COVID-19 and SARS - Learnings from Two Health Systems: Australia and Canada.

As a chief nurse in Ontario during the severe acute respiratory syndrome (SARS) outbreak in 2003, I never thought I would experience anything even remotely similar, let alone exponentially worse, in my lifetime. Seventeen years and almost 17,000 km later, the COVID-19 crisis feels eerily similar in many ways, and completely different in others.

Part 2: Nurses' career aspirations to management roles: qualitative findings from a national study of Canadian nurses.

AIM: Our aim was to investigate direct-care nurses' interests in formal management roles and factors that facilitate their decision-making. BACKGROUND: Based on a projected shortage of nurses by 2022, the profession could be short of 4200 nurse managers in Canada within the next decade. However, no data are currently available that identify nurses' interests in assuming manager roles. METHODS: Using focus group methodology, we conducted 18 focus groups with 125 staff nurses and managers in four regions across Canada. RESULTS: Major themes and subthemes influencing nurses' decisions to pursue management roles included personal demographic (education, age, clinical experience and life circumstances), personal disposition (leadership skills, intrinsic rewards and professional commitment) and situation (leadership development opportunities, manager role perceptions and presence of mentors). Although nurses see management roles as positive opportunities, they did not perceive the rewards to be great enough to outweigh their concerns. CONCLUSIONS: Findings suggested that organizations need to provide support, leadership development and succession opportunities and to redesign manager roles for optimum success. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders need to ensure that they convey positive images of manager roles and actively identify and support staff nurses with leadership potential.

Part 1: The influence of personal and situational predictors on nurses' aspirations to management roles: preliminary findings of a national survey of Canadian nurses.

AIM: To examine the influence of personal and situational factors on direct-care nurses' interests in pursuing nursing management roles. BACKGROUND: Nursing managers are ageing and nurses do not appear to be interested in nursing management roles, raising concerns about a nursing leadership shortage in the next decade. Little research has focused on factors influencing nurses' career aspirations to nursing management roles. METHODS: A national survey of nurses from nine Canadian provinces was conducted (n = 1241). Multiple regression was used to test a model of personal and situational predictors of nurses' career aspirations to management roles. RESULTS: Twenty-four per cent of nurses expressed interest in pursuing nursing management roles. Personal and situational factors explained 60.2% of nurses' aspirations to management roles. Age, educational preparation, feasibility of further education, leadership self-efficacy, career motivation, and opportunity to motivate others were the strongest predictors of aspirations for management roles. CONCLUSIONS: Personal factors were more strongly associated with career aspirations than situational factors. There is a steady decline in interest in management roles with increasing age. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leadership training to develop leadership self-efficacy (particularly for younger nurses) and organizational support for pursuing advanced education may encourage nurses to pursue nursing management roles.

Policy to practice: collaboration in the evolution of a nursing health human resources policy.

In 2007, the Ontario Ministry of Health and Long-Term Care made an investment to support full-time employment for new graduate nurses. This paper describes the collaboration of policy makers and researchers in the creation and implementation of the Nursing Graduate Guarantee (NGG). We provide historical context for the development of the initiative and discuss some of the issues related to its implementation. Relevant stakeholders assisted researchers and policy makers in the creation, implementation and evaluation of the NGG. Researchers continue to work with policy makers in ongoing evaluations of the multi-year strategy, which are informed by stakeholder input.

Leadership attributes: a key to optimal utilization of the community health nursing workforce.

This research examined leadership attributes that support the optimal utilization and practice of community health nurses (CHNs). Community health nursing is facing challenges in workforce capacity and sustainability. To meet current and future demands on the community sector, it is essential to understand workplace attributes that facilitate effective utilization of existing human resources and recruitment of new nurses. This pan-Canadian, mixed-methods study included a demographic analysis of CHNs in Canada, a survey involving responses from approximately 6,700 CHNs to identify enablers and barriers to community health nursing practice and 23 focus groups to examine organizational attributes that "best" support optimal practice within the public health nursing subsector. Nursing leadership was identified as an important attribute in organizations' utilization and support of CHNs working to work effectively. This effectiveness, in turn, will enhance community health programs and overall healthcare system efficiency. This paper highlights findings related to the role of nursing leadership and leadership development in optimizing community health nursing practice.

The ontario new graduate nursing initiative: an exploratory process evaluation.

OBJECTIVE: To conduct an exploratory process evaluation of the Ontario Ministry of Health and Long-Term Care's (MOHLTC) New Graduate Nursing Initiative implemented by one home care agency. METHODS: Qualitative data were gathered online, stored electronically and then analyzed using an Affinity Diagram. RESULTS: Seven groupings of participants' comments were created: advertising and external information dissemination; orientation; internal dissemination; impact of the program; transition to the workforce; pay/benefits; and retention. Participants viewed many aspects of the program favourably but identified the following areas for improvement: comprehensibility of the Health Force Ontario website (advertising and external information); orientation of new graduates (orientation); and communication of information about the initiative to existing staff (internal dissemination). CONCLUSIONS: This exploratory study points to both strengths and weaknesses of the New Graduate Nursing Initiative. Further study of the implementation of this policy is recommended.

A profile of the structure and impact of nursing management in Canadian hospitals.

The purpose of this study was to describe the profile of nursing leadership structures in Canada and to assess relationships among structures, processes and outcomes pertaining to nurse leaders' work. Data were collected from nurse leaders in 28 academic health centres and 38 community hospitals in 10 Canadian provinces (n = 1,164). The results of this study revealed that the current contingent of nursing leaders in Canada see themselves as an empowered and influential group within their organizations. Despite very large spans of control, nurse leaders at all levels were positive about their work life and confident in their ability to provide effective leadership on nursing affairs within their organizations. Structural and process factors significantly affected nurse manager outcomes at all levels. Senior nurse leaders' work-life factors had a significant effect on middle and first-line managers' perceptions of patient care quality in the organization. Nurse leaders averaged 49 years of age highlighting the need for succession planning.

Primary health care nurse practitioners in Canada.

Canada, like many countries, is in the midst of primary health care reform. A key priority is to improve access to primary health care, especially in remote communities and areas with physician shortages. As a result, there is an increased emphasis on the integration of primary health care nurse practitioners. As of March 2006, legislation exists in all provinces and two territories in Canada that allows nurse practitioners (NPs) to implement their expanded nursing role. In this paper, we will briefly review the historical development of the NP role in Canada and situate it in the international context; describe the NP role, supply of NPs in the country, and the settings in which they work; propose an NP practice model framework; summarize facilitators and barriers to NP role implementation in primary health care delivery; and outline strategies to address the barriers.

Healthy workplaces and teamwork for healthcare workers need public engagement.

This response challenges the healthcare system to take full responsibility for the work environments created for health human resources. While the need for healthy work environments and teamwork in healthcare are inarguable, the fact is they are not a reality in today's health system. The authors suggest strategies to address this issue and identify the person or groups that should take responsibility, including governments, organizations, individuals and the public. Strategies include ensuring that policies do not contradict one another and holding each level responsible for the outcomes of a healthy work environment - retention and recruitment of health human resources, better patient/client outcomes and healthcare costs. The need for strong and appropriate leadership for health human resources with "content knowledge" is discussed, along with recommendations for measuring the performance and success of healthy work environments and teamwork. The authors conclude that collaboration at the micro, meso and macro levels is required to facilitate the true change that is needed to improve the work environments of health human resources.

Building capacity for nursing research.

Given how important care processes are to the nursing profession, it is imperative that nurses take a lead role in building capacity for nursing research and that they make a strong contribution to building the body of knowledge in the area of patient safety. The authors present an overview of a current nursing-led patient safety study in which building capacity for research is a core component.

Staff nurse empowerment in line and staff organizational structures for chief nurse executives.

OBJECTIVE: The authors tested a model linking chief nurse executive (CNE) organizational structures (line and staff) to staff nurse perceptions of workplace empowerment in 2 large Canadian hospitals. BACKGROUND: Kanter's theoretical constructs of empowerment (ie, access to information, support, resources and opportunity, and formal and informal power) were used to explore this phenomena. No published studies were found linking organizational structure to staff nurse empowerment. METHODS: Staff nurses (n = 256) were surveyed in 2 large teaching hospitals, one with a CNE in a line structure, the other with a CNE in a staff structure. Multiple regression analysis was used to test the proposed model. RESULTS: Staff nurses with a CNE in a line structure felt significantly more empowered in their access to resources than nurses with a CNE in a staff structure. Kanter's empowerment structures explained 63% of the variance in nurses' global empowerment in a line structure and 42% in the staff structure. Access to information, resources, and formal power was an important predictor of nurses' global empowerment in the line hospital, whereas only access to support was a significant predictor in the staff hospital. CONCLUSION: Support for the model tested in this study highlights the importance of the CNE in creating and sustaining healthy work environments for nurses.