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  1. 1. <ul><li>Jan Currie </li></ul><ul><li>Vice President and Chief Nursing Officer </li></ul><ul><li>Winnipeg Regional Health Authority </li></ul>The Big Picture in Winnipeg Regional Health Authority
  2. 2. Background-the 90’s <ul><ul><li>Healthcare “Re-structuring” </li></ul></ul><ul><ul><ul><li>loss of nursing positions throughout system </li></ul></ul></ul><ul><ul><li>Nursing graduates unable to find employment in Manitoba </li></ul></ul><ul><ul><li>Closure of hospital based nursing education programs </li></ul></ul><ul><ul><ul><li>decrease in total number of nursing education seats </li></ul></ul></ul>
  3. 3. Background-the 90’s <ul><li> 1999 </li></ul><ul><ul><li>Winnipeg Regional Health Authority(WRHA) </li></ul></ul><ul><ul><li>created by amalgamating Winnipeg Hospital </li></ul></ul><ul><ul><li>Authority and Winnipeg Community Authority. </li></ul></ul>
  4. 4. Winnipeg Regional Health Authority (WRHA) <ul><li>WRHA “Unique” configuration </li></ul><ul><ul><li>9 facilities - operating agreements </li></ul></ul><ul><ul><ul><li>2 devolved; 7 non-devolved </li></ul></ul></ul><ul><ul><ul><li>Faith based agreement </li></ul></ul></ul><ul><ul><li>Community Services </li></ul></ul><ul><ul><ul><li>Public Health, Community Mental Health, Home Care devolved </li></ul></ul></ul><ul><ul><ul><li>37 Personal Care Homes - Service Purchase Agreements </li></ul></ul></ul><ul><ul><ul><li>Community Agencies - Service Purchase Agreements </li></ul></ul></ul>
  5. 5. Winnipeg Regional Health Authority (WRHA) <ul><li>Provides services to approximately </li></ul><ul><li>1 million people in catchment area </li></ul><ul><li>Also provides services to many </li></ul><ul><li>Manitobans who live outside the </li></ul><ul><li>Regional boundaries but receive </li></ul><ul><li>healthcare services from WRHA. </li></ul>
  6. 6. Background <ul><li>In February 2001 there were 1021 vacant RN positions in WRHA </li></ul><ul><li>Graduating nurses had fallen to 200 in 1999 from 700 in 1992 </li></ul>
  7. 7. Background <ul><li>Government of Manitoba and educational facilities responded to increase the number of nursing education seats in Manitoba </li></ul><ul><ul><li>In 2001 there were 198 RN graduates in Manitoba </li></ul></ul><ul><ul><li>In 2005 there were approximately 400 RN graduates in Manitoba </li></ul></ul><ul><ul><li>Total of 690 nursing graduates in 2005 </li></ul></ul>
  8. 8. Retention Strategies - Provincial <ul><li>Provincial Recruitment and Retention Fund </li></ul><ul><ul><ul><li>Created in 1999 </li></ul></ul></ul><ul><ul><ul><li>Provides funds to support Recruitment and Retention activities including funding for Regional Continuing Education Funds </li></ul></ul></ul>
  9. 9. Provincial Recruitment and Retention Fund <ul><li>Needed to facilitate processes for </li></ul><ul><li>nurses wanting to re-enter the workplace </li></ul><ul><ul><ul><li>Refresher programs subsidized through the Provincial Recruitment and Retention Fund </li></ul></ul></ul><ul><ul><ul><li>342 nurses have applied for funding to date </li></ul></ul></ul>
  10. 10. Provincial Recruitment and Retention Fund <ul><li>Provincial Recruitment and Retention Fund provides relocation incentives for nurses relocating to Manitoba </li></ul><ul><ul><ul><li>Applications have been accepted for: </li></ul></ul></ul><ul><ul><ul><ul><li>719 RNs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>23 RPNs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>108 LPN </li></ul></ul></ul></ul>
  11. 11. Retention Strategies - Regional <ul><li>Advertising for nursing positions is coordinated regionally with an emphasis on high vacancy areas </li></ul><ul><li>Facilities in WRHA provide opportunities for RN nursing students to be employed as HCAs </li></ul>
  12. 12. Retention Strategies - Regional <ul><li>RN Nursing graduates are surveyed annually to determine employment preferences. </li></ul><ul><li>Vacancy data is posted on University of Manitoba website. </li></ul>
  13. 13. Retention Strategies - Regional <ul><li>Aboriginal Initiatives </li></ul><ul><ul><li>Representative workforce </li></ul></ul><ul><ul><li>Self-declaration process </li></ul></ul>Francophone Initiatives
  14. 14. Retention Strategies -Regional <ul><li>Improving Full-time/Part-time Nursing Ratios: </li></ul><ul><ul><ul><li>Improved Continuity of Patient Care </li></ul></ul></ul><ul><ul><ul><li>Jobs for nurses in the future </li></ul></ul></ul><ul><ul><ul><li>Predictability in schedules for nurses </li></ul></ul></ul><ul><ul><ul><li>Enhanced staffing during periods of peak demands </li></ul></ul></ul><ul><ul><ul><ul><li>less reliance on nurses “picking up” shifts </li></ul></ul></ul></ul><ul><ul><ul><li>Improved fairness in scheduling </li></ul></ul></ul><ul><ul><ul><li>Reduced overtime </li></ul></ul></ul>
  15. 15. Retention Strategies - Regional <ul><li>Full-time Part-time </li></ul><ul><ul><li>Over 200 more Full-time positions in WRHA since 2002 </li></ul></ul><ul><ul><li>At the same time, the number of positions less than 0.6 EFT has decreased </li></ul></ul><ul><ul><li>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. </li></ul></ul>
  16. 16. WRHA Nursing Overtime Premium Dollars Paid
  17. 17. Agency Hours <ul><li>Use of agency nursing staff is decreasing </li></ul><ul><li>More sites are reporting that they are not using Agency nursing staff </li></ul><ul><ul><li>SBGH, HSC, MHC and RHC </li></ul></ul>
  18. 18. Retention Issues -Regional <ul><li>Variation in roles and span of control for </li></ul><ul><li>nursing managers throughout Region </li></ul><ul><ul><li>ABC project on Nursing Roles developed Regional role descriptions for CRN and Unit Managers </li></ul></ul>
  19. 19. Retention Strategies - Regional <ul><li>Perceived lack of mentorship and continuing </li></ul><ul><li>education opportunities for managers </li></ul><ul><ul><ul><li>Annual Firstline Managers workshop established </li></ul></ul></ul><ul><ul><ul><ul><li>organized by and provided free to managers </li></ul></ul></ul></ul><ul><ul><ul><li>An applied model for sustainable nursing leadership development being developed </li></ul></ul></ul><ul><ul><ul><li>Ongoing continuing education programs addressing management issues established throughout the Region </li></ul></ul></ul><ul><ul><ul><li>Leadership Mentoring opportunities </li></ul></ul></ul>
  20. 20. Retention Strategies - Regional <ul><li>Quantify staff satisfaction with workplace </li></ul><ul><ul><li>Staff satisfaction surveys developed </li></ul></ul><ul><ul><ul><li>Regional </li></ul></ul></ul><ul><ul><ul><li>Facility </li></ul></ul></ul><ul><ul><li>Information from staff surveys used to identify and address workplace issues </li></ul></ul>
  21. 21. Retention Strategies - Regional <ul><li>Provision of equipment needed to provide patient care </li></ul><ul><ul><ul><li>2000 - $1.2 million “Hallway Medicine” </li></ul></ul></ul><ul><ul><ul><li>2003 - $ 700,000 Safety and Security </li></ul></ul></ul><ul><ul><ul><ul><li>Cell phones for community nurses </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Safety training program developed and offered to </li></ul></ul></ul></ul><ul><ul><ul><ul><li>all nursing staff </li></ul></ul></ul></ul><ul><ul><ul><li>2004 – Safety Engineered Devices </li></ul></ul></ul><ul><ul><ul><li>- Bed replacement project </li></ul></ul></ul><ul><ul><ul><li>2005 – Smart Pump project </li></ul></ul></ul>
  22. 22. Retention Strategies -Regional <ul><li>Preceptoring/Mentoring </li></ul><ul><ul><li>Need for formal preceptor education programs </li></ul></ul><ul><ul><ul><li>Workshops available through facilities or University of Manitoba Faculty of Nursing </li></ul></ul></ul>
  23. 23. Transition Facilitator <ul><ul><li>Transition Facilitator </li></ul></ul><ul><ul><ul><li>assumes mentoring role for new graduates </li></ul></ul></ul><ul><ul><ul><li>2003 Nursing Sector Study – 72% of RN graduates are retained in MB </li></ul></ul></ul>
  24. 24. Retention Strategies -Regional <ul><li>Continuing Education Fund </li></ul><ul><ul><li>Funding to promote continuing education for direct care staff </li></ul></ul><ul><ul><ul><li>Funds allocated to Regional Continuing Education Committees by Provincial Government </li></ul></ul></ul><ul><ul><ul><ul><li>Nurses may receive up to $500/year in addition to $200/year allotted in Collective agreement </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Also provides subsidies for unpaid leave days taken for Continuing Education Activities </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Funding available to subsidize group activities e.g. Conferences, Seminars </li></ul></ul></ul></ul>
  25. 25. Retention Strategies -Regional <ul><li>Support for certificate and post-basic programs. e.g. ICU course, Manitoba Nephrology Nursing Course </li></ul><ul><ul><ul><li>Funding received through Provincial Recruitment and Retention fund to subsidize costs of these programs. </li></ul></ul></ul>
  26. 26. Retention Strategies - Regional <ul><li>Enhancing public image of nursing as a profession </li></ul><ul><ul><li>Utilize a number of communication strategies to promote the image of nursing </li></ul></ul><ul><ul><li>Open Letter to Nurses provides opportunity for communication to nurses in Region. </li></ul></ul><ul><ul><li>All nursing education facilities have waiting lists </li></ul></ul>
  27. 27. Retention Strategies - Regional <ul><li>Transition Facilitator role </li></ul><ul><ul><ul><li>created to enhance retention of new graduates in the workplace </li></ul></ul></ul><ul><ul><ul><li>experienced nurses who assist nursing graduates make the transition from student to practicing nurse </li></ul></ul></ul>
  28. 28. <ul><li>Challenges for the future………… </li></ul>
  29. 29. <ul><li>In September 2005 there were </li></ul><ul><li>518 vacant RN positions </li></ul>
  30. 30. <ul><li>Continue to identify need for nurses based on vacancy reports, retirement projections and the projected numbers of new graduates </li></ul>
  31. 31. <ul><li>Considerable concern about the number of nurses eligible to retire in the near future </li></ul>
  32. 32. Projected Nursing Retirements in WRHA
  33. 33. Projected Nursing Retirements in WRHA <ul><ul><li>Data is for MNU and MNU related staff </li></ul></ul><ul><ul><li>Depicts number of nurses who will reach magic 80 under the current provisions of HEPP </li></ul></ul><ul><ul><li>Shows that we are entering a period where the number of nurses eligible to retire is increasing </li></ul></ul><ul><ul><li>Trend is expected to continue to rise until 2007 and then remain at a high level until 2020 </li></ul></ul>
  34. 34. Supply of RNs <ul><li>For the next 2-3 years, we will be in a situation where we will have increasing numbers of nurses eligible for retirement </li></ul>
  35. 35. Supply of RNs <ul><li>It is essential that we continue to recruit nursing graduates to the workforce </li></ul><ul><li>The number of nursing seats in Manitoba needs to remain at its present level </li></ul>
  36. 36. <ul><li>Need to identify new strategies to: </li></ul><ul><ul><li>Retain new graduates in the workforce </li></ul></ul><ul><ul><li>Retain experienced nurses in the workforce </li></ul></ul>
  37. 37. <ul><li>Continue to develop HHR forecasting tools such as RN Projection Model </li></ul>
  38. 38. <ul><li>“ Even if you are on the right track you will get run over if you just sit there” </li></ul><ul><ul><ul><ul><li>Mark Twain </li></ul></ul></ul></ul>