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NORTHWEST TERRITORIES
Solutions to the NWT's nursing shortage have proven elusive over the past decade, despite efforts by the territorial government to train more homegrown health professionals and rid itself of costly agency fees. It's a problem that might have the GNWT revisiting its controversial decade-old decision to eliminate recruitment bonuses for nurses.

Tom Beaulieu: Minister of Health says he might be willing to reconsider signing bonuses for community nurses. - NNSL file photo

Although the department has saved millions in agency costs with its efforts, full-time nurses in what is a highly competitive industry have been hard to come by and agency fees – which have not been an issue since 2010 -- have been replaced by casual nurses who fill positions for a short time before moving on.

As of May 9, 128 nursing positions were listed as vacant by the Department of Human Resources, a 25.7-per-cent vacancy rate and a negligible improvement from 27 per cent in 2010.

In 2004, in co-operation with the University of Victoria, Aurora College graduated the territory's first bachelor of nursing sciences class.

Since then, eight more classes have received their degrees from the program and the number of locally trained nurses have begun to make a dent in the vacancy rate, although most Aurora College grads choose to stay in the capital to work, and few have been entering the GNWT's followup Community Health Nurse Development Program. Since 2005, of the more than 100 graduates from the nursing degree program, 10 graduates have taken advantage of the grad placement program to take work at a community health centre, according to the Department of Health. The department does not keep stats to indicate if those nurses have stayed in those positions, nor does it track when new grads are hired to positions outside the grad placement program. Last year, three nurses turned down grad placement offers because they were in communities outside of Yellowknife.

It's a problem Health Minister Tom Beaulieu said he recognizes and he said he is thinking of ways to entice more nurses into the community health centres, where 17 of the 45 positions – 37 per cent – are vacant and covered by nurses from the casual pool.

But retaining nurses in communities with small populations, limited amenities and at times no year-round road access takes more than good pay and benefits, according one long-time nurse in Aklavik.

Rachel Munday, a registered nurse, has been working in the community for nearly eight years. She, along with a handful of others like her, are "local heroes" in the eyes of Pertice Moffitt, the president of the Canadian Association for Rural and Remote Nursing. Moffitt said the NWT needs to build on the success of people such as Munday.

Although Munday says there are things the GNWT can do to improve conditions for nurses working in the community, she says her longevity and the retention of other community health workers ultimately comes down to the person.

Munday, who hails from the Solomon Islands, a remote archipelago in the South Pacific, said growing up in a region that is four days by air to anywhere helps when dealing with remote nursing jobs. But she said there needs to also be a paradigm shift in the thinking of new nurses.

Many nurses go into specialty areas such as pediatrics or emergency out of school, working in fully-resourced hospitals, and the idea of working in a remote primary care facility, where a nurse is responsible for all health issues starting from birth to death can be daunting, said Munday.

However, she also said the opportunity to provide that level of service is extremely rewarding.

"It takes a certain type of person. It's not for the faint of heart," said Munday. "It's a very rewarding type of nursing in that we are seeing people through everything from birth to death. It's a very complete sort of care. Once you've done it, you almost can't go back to working in a hospital."

Although Aklavik has been Munday's longest professional posting in her 23 years of nursing – all in remote, Northern regions of Canada – she says there are things the GNWT can do to attract people to the communities so they have the opportunity to fall in love with the people, land and experience as she has.

"Little improvements would go a long way," she said.

Munday said more territorial conferences to help build professional connections and keep up to date with current practices, staggered hours to allow for more down time, and improvement to housing and housing policy would go a long way.

"Housing, which is good but could be better," she said. "It's warm and sheltered but some of it is very old."

That being said, Munday added housing is a luxury many nurses wouldn't get elsewhere. "Don't expect too much. If you went for a job in Edmonton, you wouldn't be provided with housing," she said.

She also said additional staff would help alleviate burnout, but said she knows "that is asking for the moon."

Housing policy was an issue that Moffitt, who holds a doctorate in nursing, also identified as an issue.

Currently, whereas staff nurses pay rent based on the GNWT rent scale and their Northern allowance, casual nurses receive the first 10 days of their service in a community rent free.

"What happens in a certain respect is we see contract nurses keep coming back in short terms," said Moffitt. "Wouldn't it be great to have a full-time nurse and give them the benefits?"

Full-time staff has its benefits. Although cheaper than agency nurses, the GNWT pays the travel costs for casual nurses to and from a community, which can add up depending on the frequency of turnover. Casual nurses also get a full day of pay for time spent travelling to and from the community in which they are posted.

Costs aside, Moffitt said it is also important to consider the patient, and continuity of care is vital.

"I love that idea of continuity. That's where the problem lies with the communities. There has to be trust with people you are caring for," she said. "Can you imagine telling the same story to a different person again and again?"

That trust is paramount, especially if nurses are not from the community.

"Nurses in the communities are usually of a different culture and it takes time to adjust,” said Moffitt. "You have to be there for a couple of years to provide any type of health prevention."

The trick is keeping people in the community for that period of time. Munday said a few student nurses have come through the Aklavik health centre over the years, but none have stayed.

"There needs to be some benefits to keep them there, they are a central part of the community," said Moffitt, who added benefits have diminished over the years.

From a purely economics perspective, Beaulieu said he is willing to consider the reintroduction of signing bonuses for nurses, something his predecessors have been reluctant to do since recruitment bonuses were eliminated in 2002. In a recruitment strategy later that year, the GNWT labelled such signing bonuses as ineffective and inequitable, much to the chagrin of union representatives at the time.

"The economics alone would make us look at that," said Beaulieu. "I am going to have discussions with the department and college to see what we can do to produce more community health nurses."

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