“If you build it, they will come… and stay”


Hospitals across North America are facing the looming threat of a nursing shortage that borders on crisis proportions. Recently, the Ryten Report contained predictions indicating that by 2011, Canada will experience a shortage of approximately 78,000 nurses. This daunting statistic has brought hospital administrations face to face with the significant challenge of how to not only recruit new nurses, but how to keep the ones they already have. With the American Hospital Association reporting an average nursing vacancy rate of 13% in the United States, retention has become a key issue as hospitals try to hang on to their nursing staff in the face of such a potentially traumatic shortage.

Like many health-care institutions, The Ottawa Hospital is faced with approximately 14% of its Registered Nurses being of retirement age by the year 2005. Understandably so, the hospital actively advertises in Canadian nursing journals, and representatives regularly attend key national and local job fairs in the spirit of recruitment. But while the hospital hires an average of 342 nurses externally each year, successful retention initiatives in the last three years have resulted in a vacancy rate of only 1.96%, and a low turnover rate of only 8%. The Hospital is in an enviable position with regards to nurse retention, partly due to its commitment to creating enabling environments for its staff.

“The mission of The Ottawa Hospital is to be nationally recognized as the academic health sciences center of choice, and its focus on nursing brings it one step closer to achieving this goal,” says The Ottawa Hospital Vice President of Nursing, Wendy Nicklin. “The hospital administration acknowledges the important role of its nursing staff in achieving this goal by aligning hospital retention strategies with priorities outlined by its nurses.”

Since 2000, The Ottawa Hospital has put forth massive efforts towards retaining its nursing staff. Over the past three years, it has invested in the development of an Employee Physician Satisfaction Survey, a yearly Nursing Census, and a biennial survey to nurses on Quality of Work Life. It has formed Action Committees to analyze and act on the results of these surveys, and it has begun releasing yearly Quality of Work Life reports to its nurses detailing improvements made as a result of the surveys. To date, well over 50% of the Quality of Work Life issues outlined by nurses in these surveys have been identified and resolved. Partly as a result of these measures, The Ottawa Hospital has become one of the most stable work environments available to nurses in the country.

“Three years ago, hospital administration asked the question: How can the work environment for nurses be further enhanced?” said Ottawa Hospital Chief of Nursing, Dr. Ginette Rodger. “With all the measures we had been taking to make The Ottawa Hospital a Centre for Nursing Excellence, the next step was to start looking at the principles of Magnet Hospitals.”

The concept of Magnet Hospitals, developed by an American PhD student, examines differences that exist between hospitals, where some have no difficulty retaining their nursing staff, while others have such high turnover rates. After identifying principles that support recruitment and retention, the student labeled successful employers ‘Magnet Hospitals’ for their ability to attract and retain employees. Four years ago the US developed accreditation standards for Magnet Hospitals to determine where the best work environments for nurses existed. The accreditation is based on the five core principles of autonomy, accountability, knowledge, leadership, and collaboration. The Ottawa Hospital has since adopted these principles, striving to provide: visible nursing leadership within the institution, support for continuing education, support for nursing research taking place in the environment, improvement in workload issues, and the establishment of unit Clinical Practice Committees, which involve nurses in decision making around their practice.

“We are working hard at developing the Nursing Professional Practice Environment, with some work still left to do,” says The Ottawa Hospital Corporate Nursing Recruitment, Retention and Recognition Coordinator

Cheryl Anne Smith. “We still need to put more investment into research, workload issues, and support for education initiatives. There is no doubt that focusing on making nurses more autonomous though has paid off. Our low vacancy and turnover rates speak for themselves.”

The Ottawa Hospital approach to nursing is definitely attracting national attention. Several other centers across the country have already adopted some of its methods, and almost every province in Canada has sent delegations to learn more about its successes in nursing retention.

“For now,” says Dr. Rodger, “we are following the principles laid out in the American Magnet Hospital accreditation process. The final aim though, is to one day have a Canadian accreditation for Nursing Centres of Excellence in the country.” Until that time, The Ottawa Hospital will continue to support its nursing staff by striving to facilitate a quality of work life conducive to forming its own Nursing Centre of Excellence, ever moving towards that goal of becoming nationally recognized as the health sciences center of choice.