Investment in a Late Career Retention Strategy Policy to Practice – Investing in Your Workforce September 15, 2014 Prepared by the Nursing Health Services Research Unit Knowledge Translation and Exchange Program University of Toronto site

2012/2013 Late Career Nursing Initiative (LCNI) Evaluation Objectives & Methods 1.Assess the extent to which special projects align with MOHLTC action plans (document analysis) 2.Characterize employer-perceived barriers and facilitators to implementation of the LCNI across healthcare facilities and benefits resulting from participating in the initiative (interviews with leaders) 3.Characterize and quantify specific project characteristics and nurse experiences with the LCNI and determine the extent to which they vary at the individual and organizational levels (surveys of LCNs) 4.Evaluate the effect of LCNI participation, project characteristics, nurse experiences with the LCNI and nurse demography on self-reported outcome measures including job satisfaction and career intentions (surveys of LCNs) 5.Evaluate the effect of LCNI participation, project characteristics, nurse experiences with the LCNI and nurse demography on administratively- recorded absenteeism and turnover (absentee information and turnover data)

Sample characteristics:  Of 184 funded organizations, 47 organizations participated in the Evaluation (24 Acute Care + 3 Home Care + 20 Long-Term Care %) from 14 LHINs  Surveys: 761 received (404 paper-based online) (response rate ~ 35%)  Interviews: 59 completed (33AC, 3HC, 23 LTC) with the leaders from participating organizations; 17 with the leaders from non-participating organizations  Absentee & turnover data received from 21 sites 2012/2013 LCNI Evaluation Characteristics of Participating Organizations

2012/2013 LCNI Evaluation Participating Organizations by LHIN and Sectors 1. Erie St. Clair 2 (1 LTC, 1 AC) of 9 funded 8. Central 2 (2 AC) of 9 funded 2. South West 5 (4LTC, 1 AC) of 21 funded 9. Central East 3 (2 LTC, 1 AC) of 15 funded 3. Waterloo Wellington 2 (2 AC) of 14 funded10. South East 2 (2 AC) of 8 funded 4. Hamilton Niagara Haldimand Brant 8 (2 AC, 6 LTC) of Champlain 7 (2 LTC, 4 AC, 1 HC) of Central West 1 (1 AC) of 2 funded12. North Simcoe Muskoka 2 (1 LTC, 1 AC) of Mississauga Halton 2 ( 1LTC, 1 HC) of 8 funded13. North East 5 (2 LTC, 3 AC) of 12 funded 7. Toronto Central 5 (4 AC, 1 HC) of 22 funded14. North West 1 (1 LTC+AC) of 4 funded Total: 47 sites (25.5%) Legend: AC – Acute Care LTC – Long-Term Care HC – Home Care Evaluation coverage (%)

2012/2013 LCNI Evaluation Interviews with Nurse Leaders – Key Themes Having a Strategic Approach Aligning the LCNI Goals with Organizational and MOHLTC Priorities Setting Clear Goals and Monitoring Progress Starting Small, Scoping Projects and Starting Early Leveraging Staff Expertise Matching LCNs’ Interests/Skills to Corporate and Local projects Getting Nurse Buy-In Barriers with Getting Nurse Buy-In Barriers with Application, Notification and Funding processes Barriers with the Implementation Process Barriers with Reporting Requirements and Follow-Up Barriers to Applying Securing Organizational Support Getting Support from Senior Management Collaborating with Union Representatives Utilizing the Expertise of Other Interdisciplinary Team Members (e.g., computer skills) Consulting with Other Organizations Achieving Outcomes Benefits to the Organization Benefits to Nurses Benefits to Patients

“I think it’s a great opportunity for us to look at some of the key strategies as an organization that we want to initiate and support and certainly a lot of them are in alignment with the healthy Ontario strategy, the senior strategy, those are actually some of our corporate goals.” (Hospital 23) Having a Strategic Approach Leveraging Staff Expertise “Don’t have the manager pick what it needs to be, it needs to be the nurses. Have the nurses decide because they need to want to be able to do this. It needs to be beneficial to them, they need to feel good about what they’re doing. We develop that together so they’ve already got the buy in” (Long Term Care 08).

“We had everybody endorse this initiative from our CEO to our middle management, to our union rep to our HR. The implementation team presented to the leadership, to the middle management, to the client services, HR so they really understand the benefits for all the organization, the nurses as well as the clients. We needed to get the leadership on board, including nursing supervisors and managers [and]disseminate information more to the nurses at the point of care. There was definitely a lot of stakeholder consultation that happened”. (Home Care 03) Securing Organizational Support

“For the nurses definitely, the feedback received, the fact that the job satisfaction went up and the stress level went down, and all of the nurses that had participated said that they would be interested in participating again.” (Home Care 03) “A great opportunity for nurses at the end of their career to share their knowledge and expertise and be able to participate in QI initiatives or little projects on the floor, they are often able to identify improvements and contribute and feel part of something and it takes away from that arduous schedule of shift work.” (Hospital 18) “The residents are happier, the families are happier, the staff are happier based on the satisfaction level at this point.” (Long Term Care 02) Achieving Outcomes

2012/2013 LCNI Evaluation Surveys Age Professional designation Reason for not participating in LCNI Healthcare sector

2012/2013 LCNI Evaluation Project Characteristics LCN participants with higher scores were more likely to report that the LCNI helps to retain late-career nurses. LCN participants with higher scores were more inclined to report that the LCNI influenced their job satisfaction and cite work environment as an important factor influencing their decision to remain in their organization. Participants who had a less positive view of their project were less likely to believe that the LCNI aids in the retention of late-career nurses then those who had higher scores in the project characteristics inventory.

2012/2013 LCNI Evaluation Job Satisfaction and Career Intentions LCNI participants were more likely to regard co- workers as one of the most important factors influencing their decision to stay and LCNI aids in the retention of late-career nurses. Older participants were more likely to anticipate remaining in the organization and profession for a shorter time. Participants who worked FT were more likely to report that they anticipate remaining in the profession for at least 5 more years.

2012/2013 LCNI Evaluation Job Satisfaction and Career Intentions Participants who had participated in LCNI frequently were more likely to report that LCNI influenced their job satisfaction. Participants who volunteered were more likely to report higher job satisfaction than those asked to join by their manager. Retirement was the most frequently stated reason for leaving the organization or profession, especially among the participants not volunteering to participate in the LCNI.

Key Recommendations To MOHLTC: Earlier notification, longer deadlines, a tip sheet with all the relevant deliverables and timelines; flexibility in scheduling (LCN time in weeks rather than shifts; part- time and casual nurses; flexible scheduling); showcasing successful nurse leaders and LCNs. To Healthcare Organizations: Align the LCNI goals with organizational and MOHLTC priorities; Have clear goals and monitor progress; start small and scope projects; leverage staff expertise, interest, and resources; engage stakeholders and get nurse buy-in.

Key Recommendations To NHSRU-KTEP: Conduct retrospective and prospective designs and mixed methods to gain further insight into the impact and experiences at the micro (LCNs and other age cohorts of Registered Nurses and Registered Practical Nurses); meso (nurse leaders within health care organizations); and macro (provincial decision makers and associations); revise the survey item inventory by eliminating redundant items.

LCNI 2012/2013 Evaluation Knowledge Translation Presentations/ Meetings Nursing Policy and Innovation Branch – July 17, 2014 Northern and Rural Profile created for RNAO – Aug. 3, 2014 Registered Practical Nurses Association of Ontario – Aug. 14, 2014 JPNC – Sept. 8, 2014 NHSRU KTEP Policy to Practice Forum – Sept. 15, 2014 Ontario Nurses Association – Sept. 17, 2014 Publications Creating sector specific profiles Jeffs L, Nincic V, Hayes L, Jerome D, Malecki V. Insights from Nurse Leaders to Optimize Retaining Late Career Nurses. Canadian Journal of Nursing Leadership. Accepted for publication – September 5, 2014.