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  • November 2006

    Human Health Resource Series Number 5

    Andrea Baumann Jean Yan Jaclyn Degelder Kamil Malikov

    Retention Strategies for Nursing:

    A Profile of Four Countries

  • 1Retention Strategies for Nursing: A Profile of Four Countries

    Retention Strategies for Nursing: A Profile of Four Countries, November 2006 Number 5

    Andrea Baumann, RN, PhD, Associate Vice President, International Health and Director, Nursing Health Services Research Unit (McMaster University site)

    Jean Yan, Chief Scientist for Nursing & Midwifery, World Health Organization, Geneva, Switzerland

    Jaclyn Degelder, RN, BScN, Research Coordinator, Nursing Health Services Research Unit (McMaster University site)

    Kamil Malikov, MD (Russia), MSc (UK), MBA (Canada), Program Officer and Clinical Research Coordinator, International Health, Faculty of Health Sciences, McMaster University

    Howard Catton, Head of Policy Development and Implementation Royal College of Nursing, UK

    Margaret Chota, Commissioner, Nursing Services, Ministry of Health, Uganda

    Wipada Kunaviktikul, Dean, Faculty of Nursing, Chiang Mai University, Director of the World Health Organization Collaborating Centre for Nursing and Midwifery Development

    Anna Maslin, Professor, International Officer, Nursing & Midwifery, Department of Health, England, UK

    Debbie Mellor, Head of Workforce Capacity, Department of Health, England, UK

    Ashley Moore, Workforce Policy Manager, Department of Health, England, UK

    Rutja Phuphaibul, Professor, Director of WHO Collaborating Centre for Nursing and Midwifery Development, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Supanee Senadisai, Associate Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand

    Andrea Baumann Phone (905) 525-9140 ext 22581 E-mail baumanna@mcmaster.ca Website www.nhsru.com

    Authors

    Advisory

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  • Table of Contents

    Executive Summary ........................................................................................................................................3

    Recommendations .........................................................................................................................................4

    Introduction ..................................................................................................................................................5

    What is Retention? .........................................................................................................................................5

    Frameworks for Retention .............................................................................................................................6

    Analysis of National Retention Strategies ......................................................................................................6

    Uganda ..........................................................................................................................................................7

    Investment in Health ......................................................................................................................................7

    Migratory Patterns ..........................................................................................................................................7

    Policy Framework ...........................................................................................................................................7

    United Kingdom ............................................................................................................................................8

    Investment in Health ......................................................................................................................................8

    Migratory Patterns ..........................................................................................................................................8

    Policy Framework ...........................................................................................................................................8

    Canada ...........................................................................................................................................................9

    Investment in Health ......................................................................................................................................9

    Migratory Patterns ..........................................................................................................................................9

    Policy Framework ...........................................................................................................................................9

    Thailand ......................................................................................................................................................10

    Investment in Health ....................................................................................................................................10

    Migratory Patterns ........................................................................................................................................10

    Policy Framework .........................................................................................................................................10

    Conclusion ..................................................................................................................................................11

    Recommendations ......................................................................................................................................12

    References ....................................................................................................................................................13

    Annex 1. Selected Socio-Economic and Health Indicators in Canada, Thailand, Uganda, and the United Kingdom ..........................................................................................................................................16

    Annex 2. Canadian Recruitment and Retention Policies at the Provincial/Territorial Level .........................17

    Annex 3. Retention Policies in Uganda ........................................................................................................22

    Annex 4. Retention Policies in England .......................................................................................................23

    Annex 5. Retention Policies in Canada ........................................................................................................25

    Annex 6. Retention Policies in Thailand ......................................................................................................26

  • 3Retention Strategies for Nursing: A Profile of Four Countries

    Executive Summary

    A seven-point framework was used to analyze retention strategies in four countries: Uganda, the United Kingdom, Canada, and Thailand. This framework draws upon available country data and includes GDP and investment in health, mix of private/public investment, international migration, health policy frameworks, countrywide strategies, provincial/regional strategies, and professional associations/regulatory bodies. Comparison of the countries demonstrated that progress has been made in nurse retention. The analysis showed that each country has made a considerable investment in health. All had a system of basic preventive and primary health care services, a significant acute care hospital sector, and low external migration of the general population. In addition, each had a comprehensive health policy framework in place and professional/regulatory bodies that reinforced the national strategies.

    All the strategies addressed similar issues such as increasing nursing workforce numbers, role expansion of nursing aides, and a commitment to continuing education. Uganda and Thailand had strategies that included a salary plan for health personnel and professional development. In Canada and the UK, the national strategy filtered down to the regional level where other complementary policy frameworks exist. Both countries had specific human resources plans that focused on healthy workplace initiatives and strategies for improvement of nurse morale.

    The report emphasizes the relationship between health investment, policy frameworks, the existence of professional associations, and the retention of nurses. Although some might argue that this is a loose association, the countries have been successful in retaining nurses. The seven- point framework is helpful as a means for countries to look at ways to stem the rate of external migration and the continual loss of a valuable health resource.

  • 4Retention Strategies for Nursing: A Profile of Four Countries

    Recommendations

    1. Increase nursing workforce numbers through: • increasing admission to the professional education programs • signing bonuses for new graduates • retention bonuses

    2. Harmonize salary scales.

    3. Upgrade skills of nursing aides.

    4. Provide allowances for large and smaller supportive initiatives including: • housing subsidies • extended child care • flexible working times and retirement • healthy workplaces • provision of a hot lu