Transcript Health Human Resources Planning

Getting it Right: Planning for Nursing
Resources Based on Needs of
People
International Seminar of PROFAE
Salvador, Brazil, July 25, 2006
Dr. Gail Tomblin Murphy
Dalhousie University
Halifax, Nova Scotia
Canada
Nursing in Canada
•
•
Nursing workforce in Canada includes
three occupational groups
• 250,000 Registered Nurses;
• 6,000 Registered Psychiatric Nurses;
• 60,000 Licensed Practical Nurses
To obtain a license to practice nursing,
individuals must demonstrate theoretical
knowledge, clinical practice skills, as well
as pass a national exam
Acknowledgements

Team:
• Dr. Linda O’Brien-Pallas, Dr. Stephen
Birch, Dr George Kephart, research team
(health services researchers and policy
makers) in ten jurisdictions.

Funders:
• Health Canada, HRSDC,CHSRF, CIHR,
NSHRF, OMHLTC, Saskatchewan
Innovation and Science Fund, and Capital
District Health Authority.
General Features of Work:


Collaborative
• Multi-jurisdictional
• Education and Health ministries
• HHR researchers and government planning officials
Innovative
• Population health needs-based
• Testing effectiveness of planning/policy scenarios
• Readily adaptable to new
data/assumptions/commitments
Traditional HHR Planning

Most HHR planning has been:
• poorly conceptualized
• intermittent
• varying in quality
• supply-driven
• profession-specific
• made without consideration of changes in
health care needs and service provision
• made without vision or data
Challenges
Infrastructure
 Evidence
 Capacity
 Funding

Opportunities

Partnerships

Needs based and context based
planning

Data investment
Health System and Health Human Resources
Planning Conceptual Framework1
Health
Outcomes
Supply
Population
Health
Needs
Production
(education
and training)
System
Design
PLANNING & FORECASTING
Management
organization
& delivery of
services
across
sectors
Resource
Deployment
and
Utilization
Provider
Outcomes
Financial
Resources
1O’Brien-Pallas, Tomblin Murphy, Birch, 2005 (adapted from 1O’Brien-Pallas, Tomblin Murphy, Birch, & Baumann , 2001, and
O’Brien-Pallas & Baumann, 1997)
System
Outcomes
Efficient
Mix
of Resources
(Human &
Non-Human)
Analytical Framework
(Birch, Tomblin
Murphy, Kephart, O’Brien-Pallas, MacKenzie, 2005)

Estimates the health services required to meet
the needs of the population that is then
translated into the required health providers to
deliver this service.

Provider Supply
• ‘How many providers are (or will be) available to
deliver health care services to the population?’

Provider Requirements
• ‘How many providers are required to ensure
sufficient ‘flow’ of health care services to meet the
needs of the population?’
Some Profession Specific
Simulation Results


LPNs
RNs
Effects of Individual Policy Changes on LPN
Gap by Future Year, Needs Follow Observed
Trends, Atlantic Canada, 2002.
1000
(6)
500
(7)
(3)
0
0
5
10
15
20
25
30
35
40
LPN Gap
(8)
-500
(5)
-1000
Make No Changes (1)
Increase Training Seats by 20% (From 407 to 488) (2)
-1500
(4)
Decrease Program Attrition by 10% (From 11% to 10%) (3)
Decrease Grad Out-Migration by 20% (From 10% to 8%) (4)
(2)
Increase In-Migration by 10% (5)
-2000
Decrease LPN Exit Rates by 10% (6)
Shift 20% of Part-time LPNs to Full-Time (7)
Increase Productivity by 0.5% per Year (Compounded) (8)
-2500
Future Years
(1)
Effects of Cumulative Policy Changes on LPN Gap by
Future Year, Needs Follow Observed Trends, Atlantic
Canada, 2002
3000
(8)
2500
(7)
2000
1500
(5)
LPN Gap
1000
(6)
(4)
(2)
500
(3)
0
0
5
10
15
20
25
30
-500
-1000
-1500
-2000
Make No Changes (1)
Increase Training Seats by 20% (From 407 to 488) (2)
… AND Decrease Program Attrition by 10% (From 11% to 10%) (3)
… AND Decrease Grad Out-Migration by 20% (From 10% to 8%) (4)
… AND Increase In-Migration by 10% (5)
… AND Decrease Exit Rates by 10% (6)
… AND Shift 20% of Part-Time LPNs to Full-Time (7)
… AND Increase Productivity by 0.5% per Year (Compounded) (8)
-2500
Future Years
(1)
35
40
Effects of Individual Policy Changes on RN Gap by
Future Year, Needs Follow Observed Trends,
Atlantic Canada, 2002
0
0
5
10
15
(7)
-2,000
-4,000
(6)
RN Gap
(5)
-6,000
Increase
Productivity
(8)
20
25by 0.5% per Year
30 (Compounded)35
Decrease Exit Rates by 10% (6)
Shift 20% of Part-time RNs to Full-Time (7)
Increase In-Migration by 10% (5)
Decrease Grad Out-Migration by 20% (From 35% to 28%) (4)
Decrease Program Attrition by 10% (From 20% to 18%) (3)
Increase Training Seats by 20% (From 977 to 1172) (2)
Status Quo (1)
-8,000
(8)
-10,000
(4)
(3)
-12,000
(1)
-14,000
Future Years
(2)
40
Effects of Cumulative Policy Changes on RN
Gap by Future Year, Needs Follow Observed
Trends, Atlantic Canada, 2002
0
0
5
10
15
20
25
30
35
-2,000
-4,000
RN Gap
(8)
-6,000
(7)
(6)
-8,000
-10,000
-12,000
-14,000
Make No Changes (1)
Increase Training Seats by 20% (From 977 to 1172) (2)
… AND Decrease Program Attrition by 10% (from 20% to 18%) (3)
… AND Decrease Grad Out-Migration by 20% (From 35% to 28%) (4)
… AND Increase In-Migration by 10% (5)
… AND Decrease Exit Rates by 10% (6)
… AND Shift 20% of Part-Time RNs to Full-Time (7)
… AND Increase Productivity by 0.5% Per Year (Compounded) (8)
Future Years
(4)
(5)
(2)
(1)
(3)
40
Recommendations

Need based Planning

Data Investment

Partnerships
Recommendations

Needs-Based Planning
• Considering changes needs of people across
•
age, gender, and social groups.
Considering social, economic, cultural,
technological, political, geographic factors
Recommendations

Data Investment
• Ongoing investment in accessible,
•
•
comparable, and comprehensive data for
HHR planning is critical.
Ongoing data collection on the variables
needed for the supply, training, work and
productivity and needs modules
Learning from best practices
Recommendations:
• Partnerships
• Policy community (both the Ministries of
•
Education and Health), the education
community, regional health authorities,
communities, NGOs, the research community
and others are essential.
Need to commit to sharing tools, best
practices, frameworks, data, analytical
models, data, etc
Collaborative Pan Canadian
Framework: Implications for Nursing
Relevance to the Nursing Sector
in Canada


Building the Strategy for Nursing
Human Resources in Canada.
http://www.buildingthefuture.ca/
An extensive consultation process
designed to seek the views and
opinions of a wide range of nursing
stakeholders in Canada on about
nursing
Building the Strategy for Nursing
Human Resources in Canada.

5 years study with 2 phases and
examined the nursing workforce for all
three regulated nursing professions in
Canada.
• Phase I: 15 research reports on areas such
•
as nursing mobility, the international labour
market, nursing education in Canada, and
many others.
Phase II: Pan-Canadian HHR strategy in
consultation with government and nongovernment stakeholders.
Summary of Recommendations





Create a stable supply of nurses.
Develop a pan-Canadian approach to nursing education
in collaboration with the provincial, territorial and federal
governments to prepare the number of qualified graduates
needed to meet workforce needs.
Enhance data collection to improve HHRP.
Use a HHRP Framework based on population health
needs to plan for nurse resources.
Use evidence-based practices to inform staffing decisions
including retention and recruitment decisions.
Summary of Recommendations





Implement effective and efficient mechanisms
to address workload issues and improve
patient, nurse, and system outcomes.
Create work environments that maximize
patient, nurse and system outcomes.
Improve and maintain the health and safety of
nurses.
Develop innovative approaches to expand
clinical experiences in nursing education.
Maximize the ability of nurses to work in their
full scope of practice.
Three Priority Pan-Canadian
Strategies to deal with Nursing HR
Challenges

Optimize use of nurses' knowledge and skills - Allow
nurses to practice to their level of competency in all clinical
settings.

Link planning with other health professions - Develop a
pan-Canadian interprofessional health human resource
strategy.

Ensure a future supply of nurses - Provide funding to
increase the capacity of nursing education programs in
Canada.
•
Need to devote adequate funding to increase the supply of nurses
by increasing the capacity of nursing education programs in
Canada.
Workplace Priorities



Compile “Best Practices” that outline effective workplace
strategies that create effective working environments, and
maximize nurse and system outcomes.
Create a coordinated pan-Canadian strategy to inform
health system managers and policy-makers regarding the
relationship between workload and quality of patient care
and nurse health.
Address issues related to workplace health and safety
and working environments to ameliorate the effects of
overwork and burnout.
Pan-Canadian Strategies to Create a
Stable Supply of Nurses



Broaden the HHR planning framework to
be inclusive of other health professions
Develop an integrated health profession
HHR strategy
Standardize and streamline the
regulation and licensure of nurses
among jurisdictions in Canada to
facilitate mobility
Pan-Canadian Strategies to Create a
Stable Supply of Nurses (Cont’d)



Develop national standards to assess
the competencies of internationally
educated nurses
Establish supports to facilitate the
integration of such nurses into Canadian
society
Work to identify and minimize barriers to
the immigration of nurses while
establishing policies to prohibit unethical
“poaching” of nurses
Pan-Canadian Strategies for Nursing
Education



Establish a national strategy to recruit
First Nation, Inuit and Métis
Develop consistent pan-Canadian
standards for nursing education
Devote adequate funding to increase the
supply of nurses by increasing the
capacity of nursing education programs
in Canada
Pan-Canadian Strategies for Nursing
Education (Cont’d)



Provide funding assistance in the form of
scholarships and bursaries, tax
incentives for nurses who re-enter the
profession and programs to address
tuition debt relief for nurses
Promote education for nurses at the
Masters and PhD level
Develop a long-term strategy to educate
and recruit nursing faculty
Pan-Canadian Strategies to Expand
Clinical Experiences in Nursing
Education

Explore full potential of technology to enhance
learning opportunities for nurses in Canada;
e.g.:
• Web-based learning, telehealth, simulation labs




Increase simulated learning experience
Develop innovative opportunities to integrate
student placements across sectors
Fund clinical experiences in a variety of
geographical areas
Explore the development of pan-Canadian
clinical learning experiences
Pan-Canadian Strategies to Expand
Clinical Experiences in Nursing
Education (Cont’d)



Fund clinical experiences in a variety of
geographical areas
Appropriately recognize and compensate
the role of preceptor/mentor in clinical
education
Provide adequate funding for ongoing
continuing education.
Pan-Canadian Strategies to Enhance
Data Collection for HHR Planning





Develop frameworks and tools to needs based
HHR planning
Develop a unique identifier for students and
registrants in nursing groups to permit long-term
follow-up
Standardized criteria for data collection to
support HHR planning
Develop a national database for nursing HHR
Coordinate the activities of nursing research
units to share results and develop common
research agendas
Pan-Canadian Strategies for
Evidence-Based Staffing Decisions




Tools to accurately assess workloads of
nurses in various settings
Standards to regulate nurse staffing mix,
nursing workloads and maximum hours of
work allowed
Policies that will enable older nurses to play
a mentorship / expert role for younger
nurses
Share “Best Practices” related to retention
and recruitment of nurses
Pan-Canadian Strategies to
Maximize Ability to Work to Full
Scope of Practice



Ensure organizational policy eliminates
non-nursing duties for nurses
Conduct and support further research
that supports nurses working to their full
scope of practice
Disseminate knowledge of existing
research