Report highlights harms caused by Nunavut’s short-term health workforce
High turnover leads to low patient satisfaction, worse outcomes, poor communication, research shows
A report published earlier this month in the Canadian Medical Association Journal looks at solutions to Nunavut’s shortage of long-term nurses and doctors.
The report, titled “Addressing provider turnover to improve health outcomes in Nunavut,” also describes the effects of transient nurses and physicians on Nunavut’s health-care system.
In 2014-16, more than half the physicians working in Nunavut were on contracts for fewer than 20 days at a time, according to a recent analysis from the Qaujigiartiit Health Research Centre.
There is no detailed data on the turnover of nurses in Nunavut, but the report highlights that 62 per cent of health nursing positions in Nunavut were vacant, with the vacancy rate as high at 71 per cent in some regions.
“The government relies on short-term contract agency nurses to fill these positions, which, in addition to affecting continuity of care, represents an important financial burden for the Government of Nunavut,” the report states.
Although there is a lack of data on exactly how transient health care professionals affect the quality of care in Nunavut, data from other jurisdictions points to the negative impact these high turnover rates can have on patient care.
In other remote and Indigenous communities in Canada and Australia, the report states, the high turnover results in low patient satisfaction, worse health outcomes and poor communication within health care teams and organizations, among other negative impacts.
It can also be associated with increased rates of infection, overlooked symptoms and medical errors. Mental health services are particularly affected by the high turnover.
Although Nunavut relies heavily on short-term physicians and nurses, the report states that retention, not recruitment, of health-care providers is the problem.
The report states retention could be improved in the short term though cross-cultural training and orientation for professionals who come from outside the territory.
Ongoing training of local translators is also necessary for communication between patients and medical professionals who do not speak Inuktitut or Inuinnaqtun, the report said.
The report also highlights electronic medical records as a short-term solution, which can help with the coordination of care, referrals, diagnostic tests and prescription medications.
The Department of Health is still in the process of implementing an electronic records system across Nunavut.
The report points out in the middle to long term, training and hiring Inuit and northern nurses is the best strategy to strengthen community health services in Nunavut. The report notes the initiatives put in place in Nunatsiavut to retain health care professionals, which include training close to students’ home communities, the design of culturally relevant programming and guaranteed employment.
Another program highlighted in the report is the University of Manitoba’s rural practice program, which the report states, “has contributed to changing students’ attitude to northern medicine and increasing their interest in working in these communities.”
The report calls for more research on the impact of highly transient physicians and nurses specifically in Nunavut.
To ensure quality care in Nunavut communities, the report also calls for strategies to improve cultural competency and knowledge of the health-care system among short-term health-care staff .