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Canada's nursing unions will be putting a case for a similar safe staffing system to New Zealand's, says Canadian Federation of Nurses Unions' president Linda Silas.

Silas was in New Zealand to address the New Zealand Nurses Organisation (NZNO) conference this week but her visit follows 10 provincial nursing union leaders coming here in July to examine the Care Capacity Demand Management (CCDM) system in action

She told Nursing Review that Canadian nursing unions had accumulated a lot of evidence about safe staffing and safe care initiatives but nothing had been implemented which had had prompted the fact finding trip to New Zealand.

They had left impressed by the safe staffing tripartite agreement between unions, district health boards and government and believed the evidence-based global hospital approach of CCDM – that evaluated staffing hour by hour – would ultimately safe money.

"There is no employer around the world who is not concerned about the high cost of their health care systems and the cost of nurse overtime and sick leave etc."

Silas said her keynote address to the NZNO conference would share the work being done by the Federation to promote the New Zealand model including moves to approach Health Canada (the Canadian health department).

Similarities and differences

Silas says similarities facing nurses in both countries include ageing and increasing populations putting pressure on health care costs.  Also the difficulty of working out how to transfer more health care into the community and increase primary health care without starving critically needed funding to the acute care sector.   Another parallel was the need to meet the health needs of both countries' indigenous populations with Silas believing New Zealand was more advanced in addressing some of challenges.

Canada has a nursing workforce of around 300,000 nurses (including more than 3000 nurse practitioners) compared to New Zealand's around 50,000 nurses but Silas said the two countries had similar nurse to population ratios with New Zealand having one nurse to every 90 people and Canada one nurse to every 94 people.

Where New Zealand was different to Canada was New Zealand's high reliance on overseas trained nurses (more than 25 per cent) with Silas saying Canada had had a strong strategy of training, recruiting and retaining its own nurses after hitting 'rock bottom' with a major nursing shortage during the 1990s.  This included students having their own union with student members on the board of both the federation and Canada's nursing regulatory body.

Canada graduated around 10,000 nurses a year and Silas said until two years ago it had very high graduate employment but tight health care budgets meant many new graduates were now only able to find casual or part-time employment.   At the same time she said hospitals' overtime costs were the equivalent of employing 11,000 full-time equivalent (FTE) nurses so "we should be able to employ every new graduate".

Momentum for safe staffing

Silas said the 2008-2009 global financial recession had impacted on healthcare funding and provincial health care systems ability in the following decade to afford the right skill mix in the nursing workforce. She said now how to fund and manage safe staffing has become a key discussion in Canada.

"Which for us is encouraging as two years ago nobody wanted to talk about it," said Silas with providers telling unions they couldn't afford safe staffing and would instead continue running the health system on overtime.

She said Canada like New Zealand knew it needed to bring more health care closer to home and strengthen its primary health care system.

"Right now our system is paralysed by the acute care system – and in the acute care/hospital system we have very sick people so it is not like we can say 'we will close the door to our local hospital while we build our primary health care or our  closer-to-home aged care system' as both systems need to work in parallel and we have to find savings in one system to furnish the other."

She said it would be a difficult transition but in the long-term it would be sustainable as communities would be healthier, more seniors would be cared at home and the primary health care system would be built. "But to do that there needs to be that transition period…" 

Meanwhile the acute system needed to be supported and in Canada about 70 per cent of the nursing workforce worked in acute care settings with many finding it hard to accept the transition.  "They know they are taking care of the critically injured and ill – and if there's not enough staff patients are going to die. So they have a hard time  and we have to measure our changes gradually to guarantee to Canadians and the different communities we represent that 'yes if you need acute care system that you will still have the best of the best'."