When the University of Saskatchewan earlier this year announced it would be closing the Regina campus of the College of Nursing and shifting its programming to Prince Albert, Kathy Rodger, an associate professor, immediately found herself worrying about the quality of education nursing students will be receiving. In a small city with limited acute care facilities, students doing their clinical training will almost certainly not gain hands-on experience treating patients with complex conditions.
"You could have students who have never ever dealt with a bowel resection patient on the ward because they don't do bowel resections in some smaller hospitals," says Rodger, whose research focuses on clinical nursing education. "They're being cheated from the opportunities that each student nurse should have, and that impacts the quality of care.
"The decision to close Regina, in fact, triggered a non-confidence vote by faculty against the College's administration.
In a profession reeling after more than two years of the pandemic, such looming concerns are not especially welcome news. According to a recent survey commissioned by the 1,500-member Saskatchewan Union of Nurses (SUN), three in five of its members had considered leaving the profession last year, while as many as 80% said their workplaces are experiencing staffing shortfalls in 2022—double the figure from last year.
“Patients are being put at risk because there isn’t enough health care providers to be able to give safe patient care,” SUN president Tracy Zambory told Global News in April.
Yet in some universities, there's a shortage behind the shortage: tenured nurse educators. "Nurse educators are nurses," says Brenda Mishak, an assistant professor at the University of Saskatchewan College of Nursing who specializes in care in correctional facilities as well as teaching. "If there are shortages in one, there will be shortages in the other."
According to the College, about half of its nursing professors are over 50 and one in five are over 60, meaning that demographic turnover is an imminent reality. But Mishak states that her university hasn't hired tenure-track faculty since 2018; the only newcomers are clinical instructors. The College, in turn, says that the number of tenured nursing faculty has remained steady, but there's been a decline in tenure-track hires and a commensurate increase in non-tenured faculty.
"There's a strong reliance on contract faculty and sessionals," adds Rodger. "It's not that they're not capable, but they have to be oriented and supervised." Gaps, she adds, should be filled with full time faculty.
"Just over half of the faculty are missing," Prof. Sina Adl, a grievance officer for the University of Saskatchewan Faculty Association, told the CBC. "They have never been replaced."
Exhaustion, of course, is not unique to Saskatchewan's nursing profession and educators. Across the country, nurses working on the front lines of the pandemic have experienced intense stress, burnout, and post-traumatic shock, as well as illness and death due to the infection.
In some regions, nursing students have been pressed into service. Ontario, earlier this year, announced it would accelerate the deployment of internationally trained nurses to help pick up the slack. The province, according to data from the Registered Nurses Association of Ontario, lags well behind the rest of the country in registered nurses per capita.
According to the Canadian Association of Schools of Nursing (CASN), there are 97 "entry to practice" programs across the country, 88 of which grant Bachelor of Arts degrees. In 2019-2020, almost 16,000 students entered a program and just over 12,000 graduated, not including 62 who completed PhDs. The fastest growing sub-specialty are nurse practitioners.
As for faculty, there were almost 9,500 instructors as of 2019-2020, but only slightly over a quarter (26.8%) have permanent positions and many of the instructors are over 50.
The CASN last year warned that compressing nursing education, as some nursing educators worry they are being pressured to do, or taking shortcuts to address the staffing squeeze brought risks. "Multiple studies demonstrate that an inadequate educational preparation and insufficient support of new graduates in the nursing work force is highly stressful for the new nurse and brings significant risks to patient safety," the organization said in a statement. "Quality nursing education cannot be sacrificed, exchanged, or accelerated without serious consequences."
In the meantime, student applications to nursing faculties have surged, according to a survey of a dozen institutions by the Globe and Mail, which found that some schools had seen as much as a 60% increase in applications. “We were very pleasantly surprised to see the numbers coming in,”Elizabeth Van Den Kerkhof, director of the School of Nursing and Midwifery at Mount Royal University in Calgary, told the newspaper last fall.
Many provinces have responded to the shortage in nurses with increased funding for nursing education. The Saskatchewan government, for example, allocated $4.9 million for 150 new seats in nursing colleges in its 2022 budget. The Ontario government pledged $124 million over three years to modernize clinical education for nurses. In B.C., the NDP government in its budget set aside funds to add 602 new nursing seats for publicly funded post-secondary programs. The province also earmarked $9 million in bursaries to help cover assessment fees for internationally trained nurses.
The Government of Newfoundland and Labrador, meanwhile, allocated $3 million in its 2022 budget to increase Memorial University's nursing program by 25%, mainly with more capacity at its sites in Happy Valley-Goose Bay, Gander and Grand Falls-Windsor.
Yet that increase didn't impress Canadian Union of Public Employees Newfoundland and Labrador, which represents healthcare and education workers in the province, among others. “The new spaces...won’t solve the staffing problem if graduates are poured into a system that is a leaky bucket with a big hole at the bottom,” president Sherry Hillier said in a statement. “Real pay increases are needed to keep workers in health care, education, housing, transition and group homes from leaving their professions in droves.” The B.C. Nurses' Union has echoed the sentiment, cautioning that the government needs to do more to address retention.
While Saskatchewan is facing a staffing crunch due to nonreplacement of tenured professors, other nursing faculties are experiencing growing shortages of full-time nursing instructors who provide the clinical side of the training, says Tracy Oosterbroek, an assistant professor of nursing and the assistant dean at the University of Lethbridge's nursing college. "Those positions are largely filled with sessionals." The problem? Retention: "We can't keep them."
The result, explains Oosterbroek, who specializes in rural nursing education, is a lack of stability among the instructors, which has a ripple effect. Those instructors forge relationships with clinical staff in hospital or long-term care settings, and those connections enhance the learning experience for students. The churn makes that connection more difficult.
"It's a constant influx," adds Claudia Steinke, an associate professor in University of Lethbridge’s Faculty of Health Sciences and a past president of the U of L Faculty Association. "There's no stability whatsoever."
Steinke, whose own scholarship focuses on improving service in health care settings like emergency rooms, also points out that the instability in nursing faculty has contributed to a growing disconnect between the theoretical and practical aspects of nursing education. She says students going through the system today tend to be more oriented towards the tasks associated with nursing than what she describes as the "art" of the profession.
"People need to slow right down," she says. "The system isn't designed for high quality humanistic care. I never see nurses sitting down and talking to the patients at the bedside for 10 or 15 minutes, and just having a deep conversation. You never see that because there simply isn't a time and honestly, that's not a priority anymore. I think we really have done a disservice in terms of quality care."
University of Saskatchewan’s Mishak adds that the dearth of tenured professors also means there's less research being done now, in part because those who remain have seen their workloads spike, both with increased student cohorts and more time required to supervise the contract faculty who are rotating through the College.
As with many others in the profession, Mishak points out that the crunch facing nursing faculty is part of the much larger and long-predicted human resources crisis that affects every corner of the health care sector. "This really big hole isn't a surprise," she says. "It was projected. COVID just exposed how drastic things were."