Initiatives

Themes: Recruitment and Retention of Perinatal Nurses

1. Interdisciplinary Collaborative Care

Multidisciplinary collaborative maternity care is needed to sustain the availability of care providers and to improve access to maternity care
Collaborative care improves work-life balance of care providers in all disciplines, thus encouraging professionals to choose maternity care
Collaborative care allows nurses and physicians to provide early comprehensive care to more pregnant women.
Increases professional respect, trust, shared decision making, autonomy, honest, open communication, shared leadership, confidence, and the use of clinical guidelines, and decreases power struggles and hierarchy, therefore increasing job satisfaction
Collaborative maternity care leads to professional competence, and an awareness of strengths and limitations of one's own and other's disciplines.
Mutual respect is created within collaborative healthcare teams
Patient service aides should perform non-nursing duties, in order to allow nurses to focus on their job, increasing their satisfaction in their work.
Improved respectful collaborative care relationships could help with the maternity care crisis.

British Columbia Medical Association. (2004). Maternity care enhancement project: Supporting local collaborative models for sustainable maternity care in British Columbia. British Columbia: author.

Janssen, P. A., Harris, S. J., Soolsma, J., Klein, M. C., & Seymour, L. C. (2001). Single room maternity care: The nursing response. Birth, 28(3), 173-179.

Kasperski, J., Biringer, A., Belle Brown, J., Stewart, M., Price, D., Martin, C et al. (2006). Babies can't wait: Obstetrics care in crisis - Final report to Primary Health Care Transition Fund. Retrieved September 20, 2008, from: http://www.ocfp.on.ca/English/OCFP/Research/default.asp?s=1

Medves, J. M., & Davies, B. L. (2005). Sustaining rural maternity care - Don't forget the RN's. Canadian Journal of Rural Medicine, 10(1), 29-35.

Ontario Maternity Care Expert Panel. (2006). A maternity care strategy for Ontario. Retrieved September 19, 2008 from: http://meds.queensu.ca/prn/downloads/OMCEP_Final_Report_3.pdf

Peterson, W. E. Medves, J. M., Davies, B. L., & Graham, I. D. (2007). Multidisciplinary collaborative maternity care in Canada: Easier said than done. Journal of Obstetrics and Gynaecology Canada, 29(11), 880-886.

Rogers, J. (2003). Sustainability and collaboration in maternity care in Canada: Dreams and obstacles. Canadian Journal of Rural Medicine, 8(3), 193-198.

The Multidisciplinary Collaborative Primary Maternity Care Project. (2006) Guidelines for the development of a multidisciplinary collaborative primary maternity care model. Retrieved September 19, 2008, from: http://www.mcp2.ca

2. Interdisciplinary Issues

Current strain between nurses, physicians and midwives is not attractive to nurses looking for employment
Tension around respect for nurses' role as educators and skills in the intrapartum setting contributes to maternity care as being unattractive

British Columbia Medical Association. (2004). Maternity care enhancement project: Supporting local collaborative models for sustainable maternity care in British Columbia. British Columbia: author.

3. Recruiting Nurses Internationally

Recruitment of internationally trained maternity nurses should be implemented
Strive to attract people from various cultural backgrounds.

Ontario Maternity Care Expert Panel. (2006). A maternity care strategy for Ontario. Retrieved September 19, 2008 from: http://meds.queensu.ca/prn/downloads/OMCEP_Final_Report_3.pdf

4. Positive Workplace Environments and Job Satisfaction

Non-hierarchal structures, allows staff to more easily work together, creating a more pleasant environment
Supportive environments allow nurses to feel comfortable using their full scope of practice.
Models of work that supports a positive work-life balance
Addressing the ‘culture of blame' that often exists to create a more positive work environment.
Unwelcome attitudes to students and new nurses and negative unit culture is a deterrent to working in maternity care.
Positive practice environments have a favorable impact on nurse retention and satisfaction and in turn, teamwork and patient outcomes.

British Columbia Medical Association. (2004). Maternity care enhancement project: Supporting local collaborative models for sustainable maternity care in British Columbia. British Columbia: author.

International Council of Nurses. (2007). Nurse Retention and Migration. Geneva, Switzerland: Author. Retrieved September 16, 2008 from: http://www.icn.ch/psretention.htm

Ontario Maternity Care Expert Panel. (2006). A maternity care strategy for Ontario. Retrieved September 19, 2008 from: http://meds.queensu.ca/prn/downloads/OMCEP_Final_Report_3.pdf

Rogers, J. (2003). Sustainability and collaboration in maternity care in Canada: Dreams and obstacles. Canadian Journal of Rural Medicine, 8(3), 193-198.

5. Ongoing Education

There is need for continuing educational opportunities for nurses who choose maternity nursing.
Competency based perinatal educational programs allow nurses to assess their own needs and choose from a variety of learning methods.
Comprehensive education plans for all maternity care providers at undergraduate, graduate and continuing education are needed.
Educational programs focusing on interdisciplinary practice are needed for all maternity care providers.

British Columbia Medical Association. (2004). Maternity care enhancement project: Supporting local collaborative models for sustainable maternity care in British Columbia. British Columbia: author.

Janssen, P. A., Harris, S. J., Soolsma, J., Klein, M. C., & Seymour, L. C. (2001). Single room maternity care: The nursing response. Birth, 28(3), 173-179.

Medves, J. M., & Davies, B. L. (2005). Sustaining rural maternity care - Don't forget the RN's. Canadian Journal of Rural Medicine, 10(1), 29-35.

Ontario Maternity Care Expert Panel. (2006). A maternity care strategy for Ontario. Retrieved September 19, 2008 from: http://meds.queensu.ca/prn/downloads/OMCEP_Final_Report_3.pdf

6. Image of Maternity Nursing as a Career

Maternity nursing needs to be promoted as a viable career choice option
Some nurses and nursing students feel that maternity care is not valued in nursing

Ontario Maternity Care Expert Panel. (2006). A maternity care strategy for Ontario. Retrieved September 19, 2008 from: http://meds.queensu.ca/prn/downloads/OMCEP_Final_Report_3.pdf

7. Rural Maternity Care Issues

Collaborative care particularly needed to retain professionals in rural settings.
In hospitals with few births per year, nurses may find their intrapartum skills rarely used, which leads to lack of confidence and lack of desire to do the job. The challenge of retaining current skills, abilities and confidence leads to nurse who do not feel competent.
On-call rural maternity nurses are often not paid for on-call time. They are only paid if called in, leading to worse work-life balance.
Centralization and closure of rural hospitals or rural maternity units can cause rural nurses to become less satisfied with their work and less committed to their communities.
With loss of specialty maternity units in smaller cities and towns, it's harder to attract and replace skilled maternity nurses.
Health care providers are challenged in deciding the safety of providing maternity services to their communities.
It's difficult for rural nurses to fin the financial or professional resources to leave their community on a regular bases for additional training/upgrading.
Nurses may face difficulties in integrating into a small community, so may not want to remain there.
Rural maternity nurses usually have other duties within the hospital besides maternity care (ER, medical floor etc) all in one shift, which can be stressful.
Half of rural maternity nurses are only employed on a part-time basis

Gryzbowski, S., Kornelsen, J., & Cooper, E. (2007). Rural maternity care services under stress: The experiences of providers. Canadian Journal of Rural Medicine, 12(2),

89-94.

Klein, M. C., Christilaw, J., & Johnston, S. (2002). Loss of maternity care: The cascade of unforeseen dangers. CJRM, 7(2), 120-121.

Medves, J. M., & Davies, B. L. (2005). Sustaining rural maternity care - Don't forget the RN's. Canadian Journal of Rural Medicine, 10(1), 29-35.

Rogers, J. (2003). Sustainability and collaboration in maternity care in Canada: Dreams and obstacles. Canadian Journal of Rural Medicine, 8(3), 193-198.

8. Aboriginal Maternity Care Issues

Major lack of access to health care providers for Aboriginal peoples. A particular lack of access to aboriginal health care providers.
Virtually no Inuit nurses, and a huge shortage of Aboriginal nurses.
Integrating midwives and Aboriginal birthing centers may be beneficial, where women can give birth in their own communities, and Aboriginal nurses can work within their own communities.
Collaboration and engagement between health care professionals, including midwives is needed.
Create standardized guidelines, which include traditional cultural practices in order to improve patient care and health care provider confidence.
Adopt standardized curriculum for post-secondary and interprofessional ongoing educational opportunities for those working within Aboriginal communities.
Bridge the gap between professionals working in isolation (often in the North) and those working in the South, so those in the North will feel less isolated from their peers and more connected.

Native Women's Association of Canada. (2007). Aboriginal women and reproductive health, midwifery, and birthing centres. Ohsweken, Ontario: Author.

The Society of Obstetricians and Gynaecologists of Canada. (2007). An Aboriginal birthing strategy for Canada. Retrieved September 20, 2008, from: http://www.sogc.org/index_e.asp

9. Physical Structure - Single Room Maternity Care

Single room maternity care allows for more privacy, less noise, more space, family-centered care and increased quality of care, leading to a higher degree of job satisfaction
Single room maternity care promotes collaboration, accountability and competence in all areas of care
Single room maternity care may lead to a delay in receiving help from medical staff
Some nurses want to specialize and don't want to become competent in all areas of maternity care, so would not want to work in a single room maternity setting.

Janssen, P. A., Harris, S. J., Soolsma, J., Klein, M. C., & Seymour, L. C. (2001). Single room maternity care: The nursing response. Birth, 28(3), 173-179.

10. Increasing Nursing Scope of Practice

Increase the scope of maternity nurse practitioners

Ontario Maternity Care Expert Panel. (2006). A maternity care strategy for Ontario. Retrieved September 19, 2008 from: http://meds.queensu.ca/prn/downloads/OMCEP_Final_Report_3.pdf

11. Educating and Attracting New Nurses

Student nurses may choose not to enter maternity nursing because they see discouraged, unhappy trained nurses working.
Basic education from universities does not include sufficient maternity nursing education to meet entry-level expectations of labor and delivery units, so it is difficult for new graduates to seek and obtain maternity jobs with confidence.
There is a shortage of maternity nurses who are willing to mentor or act as a preceptor for students.
Incentives such as tuition reimbursement or relocation and travel reimbursement
Make maternity care a mandatory part of all nursing curriculums.
Difficult to secure positive clinical placements for students in maternity settings.
Difficult for students to be actively involved in the birthing process while at clinical placements, so it's hard to build skills and feel confident in choosing a career in maternity nursing.
Lack of student experience in maternity care is a deterrent to being recruited to maternity nursing
Decreased funding for nursing schools puts a heavier burden on students, thus making it more difficult to choose nursing as a career choice.
Students have reported negative experience in placements in intrapartum care - this environment is hostile towards learners, difficult to navigate and there are often limited learning opportunities due to unit culture. These can lead to lack of clinical confidence and a lack of desire to study perinatal nursing.
Respectful relationships between unit staff and students need to be built.
Hierarchy and gender can negatively influence maternity placements
Interprofessional education for students is needed, as students tend to have a lack of understanding of each other's roles and scopes of practice. This can lead to a more collaborative, positive experience in maternity care settings.
Maternity settings need to be transformed into positive learning environments.
Educational programs must foster confidence and competence and ensure they have the skills to work in collaboration with other health care professionals.

British Columbia Medical Association. (2004). Maternity care enhancement project: Supporting local collaborative models for sustainable maternity care in British Columbia. British Columbia: author.

Klein, M. C., Christilaw, J., & Johnston, S. (2002). Loss of maternity care: The cascade of unforeseen dangers. CJRM, 7(2), 120-121.

Ontario Maternity Care Expert Panel. (2006). A maternity care strategy for Ontario. Retrieved September 19, 2008 from: http://meds.queensu.ca/prn/downloads/OMCEP_Final_Report_3.pdf

General Nursing Issues

Social Value: Nursing is often seen as a career with limited opportunities and with low social value. Nursing may be seen as having low financial rewards, little respect, and little opportunity.
Organizational: Improved work conditions, implementation of family friendly policies, and increased pay and benefits helps to recruit and retain nurses. Low organizational commitment, autonomy, lack of leadership is not attractive. Heaving workload, inability to provide quality care, powerlessness inflexible schedules, and high stress levels is not attractive.
Education: An organization that supports professional advancement attracts nurses. Lack of in-service educational opportunities, leads to a decline in satisfaction.
Rural Issues: It is harder to recruit RN's to Aboriginal and rural communities. These communities require increased scope of practice without (necessarily) a pay increase. They also have a higher rate of violence and illness, typically.
Loss of nurses: Decline in the number of applicants to nursing school, high retirement rates and high rates of nurses choosing to switch careers makes retaining nurses difficult.
Salary: Salaries are often higher in the USA, so nurses leave Canada. Low salaries do not attract nurses.
Interprofessionalism: Lack of interprofessionalism not attractive. Ensuring collaboration and respect between professionals is attractive. This also ensures more professional autonomy.
Hours: It is often hard to find a full time job, so nurses leave nursing, or Canada.
Team: Unstable working teams and work environment is not attractive
Strategies To Recruit and Retain Nurses: increasing regular (full-time) staff, decrease casual staff, improve working conditions, family-friendly policies, facilitate the return of those who have left nursing and make nursing an attractive career option, better compensation, support of educational opportunities, strong nurse managers, overall job satisfaction, interprofessionalism, professional autonomy, positive unit culture.

Dussault, G., Fournier, M., Zanchetta, M. S., Kerouac, S., Denis, J., Bowjanowski, L., Carpentier, M., & Grossman, M. (2001). The Nursing Labor Market in Canada: Review of the Literature. The Invitational Roundtable of Stakeholders in Nursing.

Funding: Decreased funding for education
Social Value: Poor image of nursing as a viable career choice
Organizational: Unfavorable work environments that include excessive workloads, violence, stress, wage disparities and little involvement in decision-making.
Strategies: Nurses attracted to and remain in their place of work when opportunities exist for career advancement, autonomy, participation in decision-making and fair compensation. When staff members are satisfied rates of absenteeism drop, turnover decreases, and staff morale increases, productivity increases, and work performance improves.

International Council of Nurses. (2007). Nurse Retention and Migration. Geneva, Switzerland: Author. Retrieved September 16, 2008 from: http://www.icn.ch/psretention.htm

International Recruitment and Retention of Nurses - General

Employers faced with the challenges of nursing shortages should address the contributing factors relevant to their situation. Nurses should not be recruited into a dysfunctional nursing system. It is not cost-effective or ethical.

International Council of Nurses. (2007). Ethical Nurse Recruitment. Geneva, Switzerland: Author. Retrieved September 16, 2008 from: http://www.icn.ch/psrecruit01.htm