Financial incentives not enough to retain nurses, critics say

As British Columbia attempts to entice nurses to work in rural and remote communities, some say financial incentives don't go far enough to adequately address the ongoing nursing shortage. 

Christina Rogers, a registered nurse in Terrace, B.C., who specializes in labour and delivery and mental health, says the lack of resources in communities like hers could make potential nurses think twice before deciding to move for work. 

She says the small size of her team means more work and more responsibility for those on shift, which can mean more stress. 

"When a baby is born in a bigger level centre, they would call for a NICU [neonatal intensive care unit] team to come support this newborn baby. We don't have a NICU team. We are the team, the two of us, and the physician or the midwife or the resident physician. We're caring for the mom, we're caring for the baby," Rogers said.

"Maybe the weather is so bad we can't fly the baby out. So we have a 34-week preemie baby who is being taken care of by a team of two."

Rogers, who grew up in Terrace and has the support of friends and family there, notes that while monetary incentives can bring new nurses into more remote communities, there is no guarantee staff will stay longer than the required two-year commitment. 

"I think everybody deserves an incentive to go work in a place that's lacking. But it's hard for me to say that when I've been here the whole time working and dealing with the shortages and then seeing people come and seeing them go after they've worked their time."

Earlier this month the provincial government announced $237.6 million for new nurse-to-patient ratios across B.C.'s hospitals to better manage workloads and alleviate patient care. The Health Ministry launched signing bonuses of up to $30,000 in certain remote and rural communities, requiring a two-year commitment in return. 

Clifford Belgica, a clinical information specialist with Fraser Health, has worked in various health-care environments including emergency rooms in B.C. and the United States. He says incentives can be a major draw for some but hopes for more substantive changes in the province.

"Is it enticing enough? I don't know. Going to work in a remote area entails a lot of responsibility. To be able to work in an area where first of all the resources are thin and you'll be doing the job of three or four people," he said.

"So is it worth it per se in the long run to be given a big lump sum? Maybe for a while, but it depends on the person, too. Are they really willing to be there?"

Veena Sriram is an assistant professor in global health policy at the University of B.C. She calls the province's changes around nurse-to-patient ratios a "promising step" for rural retention, but adds the province should also focus on issues such as affordable housing to help support nurses who decide to relocate. 

"It has to be one part of a broader package of policies to ensure that health workers feel safe and supported and as though those are good jobs for them to take," she said. "You have to think about good housing, good supports for health workers when they move into those jobs. You need supportive communities, particularly for nurses who might be migrating from other countries, to make sure they feel as though they can build a life in those communities for the long term."

Critics also point to violence and abuse nurses face in health-care settings, and burnout.

B.C. United MLA Shirley Bond says burnout and unsafe work environments are factors that have eroded B.C.'s nursing population.

"Financial incentives may be part of what it takes to attract people to under-served areas. But I can tell you there's a lot more fundamental issues that we need to deal with when nurses are sharing stories about violence in the workplace, about being overwhelmed with work," she said.

"Their morale is so very challenged. Those are really difficult things to solve."

The financial incentives will become available on April 1, however it is unclear how many nurses have applied to work in rural and remote areas. The Ministry of Health anticipates the incentives will "strengthen and support the retention and recruitment efforts" in these communities.