Jan CurrieVice President and Chief Nursing Officer

Winnipeg Regional Health Authority

The Big Picture inWinnipeg Regional Health

Authority

Background-the 90’s

• Healthcare “Re-structuring” - loss of nursing positions throughout system

• Nursing graduates unable to find employment in Manitoba

• Closure of hospital based nursing education programs- decrease in total number of nursing education seats

Background-the 90’s

1999Winnipeg Regional Health Authority(WRHA)created by amalgamating Winnipeg Hospital Authority and Winnipeg Community Authority.

Winnipeg Regional Health

Authority (WRHA)

• WRHA “Unique” configuration• 9 facilities - operating agreements

- 2 devolved; 7 non-devolved- Faith based agreement

• Community Services - Public Health, Community Mental Health, Home Care

devolved- 37 Personal Care Homes - Service Purchase

Agreements- Community Agencies - Service Purchase Agreements

Winnipeg Regional Health Authority (WRHA)

Provides services to approximately

1 million people in catchment area

Also provides services to manyManitobans who live outside the Regional boundaries but receive healthcare services from WRHA.

Background

In February 2001 there were 1021 vacant RN positions in WRHA

Graduating nurses had fallen to 200 in 1999 from 700 in 1992

Background

Government of Manitoba and educational facilities responded to increase the number of nursing education seats in Manitoba

• In 2001 there were 198 RN graduates in Manitoba

• In 2005 there were approximately 400 RN graduates in Manitoba

• Total of 690 nursing graduates in 2005

Retention Strategies- Provincial

Provincial Recruitment and Retention Fund

- Created in 1999- Provides funds to support Recruitment and

Retention activities including funding for Regional Continuing Education Funds

Provincial Recruitment and Retention Fund

Needed to facilitate processes for nurses wanting to re-enter the

workplace- Refresher programs subsidized through the

Provincial Recruitment and Retention Fund- 342 nurses have applied for funding to date

Provincial Recruitment and Retention Fund

Provincial Recruitment and Retention Fund provides relocation incentives for nurses relocating to Manitoba

- Applications have been accepted for:• 719 RNs• 23 RPNs• 108 LPN

Retention Strategies - Regional

• Advertising for nursing positions is coordinated regionally with an emphasis on high vacancy areas

• Facilities in WRHA provide opportunities for RN nursing students to be employed as HCAs

Retention Strategies- Regional

• RN Nursing graduates are surveyed annually to determine employment preferences.

• Vacancy data is posted on University of Manitoba website.

Retention Strategies- Regional

Aboriginal Initiatives• Representative workforce• Self-declaration process

Francophone Initiatives

Retention Strategies-Regional

Improving Full-time/Part-time Nursing Ratios:

- Improved Continuity of Patient Care- Jobs for nurses in the future- Predictability in schedules for nurses- Enhanced staffing during periods of peak

demands• less reliance on nurses “picking up” shifts

- Improved fairness in scheduling- Reduced overtime

Retention Strategies- Regional

Full-time Part-time• Over 200 more Full-time positions in WRHA since

2002• At the same time, the number of positions less

than 0.6 EFT has decreased• While reliance on Part-time staff has decreased

where Relief Teams have been implemented, there are still opportunities to further decrease this reliance and to reduce overtime costs and agency use.

WRHA Nursing Overtime Premium Dollars Paid

$-

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

$8,000,00019

97/9

8

1998

/99

1999

/200

0

2000

/01

2001

/02

2002

/03*

2003

/04*

2004

/05*

Agency Hours

• Use of agency nursing staff is decreasing

• More sites are reporting that they are not using Agency nursing staff • SBGH, HSC, MHC and RHC

Retention Issues-Regional

Variation in roles and span of control for

nursing managers throughout Region

• ABC project on Nursing Roles developed Regional role descriptions for CRN and Unit Managers

Retention Strategies - Regional

Perceived lack of mentorship and continuing

education opportunities for managers- Annual Firstline Managers workshop

established• organized by and provided free to managers

- An applied model for sustainable nursing leadership development being developed

- Ongoing continuing education programs addressing management issues established throughout the Region

- Leadership Mentoring opportunities

Retention Strategies - Regional

Quantify staff satisfaction with workplace• Staff satisfaction surveys developed

- Regional- Facility

• Information from staff surveys used to identify and address workplace issues

Retention Strategies - Regional

Provision of equipment needed to provide patient care

- 2000 - $1.2 million “Hallway Medicine”- 2003 - $ 700,000 Safety and Security

• Cell phones for community nurses• Safety training program developed and offered to all nursing staff

- 2004 – Safety Engineered Devices - Bed replacement project- 2005 – Smart Pump project

Retention Strategies-Regional

Preceptoring/Mentoring• Need for formal preceptor education

programs- Workshops available through facilities or

University of Manitoba Faculty of Nursing

Transition Facilitator

Transition Facilitator- assumes mentoring role for new

graduates- 2003 Nursing Sector Study – 72% of RN

graduates are retained in MB

Retention Strategies -Regional

Continuing Education Fund• Funding to promote continuing education

for direct care staff- Funds allocated to Regional Continuing

Education Committees by Provincial Government• Nurses may receive up to $500/year in

addition to $200/year allotted in Collective agreement

• Also provides subsidies for unpaid leave days taken for Continuing Education Activities

• Funding available to subsidize group activities e.g. Conferences, Seminars

Retention Strategies-Regional

Support for certificate and post-basic programs. e.g. ICU course, Manitoba Nephrology Nursing Course

- Funding received through Provincial Recruitment and Retention fund to subsidize costs of these programs.

Retention Strategies- Regional

Enhancing public image of nursing as a profession• Utilize a number of communication

strategies to promote the image of nursing

• Open Letter to Nurses provides opportunity for communication to nurses in Region.

• All nursing education facilities have waiting lists

Retention Strategies - Regional

Transition Facilitator role- created to enhance retention of new

graduates in the workplace- experienced nurses who assist nursing

graduates make the transition from student to practicing nurse

Challenges for the future…………

In September 2005 there were 518 vacant RN positions

Continue to identify need for nurses based on vacancy reports, retirement projections and the projected numbers of new graduates

Considerable concern about the number of nurses eligible to retire in the near future

Projected Nursing Retirements in WRHA

Winnipeg Magic 80 by Year

0

50

100

150

200

250

300

350

400

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Projected Nursing Retirements in WRHA

• Data is for MNU and MNU related staff

• Depicts number of nurses who will reach magic 80 under the current provisions of HEPP

• Shows that we are entering a period where the number of nurses eligible to retire is increasing

• Trend is expected to continue to rise until 2007 and then remain at a high level until 2020

Supply of RNs

For the next 2-3 years, we will be in a situation where we will have increasing numbers of nurses eligible for retirement

Supply of RNs

It is essential that we continue to recruit nursing graduates to the workforce

The number of nursing seats in Manitoba needs to remain at its present level

Need to identify new strategies to:• Retain new graduates in the

workforce• Retain experienced nurses in the

workforce

Continue to develop HHR forecasting tools such as RN Projection Model

“Even if you are on the right track you will get run over if you just sit there”

Mark Twain