The Impact of an Aging Nursing Workforce on the Canadian Health Care System

 

The Impact of an Aging Nursing Workforce on the Canadian Health Care System

 

Introduction

Nurses are the most critical personnel in any health care facility. This is because they have an obligational responsibility of ensuring that patients receive quality care. To achieve this responsibility, they have to spend most of their time with patients monitoring their progress, performing diagnostic tests, administering medications, educating and supporting them, recording errors that may result to adverse outcomes (Twigg, Gelder, & Myers, 2015), among other duties and responsibilities. In Canada, nurses constitute the largest workforce in the health care industry. According to Statistics Canada (2019), nursing and social assistance was the most populated industry in Canada in 2016, representing 13 per cent or 2,300,000 million of the national workforce. Statistics Canada (2019) further established that the nursing and social assistance industry was among the most improved sectors in terms of workforce enrolment between 1996 and 2016, with a definite improvement of 68% per cent.

However, although there has been a massive improvement in the enrolment of nurses between 1996 and 2006, the Canadian nursing industry is still threatened by an aging workforce (60 years and above). For instance, the CIHI (Canadian Institute for Health Information) estimated in its 2018 report about the nursing shortage that by 2016, about 25 per cent of the nursing professionals would be aged 60 and above (CIHI, 2018). Additionally, by 2016, Statistics Canada (2019) established that for every 5 RNs (registered nurses) and/or RPNs (registered psychiatric nurses), there is 1 R.N. and/or RPN aged 55 and above. This trend is double less compared with 1 out of 10 as of 1996. It should be noted that registered nurses and registered psychiatric nurses constitute the largest profession in nursing in Canadian health care. An aging workforce has not affected the nursing industry only. Statistics Canada (2019) established that specialist physicians as well, are among the largest professions in the Canadian health care impacted by an aging workforce. According to Statistics Canada (2019), 31 per cent of specialist physicians constituted of older workers (60 years and above) as of 2016, compared to 23 per cent in 1996. These reports of the aging workforce in nursing implies that the Canadian health care system should fast-track its strategies in navigating the looming nursing shortage crisis. This paper presents a discussion on the background of the aging nursing workforce, the definition/scope, the benefits that senior nurses have on the Canadian health care system, the challenges, and some recommendations on how to navigate the crisis.

Background
According to the Government of Canada (2014), 23 per cent of the Canadian population will consist of seniors by 2030, compared to 15.6 per cent in 2014. Furthermore, by 2030 the average life expectancy of women and men at birth will also increase to 86.2 years and 82.9 years, as compared to 84.2 years and 80 years in 2014 (Government of Canada, 2014). These reports imply that the elderly population in Canada is not only living longer but also leading a healthier life. According to the Government of Canada (2014), the geriatric population is going through a fundamental shift where back in 2012, 1 out of 7 Canadians was a senior, whereas, in 2030, this number will rise to about 1 out of 4.

Several factors are favouring the rise of the geriatric population in Canada. Firstly, Statistics Canada (2018) attributed the surge in the senior community in Canada to the fall in fertility rates. Statistics Canada (2018) established that from the mid-1940s to mid-1960s, the rate of fertility in Canada was three or more children per woman, which fell rapidly to 1.61 children per woman in 2011. However, the average age of a woman giving birth climbed to over 30 years old in 2011 as compared to 24 years old between the 1950s and 1970s (Statistics Canada, 2018), thus suggesting a reduced time-frame for childbearing.

Secondly, the increase in the aging population in Canada is attributed to the rise in life expectancy. As aforementioned, the Government of Canada (2014), established that by 2036 the average life expectancy of women and men at birth would also increase to 86.2 years and 82.9 years, respectively, as compared to 84.2 years and 80 years in 2014. Various factors are influencing the rise in life expectancy among Canadians. For instance, the Government of Canada (2014) attribute it to advanced medical care, consequently resulting in better survival rates despite the underlying health issues, especially among the elderly. For instance, the Government of Canada (2002), Douglas (2011), and Both-Nwabuwe, Dijkstra, Klink, & Beersma (2019) reported that four out of five seniors would suffer from chronic health problems such as arthritis, rheumatism, high blood pressure, allergies, back problems, chronic heart problems, cataracts, and diabetes. However, the Canadian healthcare system has instituted viable workforce strategies to foster retention and sustainability of nurses to cater to such old-age complications adequately.

Ironically, however, as Canada’s geriatric population is surging, so does its nursing workforce. This phenomenon is an issue of national concern as it has negative implications on the Canadian nursing system (the backbone of the health care industry). For instance, The McGill Nursing Collaborative for Education and Innovation in Patient-and Family-Centered Care (2019) observed that geriatric nurses exhibit lower rates in workforce participation than their youthful colleagues. Thus, if this trend persists, then the Canadian nursing industry risks experiencing a severe nursing shortage, implying that patients will lack sufficient nursing services (Sasso et al., 2019). However, contrary to The McGill Nursing Collaborative for Education and Innovation in Patient-and Family-Centered Care (2019) observation, Douglas (2011): RNAO (2017): Shin (2018) observe that geriatric nurses are just as competent as their youthful colleagues provided that the workplace environment is not stressful. Stressful workplace environment negatively impacts the well-being of geriatric nurses, resulting to adverse outcomes including insurmountable stress, burnout, workplace violence, job dissatisfaction, absenteeism, and worst of all exiting their position and/or the profession (Douglas, 2011, RNAO, 2017, Shin, 2018).

It is noteworthy that of the results as mentioned earlier of stressful workplace environment on geriatric nurses, workplace violence has the worst far-reaching implications. According to CNA (2019), workplace violence refers to any kind form of either verbal or physical abuse from colleagues, patients, or from persons in authority towards geriatric nurses due to their (geriatric nurses) age. The ultimate reward for workplace violence towards geriatric nurses is that it dampens their spirit for workforce participation, consequently triggering their intention to exit the nursing profession (RNAO, 2017).

Definition and Scope

Land & Lamb (2017) define population aging as the changes in the age composition of a population such that there is an increase in the proportion of the older population. For Canada, population aging is a phenomenon that impacts the entire country. The phenomenon is attributed to two significant factors, namely; low population growth and high life expectancy. The initial factor (low population growth) is triggered by the decrease in the fertility rate of Canadian women and a rise of their childbearing age. Statistics Canada (2018) reported that from the mid-1940s to mid-1960s, the rate of fertility in Canada was three or more children per woman, which fell rapidly to 1.61 children per woman in 2011. However, the average childbearing age climbed to over 30 years old in 2011 as compared to 24 years old between the 1950s and 1970s (Statistics Canada, 2018).

As for the latter factor (high life expectancy), it is triggered by projected that by the advanced medical care, consequently resulting to better survival rates despite the underlying old-age health complications (such as arthritis, rheumatism, high blood pressure, allergies, back problems, chronic heart problems, cataracts, and diabetes) (Steensma, Loukine, & Choi, 2017). It is important to note that even though the increased age does not necessarily mean disability or any health issue, the demands of the aging population are expected to increase. Thus, there is a need to promote healthy aging and provide optimal care to the elderly population. As for geriatric nurses who are still in the workforce, there is a need to integrate them for their resourcefulness despite their age by providing them with an accommodative workplace environment Douglas (2011): RNAO (2017): Shin, Park, & Bae (2018).

Benefits and Challenges
As aforementioned, nurses are the most critical personnel in any health care facility because they have an obligational responsibility of ensuring that patients receive quality care. On the other hand, the nursing profession records the highest rate of absenteeism than any other personnel in the health care industry (CFNU, 2012). According to CFNU (2017), nurse absenteeism cost the Canadian health care system approximately $989,000,000 in 2010. Drenan & Ross (2019) observed that old age is among the significant causes of absenteeism in the nursing profession. Thus, the health care system and the government must implement proper strategies to keep senior nurses in the profession. It is evident that high rates of nurse turnover negatively impacts the Canadian health care system. According to CFNU (2012), 1 out of 5 nurses in Canada exit the nursing profession every year due to geriatric-related complications. Based on the Canadian data between 2005 and 2008, CFNU (2012) observed an average exit rate of 13 per cent of nurses above the age of 60.

Nurse turnover is expensive for a health care facility. Hairr, Salisbury, Johannsson, & Redfern-Vance (2014) estimated the cost of nurse turnover to range from $42,000 to $80,000. In Canada, CFNU (2012) estimated the cost of nurse turnover per nurse to be as high as $25,000. These costs are attributed to the expenses incurred for the replacement of an exiting nurse through recruitment, orientation, in addition to other additional turnover costs (CFNU, 2012). One may argue that, why not replace the exiting senior nurses with new ones? But what if the new nurses leave the profession after recruitment and training? Hairr, Salisbury, Johannsson, & Redfern-Vance (2014) reported that 30 per cent of newly recruited nurses exit the profession within five years in France as is 43 per cent in Quebec (Lavoie-Tremblay, O’Brien-Pallas, Gélinas, Desforges, & Marchionni, 2008), 30 per cent in New Zealand, and 20 per cent in Australia (The McGill Nursing Collaborative for Education and Innovation in Patient-and Family-Centered Care, 2019). The findings illustrate a multinational trend in the rate of turnover for new nurses, implying that it is cheaper for health care facilities to retain their senior nurses (60 years and above) and capitalize on their experience in nursing than recruiting new nurses.

Recommendations

As discussed, it is evident that the aging nursing workforce will have negative implications on the Canadian health care system. Even though inadequate nurse staffing also negatively impacts the nursing profession, subjecting old nurses to the stressful work environment and overburdening them with bigger workloads can trigger them to exit the profession. Based on the literature discussion, concerns of the old nurses must be prudently addressed to improve the quality of the health care systems as well as patient care.

Firstly, despite the plethora of findings regarding this topic, I believe that the Canadian health care system should implement strategies that can promote the retention of nurses. Such strategies include the provision of safe and healthy workplace conditions and sufficient nurse staffing. If implemented, these strategies would encourage job satisfaction among nurses, reduce burnout and stress, thereby promoting nurse retention. Healthy workplace environments comprise of many factors, including authentic leadership practices, teamwork, professional autonomy, as well as professional development opportunities. In the UK, Portugal, and Finland, for example, nurses have flexible working hours and self-scheduling programs that promote job satisfaction and reduce burnout and stress. Thus, I would recommend the Canadian government and other stakeholders to emulate these nations by making prudent investments to improve the retention of old nurses as it will help to cushion the industry in the wake of the forecasted nursing shortage.

Secondly, as discussed, poor workplace environment that promotes verbal or physical abuse of the elderly nurses triggers absenteeism as well as their desire to quit the profession, thereby creating a nursing shortage. A healthy work environment, according to The McGill Nursing Collaborative for Education and Innovation in Patient-and Family-Centered Care (2019), is one whereby the authority provides the practices, policies, and structures that favour nurses to participate in the workplace duties and establish workplace relationships that promote quality patient care results. Therefore, I believe that through instituting favourable workplace environment, for example, by reducing their workloads and lowering the job’s physical demands can improve absenteeism. As for reducing the rate of nurse turnover, I would strongly recommend that the Canadian health care system implements proper nurse staffing to improve nurse retention.

Thirdly, since the nursing profession in Canada is gripped with a looming crisis of nurse shortage, I would recommend that Canada’s health care system coordinates well with the education sector in order to increase the supply of nurses in the future. The strategy has proven to be fruitful in several E.U. countries like the UK, Finland, Denmark, and Ireland (Attree, Flinkman, Howley, Lakanmaa, Lima-Basto, & Uhrenfeldt, 2011). It is important to note that this recommendation does not mean that the Canadian government should increase the number of institutions offering nursing courses or the number of students.  This is because the number of students that a nursing institution can admit for its programs shall limit the admission of students as well as the costs of education, thereby limiting the nurses’ wages and the ability of the nursing profession to influence prospective applicants (Attree, Flinkman, Howley, Lakanmaa, Lima-Basto, & Uhrenfeldt, 2011). Apart from the Canadian government coordinating with the education sector so as to increase the supply of nurses in the future, I would recommend that the government encourages health care institutions to outsource nursing services by hiring qualified nurses from other countries. It is noteworthy that this strategy has proven to work for many industrialized such as Denmark.

Conclusion
The demographic shift in Canada, as established in this discussion, is going to have a significant impact on both patient care and nursing practice. The increased number of senior Canadians, along with a longer life span, are putting pressure on the health care system, thus causing it to adapt very quickly. As nurses are in the centre of health care, they must identify different strategies to integrate elderly nurses in the workforce while recruiting newer nurses (either domestically or internationally) to replace the outgoing older ones. This discussion paper has presented three recommendations; Firstly, the Canadian health care system should implement strategies that can promote the retention of nurses, such as the provision of safe and healthy workplace conditions and sufficient nurse staffing. Secondly, health care stakeholders should institute a favourable workplace environment, for example, reducing their workloads and lowering the job’s physical demands to improve absenteeism. As for reducing the rate of nurse turnover, the researcher recommended that the Canadian health care system should implement proper nurse staffing to improve nurse retention. Finally, it was recommended that Canada’s health care system coordinates well with the education sector in order to increase the supply of nurses in the future. Additionally, apart from the Canadian government coordinating with the education sector so as to increase the number of nurses in the future, the researcher recommended that the government of Canada should encourage health care institutions to outsource nursing services by hiring qualified nurses from other countries.

 

 

 

 

 

 

 

 

 

 

 

 

 

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