International RNs help Edmonton turn the corner on nursing shortage

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Even at the start of a 12-hour night shift, Tania Scott radiates optimism about her job as a Registered Nurse in the Intensive Care Unit at University of Alberta Hospital. The New Zealander has worked in Edmonton for two years; she’s now a Permanent Resident and in the final stages of qualifying for Canadian citizenship. At 31, Tania has already been working her way around the world for eight years; she’s the embodiment of the mobile workforce that health employers around the world compete for. Edmonton is home for now, although she insists she and husband Angus will find their way back to New Zealand eventually. “I’m the happiest I’ve ever been,” she says. “There’s loads to learn in the ICU, and having Christmas with snow is still a novelty.” Edmonton’s long winter doesn’t put her off – she bikes to work 365 days a year.

Tania is one of 106 international RNs currently working for Capital Health, the $1.6-billion regional integrated academic health system serving Edmonton and area. The region launched an international recruitment campaign in the Fall of 2000, focused on New Zealand, Australia, and the UK. That campaign may be the most successful of its kind in Canada in recent years, says Wendy Hill, Capital Health’s Executive Nursing Officer. More than 40% of the international recruits have applied for a second year’s work and one in five has applied for permanent residency, like Tania.

International nurses were a short-term fix when the region urgently needed one, says Hill. “Back in 2000, government was reinvesting heavily in the system and we needed new staff to expand our services. Our local training programs were expanding their intake, but we needed more nurses right away. The internationals helped us through the two-year hiatus while larger classes worked through their training. Now we’re seeing more graduates from our own local programs, so we’re beginning to wind down our recruitment of the internationals as planned; but keeping so many of them is a big bonus.”

Hill stresses that the real key over the long term is local supply: training more nurses, and keeping them in the region. “Government and the post-secondary institutions did their part, by adding more nursing seats and creating accelerated programs for students with advanced standing. This year’s graduating class at University of Alberta was the biggest in five years, and total enrolment will be growing by another 30% by 2005.” In turn, Capital Health has concentrated on recruiting more of those new graduates, through a new Graduate Nurse Program. The program funds supernumerary positions to give new grads the experience they need to qualify for many full-time positions. The initiative helped the region hire 75% of the U of A graduating class last Spring, up from 25 – 30% before the program was introduced.

Increased local recruitment – with a boost from Down Under – has helped Capital Health turn the corner on the nursing supply, says Judy Bloom, Regional Manager of Recruitment. The shortage is still an issue, says Bloom, but the numbers are going the right way. The region’s overall vacancy rate in nursing edged below 6% in September, down from 7.5% earlier in the year. The region has seen a net gain of more than 200 nurses in the first half of the 2002-03 fiscal year, which has also helped reduce overtime by 15%, from 4.3% of all hours worked by nurses in 2001 to 3.6% so far in 2002.

Intensive Care Units have historically borne the brunt of the shortage, because of the need for added training and the fierce competition for qualified staff. The region has turned things around in the ICUs as well, through a dedicated 15-week training course offered in partnership with Calgary’s Mount Royal College. Vacancy rates have been cut in half, from 20% or more to less than 10% at the University Hospital site. Overtime on the unit has been cut in half since last year, says Critical Care Patient Care Director Jo Ann Nettleton.

Capital Health doesn’t have all the answers on nursing supply, says Hill; but with the focus on health human resources in the Kirby and Romanow reports, she thinks other parts of the country could learn from the region’s experience. “The nursing shortage is a huge issue but it’s one you can deal with, if you work through the whole supply cycle and if you stick at it over time. You can’t address it in pieces: you have to estimate the need, invest in training programs, recruit the new graduates, and then target them to the areas where you most need them through supplementary training. And of course, you also have to invest in building the kind of workplace where they’ll stay.”

As for Tania Scott, she just hopes the snow won’t be too deep when she gets on her bike to go home in the morning.