition if you want changes to be made to help stop the nursing shortage.

  • Our Mission

    To raise awareness amongst the public, nurses, health professionals, and all levels of government about the issue of the nursing shortage, short staffing and its related impacts on quality patient care and safety, nurses’ health, and its impact on the health care system at large.

    About Us

    We are a group of passionate 4th year Nursing students at the University of Ottawa, Ottawa (ON), Canada. Our group members are:

    • Matthew Bullock
    • Mosammat Nazneen
    • Emily R. C. Bulmer
    • Megan Doyle
    • Samantha E. Thompson
    • Fabiola E. Tatone-Tokuda.

  • CNO & CNA standards

    Nurses are expected to adhere to standards that ensure the public's safety. The standards set by the CNO include: Accountability, continuing competence, ethics, knowledge, knowledge application, leadership, and relationships (CNO, 2011; College of Nurses of Ontario, 2002). The CNA Code of Ethics also dictates that nurses must: Provide safe, compassionate, competent and ethical care; promote health and well-being; promote and respect informed decision-making; preserve dignity; maintain privacy and confidentiality; promote justice; and be accountable (CNA, 2008). When the nursing workload proves too much to bear, nurses are at risk of compromising nursing ethics and standards. A significantly large workload can lead to the shortage of nurses. The consequences of a nursing shortage can significantly compromise the nursing profession and the public.

    Factors leading to a Nursing Shortage

    There is no doubt that a heavy workload can lead to a nursing shortage. Studies have shown that nurses who are forced to take on heavier workloads fall victim to burnout and absenteeism (MacKusick & Minick, 2010). The inherited larger workload has intimidated nurses from picking up their own phones on their days off for fear that they may feel pressured to come in to work (MacKusick & Minick, 2010). Due to the large workloads which lead to fatigue and job dissatisfaction, it is estimated that 30-50 percent of nurses decide to either change positions or leave nursing all together within the first three years of practice ( MacKusick & Minick, 2010). Other predictions indicate that nursing vacancy rates will reach 29% by 2020 (Sawatzky & Enns, 2012). Other consequences of a heavy workload that contribute to compromised nursing integrity include: Lack of competent, honest and ethical managers and lack of compassion satisfaction (pleasure one gets from doing their job well) (Sawatsky & Enns, 2012). Most significantly nurses experience emotional distress caused by the inability to provide proper patient care. The shortage has made nurses feel that their efforts in patient care are compromised (MacKusick & Minick, 2010).

  • Facts & Stats on the Nursing Shortage, Short-staffing, and Burn-out:

    • • Although approximately 268,512 Registered Nurses (RN) were employed in Canada as of 2010 (Canadian Institute for Health Information, 2011), there was a shortage of 11,000 Full-Time-Equivalent (FTE) RNs to meet health-care needs in 2007, and, given the current trend, this is projected to climb to a shortage of 60,000 FTE RNs by 2022 (Canadian Nurses Association (CNA), 2009);

    • • The College of Nurses of Ontario (CNO) does not specify the maximum hours a nurse can work and does not plan to pursue any legislation regarding this issue (CNO, 2012);

      • Impacts on Patients:

    • • Mortality rates, hospital acquired pneumonia, urinary tract infections, surgical site infections, sepsis, nosocomial infections, pressure ulcers, upper gastrointestinal bleeding, shock and cardiac arrest, medication errors, falls, and longer stays in hospital (Cimiotti, Aiken, Sloane, & Evan, 2012; Needleman, Buerhaus, Mattke, & Stewart, 2002);

    • • The odds of a patient dying under a nurse’s care increase by 7% for every one surgical patient added to a nurse’s workload (Aiken, Clarke, Sloane, Sochalski, & Hiber, 2002);

    • • The odds of dying from pneumonia have been reported to increase by 31% in hospitals where nurses work long hours, and by 24% when nurses have limited breaks between shifts (Trinkoff et al., 2011);

    • • Nurse fatigue is associated with reduced patient safety, diminished judgment, poor decision-making, reduced concentration and slowed reaction time, clinical errors, and decreased quality of interactions with patients and colleagues, among others (CNA, 2010);

    • • The likelihood of making an error (including medication errors, procedural errors, charting errors, and transcription errors) has been found to be three times higher in nurses who work 12.5 hours or more in a shift (Rogers, Hwang, Scott, Aiken, & Dinges, 2004);

    • • Increased nursing staffing levels were shown to predict fewer occurrences of Methicillin resistant staphylococcus aureus (MRSA) infection in a recent Canadian study (Manojlovich, Souraya, Covell, & Antonakos, 2011);

    • • Staffing units with degree-prepared nurses who can work to their full scope of practice improves patient care and improves nurses’ job satisfaction which in turn impacts patient’s health behaviour (Canadian Health Services Research Foundation, 2004).

      • Impacts on Nurses:

    • • Increased job dissatisfaction (Aiken et al., 2001; Aiken et al., 2013);

    • • Increased fatigue, burnout, absenteeism, and turnover (Canadian Federation of Nurses Unions (CFNU), 2011; CNA & Registered Nurses Association of Ontario (RNAO), 2010; Berry & Curry, 2012; O’Brien-Pallas, Tomblin Murphy, Shamian, & Hayes, 2010);

    • • Each week in 2010, an average of 19,200 Canadian nurses were absent from work due to illness or disability, a cost of $711 million (CFNU, 2011);

    • • In comparison to nurses who work 8.5 hour shifts, nurses who work 12 hours or more are more likely to have needle-stick injuries, musculoskeletal disorders, drowsy driving which increases the risk of collisions, and sleep deprivation with its associated health consequences (Geiger-Brown & Trinkoff, 2010).

      • Impacts on Healthcare Costs:

    • • Overall, the costs of increasing RN staffing have been shown to be offset by the costs saved through a reduction in post-discharge ER visits (Bobay, Yakusheva, & Weiss, 2011) and through the financial benefit of saving lives (Shamliyan, Kane, Mueller, Duvall, & Wilt, 2009).

  • Action is needed!

    1. Government funding from all levels and policies to focus on improving nursing workloads and providing adequate staffing to improve quality of nursing work life are needed to ultimately improve patient outcomes, patient care and have positive financial implications (Berry & Curry, 2012; CNA, 2010);

    2. Regulatory requirements and funding to address staffing levels and mandatory nurse-to-patient ratios must be implemented using evidence-based safe staffing models (Berry & Curry, 2012);

    3. The benchmarks currently used to evaluate the healthcare system must move beyond “wait-times” and other volume/performance indicators to include nursing indicators such as a reduction in absenteeism, fatigue, burnout, and turnover so as to enforce a safe and accountable health care system that provides quality patient care (Berry & Curry, 2012; CNA, 2010);

    4. Employers must be held accountable for staffing decisions and related impacts on patients, staff, and budgets (Berry & Curry, 2012);

    5. Policies must be instated to increase enrolment in RN educational programs and improve retention of practicing RNs to reduce the nursing shortage (CNA, 2009; CNA 2010);

    6. Awareness must be raised to inform the public, nurses, health professionals, and all levels of government about the issue of nurse fatigue and its related impacts on patient safety, nurses’ health and job satisfaction, and its impact on the health care system at large (CNA 2010).

  • Poll

  • Petition

    Petition to stop nurse burnout from heavy patient work load
     To:
    The Honourable Leona Aglukkaq
    Minister of Health
    Health Canada, Brooke Claxton Building, Tunney's Pasture
    Postal Locator: 0906C
    Ottawa, ON K1A 0K9 Canada

    and

    The Honourable Deb Matthews
    Ontario Ministry of Health and Long Term Care
    M-1B114, Macdonald Block
    900 Bay Street
    Toronto, ON M7A 1N3 Canada

    Date: March 20, 2013

    Summary: A shortage of 60,000 FTE RNs is projected by the year 2022. Action is needed as short-staffing leads to nurse burn-out, negative patient outcomes, and increased healthcare costs! Funding and policies are needed immediately to provide adequate staffing and regulate nurse-to-patient ratios.

    We, the undersigned Nurses and residents of Canada, urge the Ministry of Health to pass strict federal and provincial policies and regulations to address staffing levels and the patient workload in Canadian health institutions. The nursing shortage has led to short-staffing and unsafe nurse-to-patient ratios. Funding and strict policies are needed to implement evidence-based safe staffing levels that will protect nurses from burnout due to a high patient work load and lack of support, and to protect patients from unsafe practices.

    Having overworked nursing staff results in negative nurse outcomes, such as: Increased stress, fatigue, high blood pressure, headaches, increased injuries, burnout, absenteeism and turnover. As a result, patients are also affected as nurses are unable to keep up with a heavy patient workload, leading to increased medical errors, unsafe patient care, and poor patient outcomes. As we very well know, such negative outcomes affect patients’ valuable lives and impacts overall healthcare costs.

    We urge the Government and Ministry to investigate this matter and set standards and strict regulations to address nurse burnout and provide appropriate supports by:

    1. Implementing regulatory requirements and funding to address staffing levels and mandatory nurse-to-patient ratios using evidence-based safe staffing models;

    2. Implementing regular audits in hospitals and health institutions to ensure adequate support for nurses are provided and to hold employers accountable for staffing decisions and related impacts on patients, staff, and budgets;

    3. Re-evaluating the benchmarks currently used to evaluate the healthcare system to move beyond “wait-times” and other volume/performance indicators to include nursing indicators such as a reduction in absenteeism, fatigue, burnout, and turnover so as to enforce a safe and accountable health care system that provides quality patient care;

    4. Ensuring increased enrolment in RN educational programs and improve retention of practicing RNs to reduce the nursing shortage.

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  • References

    Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R., Clarke, H., … Shamian, J. (2001). Nurses' reports on hospital care in five countries. Health Affairs, 20, 43-43.

    Aiken, L.H., Sloane, D.M., Bruyneel, L., Van den Heede, K., Sermeus, W., RN4CAST Consortium. (2013). Nurses' reports of working conditions and hospital quality of care in 12 countries in Europe. International Journal of Nursing Studies, 50, 143-53.

    Aiken, L., Clarke, S., Sloane, D., Sochalski, J., & Hiber, J. (2002). Hospital nurse staffing, patient mortality, nurse burnout, and job satisfaction. Journal of the American Medical Association, 288, 1087-1993.

    Bernat, N.L. (2008). Chapter 12: Effective staffing. In P. Kelly, & H. Crawford (Eds.), Leadership and Management, First Canadian Edition (pp. 214-236). Scarborough, ON: Nelson Education Ltd.

    Berry, L., & Curry, L. (2012). Nursing workload and patient care: Understanding the value of nurses, the effects of excessive workload, and how nurse-patient ratios and dynamic staffing models can help. Ottawa, Ontario: The Canadian Federation of Nurses Unions. Retrieved from http://www.nursesunions.ca/sites/default/files/cfnu_workload_printed_version_pdf.pdf

    Bobay, K., Yakusheva, O., & Weiss, M. (2011). Outcomes and cost analysis of the impact of unit-level nurse staffing on post-discharge utilization. Nursing Economics, 29, 69-87.

    Canadian Federation of Nurses Unions. (2011). Trends in own illness or disability-related absenteeism and overtime among publicly-employed registered nurses: Quick facts. Ottawa, ON: Informetrica Limited. Retrieved from http://www.nursesunions.ca/report-study/trends-in-own-illness-or-disability-related-absenteeism-and-overtime-among-publicly-e-0

    Canadian Health Services Research Foundation. (2004). Evidence-based standards for measuring nurse staffing and performance. Ottawa, ON: Author. Retrieved from www.cchrsf.ca

    Canadian Institute for Health Information. (2011). Regulated nurses: Canadian trends, 2006 to 2010. Ottawa, ON: Author. Retrieved from https://secure.cihi.ca/free_products/RegulatedNursesCanadianTrends2006-2010_EN.pdf

    Canadian Nurses Association. (2008). Code of ethics for registered nurses. Ottawa, ON: Author. Retrieved from http://www.cna-aiic.ca/en/improve-your-workplace/nursing-ethics/

    Canadian Nurses Association. (2009). Tested solutions for eliminating Canada’s Registered Nurse shortage. Ottawa, ON: Author. Retrieved from http://www.nursesunions.ca/sites/default/files/rn_shortage_report_e.pdf

    Canadian Nurses Association. (2010). Position statement: Taking action on nurse fatigue. Ottawa, ON: Author. Retrieved from http://www2.cna-aiic.ca/CNA/documents/pdf/publications/PS112_Nurse_Fatigue_2010_e.pdf

    Canadian Nurses Association, & Registered Nurses Association of Ontario. (2010). Nurse fatigue and patient safety: Research report. Ottawa, ON: Canadian Nurses Association. Retrieved from http://www2.cna-aiic.ca/CNA/practice/safety/full_report_e/files/fatigue_safety_2010_report_e.pdf

    Cimiotti, J.P., Aiken, L.H., Sloane, D.M., & Wu, E.S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40, 486-490.

    College of Nurses of Ontario. (2002). Professional standards. Toronto, ON: Author. Retrieved from http://www.cno.org/Global/docs/prac/41006_ProfStds.pdf

    College of Nurses of Ontario. (2011). Standards and guidelines. Toronto, ON: Author. Retrieved from http://www.cno.org/learn-about-standards-guidelines/publications-list/standards-and-guidelines/

    College of Nurses of Ontario. (2012). Nursing and fatigue. Toronto, ON: Author. Retrieved from http://www.cno.org/learn-about-standards-guidelines/educational-tools/ask-practice/nursing-and-fatigue/

    Geiger-Brown, J., & Trinkoff, A.M. (2010). Is it time to pull the plug on 12-hour shifts?: Part 1. The evidence. The Journal of Nursing Administration, 40, 100-102.

    MacKusick, CI., & Minick, P., (2010). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. MedSurg Nursing, 19, 335-40.

    Manojlovich, M., Souraya, S., Covell, C., & Antonakos, C. (2011). Nurse dose: Linking staffing variables to adverse patient outcomes. Nursing Research, 60, 214-220.

    Needleman, J., Buerhaus, P., Mattke, S., & Stewart, M. (2002). Nurse staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346, 1715-1722.

    O’Brien-Pallas, L., Tomblin Murphy, G., Shamian, J., Li, X., & Hayes, L. (2010). Impact and determinants of nurse turnover: A pan-Canadian study. Journal of Nursing Management, 18, 1073-1086.

    Rogers, A.E., Hwang, W.T., Scott, L.D., Aiken, L.H., & Dinges, D.F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23, 202-212.

    Sawatzky, J.V., & Enns, C. (2012). Exploring the key predictors of retention in emergency nurses. Journal of Nursing Management, 20, 696-707.

    Shamliyan, T., Kane, R., Mueller, C., Duvall, S., & Wilt, T. (2009). Cost savings associated with increased RN staffing in acute care hospitals: A simulation exercise. Nursing Economics, 27, 302-331.

    Trinkoff, A., Johantgen, M., Storr, C., Gurses, A., Liang, Y., & Han, K. (2011). Nurses’ work schedule characteristics, nurse staffing, and patient mortality. Nursing Research, 60, 1-8.

Nurse Burnout Affects You Copyright 2013