Nursing Leadership

Health inequity among Indigenous populations continues to widen despite advances in Indigenous health research. Under Canada's esteemed universal healthcare system, Indigenous populations continue to experience much poorer health outcomes due to the intersectional legacies of colonialism and racism. In this commentary, we reflect on structural, systemic and service delivery racism at all levels of care, which are deeply embedded in historical, political, institutional and socioeconomic policies and practices that continue to perpetuate harm and genocide of Indigenous Peoples...

Interior Health in British Columbia advocates for and supports advanced practice nurses, inclusive of regional clinical nurse specialists (CNSs). CNSs develop evidence-informed programs, education, policies and practice standards. The article uses an advanced practice nursing framework to anchor two case studies: (1) the operationalization and implementation of a regional CNS role in primary care and (2) the use of a knowledge translation strategy to build clinical capacity in serious illness conversations...

Just culture supports learning, encourages transparency and minimizes harm following reported patient safety incidents. Healthcare leaders have a key role in establishing and maintaining a just culture to improve patient safety at the macro, meso and micro levels of the healthcare system. In this paper, we discuss the role of leaders at various levels in the healthcare system in fostering a just culture to support the reporting of and learning from patient safety incidents. Specifically, leadership challenges related to establishing a just culture to improve patient safety are analyzed...

BACKGROUND: There is a growing interest in quality improvement collaboratives (QICs), even though less remains known about contextual factors that impact collective and local project implementation. A study was undertaken that used the Consolidated Framework for Implementation Research (CFIR) to explore the contextual factors impacting the use of this nationwide QIC in Canada. METHODS: A deductive or direct qualitative content analysis using CFIR was employed to explore the contextual factors impacting the implementation of a nationwide QIC and participating organizations...

A global health human resource crisis has intensified the need for innovative education programs to maximize the supply of nurses worldwide. In response to the current and anticipated shortage of nurses globally, a novel collaborative undergraduate nursing program was developed at the University of New Brunswick in Fredericton, NB, and Manipal Academy of Higher Education in Karnataka, India. The resulting dual degree model is shaped by the contexts of the participating countries and current activities related to the international recruitment and migration of registered nurses...

As we begin the year 2024, we do so with some very big challenges that have spilled over from 2023 and, indeed, many years before that. Every day, we are confronted with concerning experiential and research-based evidence about worsening access to healthcare, pervasive racism and widening disparities. Clearly, there is a great deal of work to be done in our healthcare system to support and improve the health of the diverse populations that we serve. Yet, along with the challenges come opportunities to reflect, collaborate, innovate, evaluate and learn...

Taking Care, published by HarperCollins Publishers in 2023, is a rich and beautifully written story of nursing that moves beyond the narrow confines of professional nursing. This book is about the work that is nursing and the stories of inspiring nurse leaders and the challenges that they have and continue to overcome. The book is divided into ten chapters named in a way that is reminiscent of a nursing textbook - "Chapter 1: Origins," "Chapter 4: Community," "Chapter 7: Environment" and so on. The introduction is a powerful "chapter" in itself...

As the number of people with dementia admitted to hospitals is expected to grow, now is the time to identify methods to improve nursing care of this population. We conducted an environmental scan to identify and describe interventions in Canadian hospitals to improve the nursing care of people with dementia, how they are being evaluated and what issues influence the success of interventions. Methods included a search of published and unpublished literature and key stakeholder interviews. Interventions are described under three categories: (1) interventions to improve nurses' knowledge, attitudes and skills; (2) interventions to address responsive behaviours; and (3) interventions to help nurses individualize care...

The Public Health Leadership program administered by the Public Health Branch at the Regional Municipality of York, ON, focused on enhancing people-centred competencies of managers to effectively support staff during the pandemic. The program aimed to boost participative management competencies and resiliency skills of managers by providing them with peer mentorship, ready-to-use resiliency tools, debriefing supports and actionable strategies in the form of e-blasts. Program participants provided feedback collected through two program evaluation surveys...

Organizational support for nurse managers (NMs) is not a new phenomenon. However, generally speaking, NMs are not well supported in their roles. This lack of support is burdensome to NMs' role functioning and has impacts on NM recruitment and retention; NM job satisfaction; and outcomes for front-line nurses and patients. There is a gap in the nursing literature as to what supports are currently in place to effectively support NMs. A scoping review ( n = 24) focusing on North American healthcare organizations was conducted to examine what organizational supports are currently in place to support NMs and highlight gaps...

To increase retention of nurses and ease the nursing shortage, innovative mentorship strategies must be implemented. Our rapid review shows that mentorship programs in hospitals for early-, mid- and late-career nurses is an effective way to improve nurse retention. The unique needs of internationally educated nurses must also be considered in these programs to bolster the Canadian nursing workforce supply. We highlight five tools that are critical to the successful implementation of nurse mentorship programs in hospitals: (1) establish reciprocal relationships between mentors, mentees, hospital administrators and leaders ; (2) facilitate administrative structures, resources and support for mentors and mentees ; (3) enable effective features of mentorship programs ; (4) ensure that mentorship promotes professional and personal development ; and (5) support internationally educated nurses through mentorship...

It is easy to get lost in a sea of negativity about everything that is going wrong with healthcare and nursing today. Nurses' Voices (https://nursesvoices.ca/) was launched to amplify the voices of Canadian nurses in challenging times. We listened to amazing stories of nurses making a difference in our healthcare system despite the difficult situations they faced. Our guests talked about their experiences, their aspirations, their challenges, what brings them joy in tough situations and their determination to deliver the best care possible to Canadians despite everything...

As summer slowly gives way to autumn, I find myself reflecting on the activities of the summer. One memory that stands out is attendance at the 29th International Congress of Nurses held in Montreal in July 2023. Cohosted by the International Council of Nurses and the Canadian Nurses Association, it was an amazing opportunity to meet and learn with nurses from all over the world. It was wonderful to be able to get together in person and feel the palpable energy created by more than 6,000 delegates from 123 countries gathered together for a common purpose...

Homecare nurses provide essential healthcare services at home. Changes in the nature of homecare nursing practice, however, suggest that older and frail homecare clients are less likely to have timely access to needed homecare nursing services as acute management takes priority. This has an impact on people's ability to be cared for and to die at home, a reported priority for many Canadians. This study highlights how health system changes may be constraining homecare nurses' abilities to enact care that is consistent with palliative care principles and philosophies, and calls for consideration of how shifts in homecare nursing practice have implications for families and clients receiving palliative care at home...

AIM: We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study. METHOD: Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis examined factors associated with domain involvement. RESULTS: Respondents ( n = 1,107) represented all provinces/territories, including 396 specialized nurses (SNs), 211 clinical nurse specialists (CNSs) and 490 nurse practitioners (NPs)...

Existing engagement and retention strategies fall short in comprehensively addressing the ongoing nursing workforce crisis and need to be supplemented with proactive, relationship-building approaches such as stay interviews. Stay interviews are structured discussions that leaders conduct with staff members to learn the specific actions that must be taken to strengthen their engagement with the organization. Nurse leaders play a critical role in responding to the current workforce challenges, and stay interviews can support them in developing interventions to promote engagement and retention...

Decades of commissioned reports have pointed to solutions for nurturing nursing practice environments as essential to sustaining a nursing workforce. Beyond salary compensation and other solutions, we discuss the critical need for collaborative leadership in practice and education as a priority policy agenda aimed at confronting the shortage of nurses. The COVID-19 pandemic has intensified the nursing shortage and shortage of capacity in practice education, and we explore some learning in this context. Our paper draws on two initiatives in the province of British Columbia: the development of a transformative practice education model and an expanded Collaborative Learning Unit initiative...

The retention of Canada's advanced practice nurses (APNs), including clinical nurse specialists and nurse practitioners, is a national health human resources issue. APNs are essential within the Canadian healthcare workforce for meeting patient and population health needs, often in underserved communities. A shortage of APNs will exacerbate barriers to access to care for patients across sectors, including primary, acute, long-term and transitional care settings. This paper provides highlights from literature reporting on the state of APN human resources in Canada, including influential barriers and facilitators, and recommendations for retaining these important leaders in the healthcare workforce...

Founded in 1945, the United Nations (UN) system has become the place where countries come together to discuss complex and multifaceted issues that no one country can tackle alone. Civil society continues to be an integral part of the UN system, supporting the work of various entities and providing expertise on core pillars such as development, human rights and peace and security. Some global nursing leaders have made considerable progress in increasing nursing engagement and visibility across the system; however, representation remains small...

This issue is the last of the three-part series focused on the critically important challenge of nurse retention. The articles that we have selected span a range of topics from the personal to political with implications for readers in leadership positions across nursing practice, policy and education. What we are learning is that retention is as multi-faceted and dynamic as the times we are living in. There is no one-size-fits-all solution, no Holy Grail - if we could only find it - that will turn the tide of exodus from the profession...