Improving Retention and Recruitment in Smaller Communities: The 80/20 Project

British Columbia

Interior Health serves a large geographic area covering almost 215,000 square kilometres of inland British Columbia. The Interior Health Authority (IHA) is finding it increasingly difficult to retain and recruit nurses and other health care providers. To meet this challenge, the IHA partnered with the British Columbia Nurses’ Union (BCNU), Thompson Rivers University (TRU), senior management of the Royal Inland Hospital (RIH), and the BC Ministry of Health. Given the current vacancy rate, an aging workforce and imminent retirements, the partners determined to pilot a retention and recruitment initiative to address the nursing shortage.

An innovative 80/20 staffing model, developed by the University Health Network in Toronto (Bournes and Ferguson-Paré, 2007), was adapted for Interior Health’s RIH. The RIH is a primary acute care facility and the major health care employer in Kamloops, a city of approximately 85,000 residents. The 80/20 model has been effectively implemented in a large urban hospital in Toronto, but not yet in a smaller rural centre like the RIH. The model allows nurses to spend 80% of salaried time in direct patient care and 20% in other activities that will enhance patient care, like professional development and mentoring. Implementation of the 80/20 staffing model has been shown to enhance nurses’ satisfaction with their practice and to respond to calls for patientcentred care.

Project Objectives: 
  • Improve staff retention and enhance the RIH’s profile as a desired workplace
  • Provide time for nurses to develop leadership and clinical skills, and engage in professional development and mentoring
  • Introduce staff to research and allow time for engaging in relevant research
  • Improve measured job satisfaction indicators and staff engagement
  • Identify effective practices with respect to intersectoral collaboration
  • Positively impact work environment indicators like overtime and sick leave
Project Implementation: 

Eleven RNs and four LPNs working on the Pediatric Unit at the RIH participated over a nine-month period. Nurses worked with a professor from the TRU School of Nursing to create individualized learning plans. A Clinical Educator helped the nurses carry out their learning plans and locate specific professional development activities. Project nurses were able to access up to $2,500 each in additional funding to pay for some or all of their professional development activities. This funding provided reimbursement for expenses such as tuition, supplies and travel.

In order to cover the time spent in professional development, two RN and one LPN backfill positions were created based on backfill rotations developed by experts from RIH and BCNU. All of the nurses hired for these positions chose to participate in the 80/20 project as well. In contrast with the pre-project challenges filling vacant positions on the unit, nurses readily applied for the backfill positions.

Nurses engaged in a variety of professional development activities based on their personalized learning plans. For example, one LPN began coursework towards obtaining her BScN, and one RN developed a pamphlet designed for children to introduce them to the pediatric surgery unit.

Project Outcomes: 

• Over the nine months of the project there was a marked increase in collaboration and team spirit — the high level of staff engagement arose from a foundation of collegial caring, a positive work environment, increased staff morale, and the bonding that developed over the life of the project
• Paid professional development helped nurses achieve work-life balance, create a positive work environment and enhance patient care, ultimately contributing to the retention of nurses
• Job satisfaction and staff engagement improved and many of the nurses indicated that because of the project they intended to remain employed at RIH
• After the project, there was an increase in the number of nurses wanting to work on the implementation unit
• The increased skills and competencies of the unit nurses is benefiting patients and has enhanced the employer’s capacity to provide services
• The project demonstrated that nurses unions, employers, governments and academics can successfully engage in collaborative partnerships to address specific nursing workforce issues outside, and in addition to, normal labour relations and the collective bargaining environment