Nursing Service and ResourceManagement PlanJuly 2004Submitted toDepartment of Health and Wellnessby

AcknowledgementsThis Nursing Service and Resource Management Plan (2005-2010)represents the culmination of a seven-month process that involvedextensive consultation with nurses and nursing stakeholdersthroughout the Province of New Brunswick. The first such plan wasreleased in December 1993 and has contributed to system redesign over the last decade.The new Nursing Service and Resource Management Plan (2005–2010) is aligned with recent national and provincial health reportsand serves as a roadmap for complementary development of thenursing sector. The Plan highlights recent progress, identifieschallenges and recommends strategic directions for the next fiveyears.The project approach was designed to enable relevant comparisonswith data presented in the original 1993 Nursing Service andResource Management Plan.Caution must be exercised not todirectly compare data in this Plan with other data sourcesdeveloped for different purposes.For the most part, secondarydata sources were accessed with minimal primary data collectionrequired.The Government of New Brunswick wishes to acknowledge yCommittee (NRAC) and the contributions of over 400 individualsthat participated on the Steering and Stakeholder Communicationcommittees, focus and key informant groups, and individualconsultations.i

Table of ContentsAcknowledgements. iTable of Contents . iiIntroduction . iiiProject Purpose and Approach . 1Background and Context . 2Nursing Service and Resource Management Plan (1993) . 3A Nursing Resource Strategy for New Brunswick Strategy (2001-2004) . 4Health Renewal: Report from the Health Quality Council (2002) . 5Provincial Health Plan (2004-2008) . 5Nursing Role and Leadership . 6Progress over the Last Decade . 6Challenges to Future Development . 7Context for Strategic Action . 8Strategic Directions. 9Strategy 1: Primary Care Reforms . 9Strategy 2: Nurse Practitioners and Full Scope Nursing . 9Strategy 3: Nursing Leadership Strategy . 10Strategy 4: Regional Leadership Development and Succession Planning. 10Strategy 5: Role and Benchmark Development for Clinical Nurse Managers . 10Nursing Education . 11Progress over the Last Decade . 11Challenges to Future Development . 12Context for Strategic Action . 13Strategic Directions. 15Strategic Direction 1: Multi-Year Nursing Education Plan . 15Strategic Direction 2: Nursing Student Clinical Experience. 15Strategic Direction 3: Recruitment and Retention . 15Strategic Direction 4: Education Standards for Unregulated Care Providers . 16Nursing Skill Mix . 17Progress over the Last Decade . 17Challenges to Future Development . 18Context for Strategic Action . 19Strategic Directions. 20Strategic Direction 1: Best Practices in Nursing Skill Mix. 20Strategic Direction 2: Evaluation and Implementation of Skill Mix Changes . 21Strategic Direction 3: Deployment of Nurse Practitioners . 21Strategic Direction 4: Employment Standards for Unregulated Care Providers. . 21Nursing Human Resources . 22Progress over the Last Decade . 22Challenges to Future Development . 24Context for Strategic Action . 24Strategic Directions. 25Strategic Direction 1: Integrated Human Resource Planning and Management . 25Strategic Direction 2: Nursing Supply and Demand Projections . 26Strategic Direction 3: Workload and Workforce Management . 26Strategic Direction 4: Healthy Workplaces. 27ii

NURSING SERVICE AND RESOURCE MANAGEMENT PLANProposed Directions for ChangeStrategic Directions: Nursing Role and LeadershipStrategy 1: Primary Health Care ReformsActively participate in the renewal and innovation of primary health care as partof health system reform, promoting the role of the nurse in communitysettings: Community Health Centers Primary Care Collaborative Practice Settings including nurses and other healthprofessionals. Alternate Primary Health Care DeliveryStrategy 2: Nurse Practitioners and Full Scope NursingExpand the opportunities for nurse practitioners and full scope nurses (RNs andLPNs). Expand utilization of nurse practitioners to nursing homes, emergencydepartments, community mental health centers and family practices. Increase the utilization of clinical nurse specialists in complex nursing practicesituations. . Increase the utilization of licensed practical nurses within the acute, communityand long term care programs. Remove as appropriate, legislative or administrative barriers which restrict theability of the system to utilize the most appropriate service provider to meet theneeds of individuals in all settings.Strategy 3: Nursing Leadership StrategyDevelop a sector partnership at the provincial level to strengthen nursingleadership. Develop a strategy that strengthens clinical leadership and supportscollaborative practice on the front line. Increase leadership initiatives for continuing education, career advancementopportunities and work re-structuring at the unit or front-line level.iii

Continue to include leadership preparation and competency development withinbasic RN and LPN programs.Strategy 4: Regional Leadership Development and Succession PlanningAccess leadership development for nurse leaders identified at the regional level. Recruit, educate and retain nursing leaders in light of increasing attrition due tore-structuring, turnover, and retirement. Implement a leadership mentoring program for new nurse administrators andclinical leaders/managers. Promote direct involvement of executive and front line nursing leaders in systemdecisions that impact the organization and delivery of nursing services. Continue supporting the clinical nursing mentorship program at the regionallevel.Strategy 5: Role and Benchmark Development for Clinical Nurse ManagersDefine the role of Clinical Nurse Managers and establish human resourcebenchmarks. Investigate current utilization of clinical nurse managers and reportingstructures. Establish human resource benchmarks for nurse leaders/managers consideringscope and effective span of control in the context of collaborative practice andexpected level of independence in practice.Strategic Directions for Nursing EducationStrategic Direction 1: Multi-Year Nursing Education PlanDevelop a multi-year nursing education plan that provides an adequate supplyof nursing service providers. Fill current funded BN seats.Modify the number of seats given supply and demand projections.Maintain an effective de-centralized delivery system for nursing education.Provide appropriate funding mechanisms for universities and colleges to meetsupply targets and establish accountability mechanisms. Investigate Prior Learning Assessment and Recognition (PLAR) and LPN-BNbridging programs as alternate mechanisms to meet RN and LPN supply targets. Initiate targeted succession planning for faculty.iv

Strategic Direction 2: Nursing Student Clinical ExperienceCoordinate adequate and affordable clinical experiences for RN and LPNstudents. Address shared clinical issues through an existing or new process involvinguniversities, RHAs, NBCC and nursing homes that ensures access to facilitiesand / or nursing units and programs, sharing clinical settings, and the ability topractice all competencies. Work with CASN to explore alternate methods such as co-op programs foruniversity nursing students in order to decrease the high costs associated withproviding clinical experience.Strategic Direction 3: Recruitment and RetentionContinue to target effective recruitment and retention strategies for nurses. Continue the bursary program for students RNs and LPNs with servicecommitment for hard-to-recruit areas. Consider including, within the bursaryprogram, Masters and PhD students with a specific strategy for student nursepractitioners and consideration of student loan forgiveness or paid educationleave. Continue to fund the summer employment program for nursing students,increase student nurse positions, and add student LPN positions. Continue to fund tuition for RN and LPN refresher completion. Introduce “bursary” program to support faculty development and succession. Continue to support orientation and continuing education programs.Strategic Direction 4: Education Standards for Unregulated Care ProvidersDevelop education standards for unregulated care providers in targeted areas. Review the on-site training provided by RHAs and Nursing Homes and establishminimum education standards. Continue to collaborate within Atlantic Canada on the development ofeducational standards for UCPs. This collaboration can occur through an ad hoccommittee involving NBCC and DHW and build on the recent regional workrelated to Health Human Resources.v

Strategic Directions for Nursing Skill MixStrategic Direction 1: Best Practices in Nursing Skill MixDetermine new provincial skill mix guidelines to ensure full scope nursing andsupport the best utilization of RNs and LPNs across the health system. Complete the collaborative RN-LPN evaluation of skill mix and re-organizationof nursing services at the regional level. Establish a provincial information network to share best practices in nursingskill mix and service organization. Establish a provincial implementation committee to review regional work andrecommend provincial skill mix guidelines for different contexts of practice. Provide education for collaborative nursing practice and improved RN-LPNunderstanding of scope of practice and roles.Strategic Direction 2: Evaluation and Implementation of Skill Mix ChangesEvaluate the outcome of skill mix changes on patients, system and providers. Identify outcomes measures to evaluate patient, system and provider outcomes. Evaluate the feasibility of introducing LPNs in community services Extra Muraland Public Health . Conduct utilization survey of nursing service providers every three years inRHAs, Nursing Homes and community services.Strategic Direction 3: Deployment of Nurse PractitionersDevelop a deployment strategy for full utilization of Nurse Practitioners in thesystem. Target priority areas for expanded utilization given the projected supply andfuture needs. Develop a communication strategy for nurse practitioners focusing onphysicians, system managers, nurses and the general public. Address the impact introducing nurse practitioners on family physicians,including compensation and

Strategic Direction 4: Employment Standards for Unregulated CareProviders.Develop employment standards for unregulated care providers to ensuresystem flexibility and service quality. Investigate the need for employment standards for unregulated care providers(UCPs) and evaluate the service and financial impact of introducing suchstandards. Target priority areas for implementation of employment standards for UCPs.Strategic Directions for Nursing Human ResourcesStrategic Direction 1: Integrated Human Resource Planning andManagementCollaborate at Pan-Canadian and Atlantic levels toward the integrated healthhuman resource planning. Determine what types of nursing human resources are required and for whichpractice setting based on the skills and capacities of RNs, LPNs and UCPs. Develop an Integrated Human Resource Planning Framework for nursingservices that addresses consumer and system needs, supply-demand, educationand deployment. Adopt an Integrated Health Human Planning approach that is inter-sectoral andinter-professional.Strategic Direction 2: Nursing Supply and Demand ProjectionsImplement the supply and demand projection model with commitment toregular and ongoing adjustments. Update annually the profile of Nursing Human Resources. Update annually the vacancy information. Consider the weighted supply and demand factors annually through annualconsultation with nursing stakeholders. Update projections in light of staffing full time equivalents and skill mixguidelines. Implement a workload management system to better resource planning innursing homes to meet population needs.vii

Strategic Direction 3: Workload and Workforce ManagementDevelop regional strategies to resolve operational workforce managementissues: workload, overtime, absenteeism, employment status, scope of practiceand non-nursing tasks. Review, implement and maintain workload measurement tools in all practicesettings to assess patient needs and match needs with adequate nursing staff atthe appropriate level. Hire sufficient nurses to ensure a reasonable workload and continue to addressissues of staff mix and work status. Work with employers and unions to increase the proportion of nurses workingfull time in all health settings. Work with staff nurses and unions to (i) develop flexible scheduling that suitsboth nurses and employers, and (ii) develop and implement ways of addressingcontingency staffing that minimizes overtime. Collaborate with nurses, employers and unions to determine the reasons forabsenteeism with the goal of reducing it to the equivalent of the nationalaverage for full-time workers. Work with nurse leaders and unions to provide phased-in retirement programsfor older nurses in order to keep them in the work force longer. Continue to put in place policies that will allow RNs and LPNs to function to themaximum of their professional practice abilities. Employ sufficient numbers of support staff to allow nurses to focus fully onpatient care.Strategic Direction 4: Healthy WorkplacesCreate an inter-disciplinary practice environment in New Brunswick health careorganizations that will attract and retain a healthy committed workforce. Mandate Regional Hospital Corporations and Nursing Homes to develop a processwhereby nursing leaders and administrators work with front-line nursing staff toassess the workplace environment on an ongoing basis to identify problems, andplan and implement changes to address them. Provide salaries and benefits that are competitive and reflect the current realities ofboth the workforce and the workplace, in order to retain and attract new nurses. Provide first-line managers with human and technical resources that allow them todo the required work within reasonable hours.viii

Investigate the feasibility of funding continuing education for nurses on paid timeoutside of regular shifts. Continue to fund continuing education for specialty courses, and monitor the needfor critical care, mental health and other specialty programs. Recognize and reward nurses who act as preceptors and mentors.ix

Proposed Nursing Service and Resource Management Plan (2005-2010)IntroductionHow does a government report on progress in nursing service and resourcemanagement over the last decade and at the same time set the agenda forcontinued development? Such a report must begin with reminding NewBrunswickers what the Nursing Service and Resource Management Plan (1993)outlined and what has been accomplished. Although the 1993 plan wasdeveloped under different conditions, it sounded the call for significant change.Clearly a progress report on change is not enough. This Plan presents a visionfor continued sector development, “Moving Nursing Forward Together”. TheNursing Service and Resource Management Plan (2005 – 2010) identifieschallenges and proposes strategic nursing investments to “continue the legacy””of improved nursing and health services in New Brunswick.What challenges face the successful organization and delivery of nursingservices? Together, we must address priority nursing issues in the areas of roleand leadership, education, skill mix and human resources. The recentlyreleased “Provincial Health Plan (2004 – 2008)” sets the stage for systemchange and this Nursing Service and resource Management Plan (2005 – 2010)proposes strategic directions to complement and support such transformation.Project Purpose and ApproachIn December 2003, the Department of Health and Wellness (DHW) launched aninitiative identified in A Nursing Resource Strategy for New Brunswick (2001) toupdate the Nursing Service and Resource Management Plan (1993). Under theleadership of the Planning and Evaluation Division, the review process wascoordinated by Management Dimensions, a N.B. consulting firm with previousexperience in this area. The strategic update builds on existing work andinvolves the analysis of findings from recent national and provincial initiativesin the field and input from key provincial stakeholders.The purpose of the initiative was to develop a new Nursing Service andResource Management Plan relevant to 2004 and beyond. The specificobjective of the new plan is to