Report highlights harms caused by Nunavut’s short-term health workforce

High turnover leads to low patient satisfaction, worse outcomes, poor communication, research shows

Baker Lake’s health centre was limited to emergency care for several weeks in January due to nursing shortages in the Kivalliq community. A report published this month in the Canadian Medical Association Journal looks at the territory’s shortage of long-term nurses and doctors. (File photo)

By Emma Tranter

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 .

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(12) Comments:

  1. Posted by Resident of NU on

    “The Department of Health is still in the process of implementing an electronic records system across Nunavut”

    Wow… welcome to the 1990s guys!

    Cultural competency and intercultural understanding is a good idea. It should go both ways though to ensure respect and understanding all around.

  2. Posted by Retention on

    Is it any wonder retention is difficult to improve? Quality of life is lower in Nunavut, even in the capital, than anywhere else in Canada. Yes, Nunavut pays more, but at the end of the day health care professionals, like most people, are not going to be satisfied long term with living in small, one-bedroom staff housing units.

    • Posted by Of course on

      Nor with the quality of life in most communities. There are a few who can handle it, a few who thrive in it, but even less who are willing to settle and make a home here. The ones who do are often looked on as misfits and who can’t make it in the south. So of course, with attitudes like that directed toward you, no wonder people only commit to it for the quick cash.

  3. Posted by No wonder on

    Most health centres have not seen any significant staffing increases in years and yet the communities have grown and so has the workload. You end up working night and day, weekends too. The only option to avoid burning out is to work contracts. Get in and get out so you can rest, recover and do it all over again. Is it Ideal? No, of course not but until the GN gets serious and addresses staffing it will always be like this. And, good luck keeping Inuit nurses, most of whom have families which makes the long hours in the communities that much more difficult to deal with. People cannot be expected to work in high stress, life and death situations and put in the amount of overtime that is currently required. It isn’t safe — not for the patients or the nurses.

    • Posted by Israel McArthur on

      So, what are we doing to make Nunavut a desirable place to work? Medical professionals like nurses are in demand everywhere, they have their pick of jobs, and they can write their own ticket. Have we looked at the solution that some provinces have taken, immigration programs that target newcomers with specific skills? I’m not sure how well suited Nunavut is to such programs, but it is certainly something to look at.

      As for cultural training – absolutely, but it has to be a two-way street. In my first hamlet we had nurses come from Toronto, one Jamaican-Canadian and the other Indian-Canadian. They were treated horribly by some hamlet residents, had their intelligence questioned, and wanted Caucasian nurses, etc. I know that many of the small hamlets have little experience with ethnic or cultural diversity, but if we are going to call upon a larger pool of potential staff, then that will need to change.

  4. Posted by Israel McArthur on

    Absolutely agreed, what are we doing to make Nunavut a desirable place for these health care workers? They can choose to work anywhere, are in high demand, and can write their own ticket. What have we done to make life in the communities desirable and in-demand? The fact is that our own system won’t ever produce enough medical professionals to meet our needs. So, how do we encourage medical professionals to come here? One obvious partial answer is increased immigration through a territorial nominee program like some of the other provinces use, but I’m not sure that the territory is ready for such a step, and such a change in its demography.

    The cross-cultural training absolutely needs to be a two-way street. I saw health care workers of colour treated absolutely horribly in my first Nunavut community. The patients questioned the abilities and the intelligence of some of the nurses because they were originally from the West Indies and India. Yes, the patients had only ever dealt with Caucasian nurses before, but if your patients display racist attitudes towards you, it is not likely to encourage you to stay in the hamlet you’re in. So, bring on the intercultural tolerance and training, but make sure that it is also provided to the patients, particularly in the small hamlets.

    • Posted by None of it on

      The number of qualified nurses in Nunavut at the present moment is probably less than 5. Nunavut has no choice but to take Agency nurses because in general nurses don’t want to stick around too long anymore. They work practically 24/7 and are exhausted. They can’t participate in anything in the community most of the time because they are always working and exhausted. And of course there is the on going abuse from clients in person and on social media all the time. Who could blame them for not wanting to work in Nunavut. The demand for qualified nurses is high everywhere and they can certainly pick and choose where they want to work.Teaching and other professions are facing the same problem and each year that passes by the problem gets worse. Last year there were 62 unfilled teaching positions, about 53 the previous year and this year will probably be worse. Nunavut is not an attractive place to work anymore. The living accommodations are very expensive and sub par and you usually find yourself having to share accommodations with a stranger. The cost of living is ridiculous and on top of all that you have to put up or shut up with all the racial stuff. If you have children chances are they will be miserable because the other kids will be bullying them and calling them racist names all the time. Who wouldn’t want to work here?

  5. Posted by Sadie on

    The Canada-wide Nursing shortage is visited upon us.
    Hire Inuit Nurses! Lessen hours so they can rest and have a life with kids & spouses!
    Have senior nurses with a great deal of experience supervise them and they will do great.

    • Posted by Israel McArthur on

      Where are you going to find these Inuit nurses? The territory has a roughly 50% high school graduation rate. Only a very tiny percentage of the population has the education to enter a nursing program.Of the small percentage who could be accepted to nurse training program, how many actually want to?

      No, Inuit nurses alone won’t be the answer for decades.

    • Posted by So much genius on

      “Hire more Inuit nurses!”

      Wow, what a clever solution! So simple, why hasn’t anyone thought of this? Why aren’t you in the Legislature?! Or, maybe you are?

    • Posted by Overtime on

      The issue isn’t the scheduled hours. Its the overtime coverage that is required. Nurses cannot say no to emergencies. And are called nonstop for non-emergency situations, at all hours of the night. When a medivac flight takes 6+ hrs to arrive after stabilizing a patient, a nurse cannot walk out because they are tired. As communities grow, the volume of call increases. Staffing levels need to be increased, health centres may need to reevaluate their 9-5 with after hours model. To do this, more staff are needed. And to train Inuit nurses, there is a need for increased quality of education and graduation rate. A Bachelor of Nursing degree is not easy to obtain. And even after the degree, a potential nurse needs to pass the NCLEX to be registered. It is not going to be a quick fix.

      • Posted by Education on

        And anyone from Nunavut who wants to get a nursing degree or medical degree is already starting well behind because the majority of the high schools in the territory don’t offer biology or chemistry (let alone any other science), so a student will have to make that up before they can even start university-level courses.

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