Road to recovery: Cancer in the COVID-19 era

Solving the health human resources crunch

Explore the actions needed for solving the health human resources crunch:

1. Address staffing shortages
2. Identify and mitigate capacity crunch points
3. Focus on training, recruitment and retention

1. Address staffing shortages

More practitioners are needed to handle the near-term surge in demand for cancer care services. To address the current shortage, some jurisdictions have hired back retired nurses, incentivized currently employed technicians and practitioners, brought more nursing students and international trainees into the system, and implemented labour-substitution strategies (e.g., training paramedics to perform palliative care).

Solutions from across Canada:

• New trainees: Manitoba plans to hire and train up to 13 new anesthesia clinical assistants over the next three years — double the number currently working in operating rooms across the province — to help reduce its surgical and diagnostic backlog.
• Student nurses: Alberta hired 648 student nurses to provide care at hospitals and alleviate staff shortages. The student nurses were assigned to areas of greatest need, such as inpatient wards and emergency departments.
• International recruits: In February 2022, Quebec announced plans to recruit 1,000 nurses internationally over a two-year period and will designate those nurses to work in regions that currently lack health workers.

2. Identify and mitigate capacity crunch points

Within the cancer system, some providers may be significantly backlogged while others in the same vicinity have capacity. Centralizing the intake of cancer patients for diagnosis and treatment would create opportunities to relieve specific pressure points and maximize available capacity system-wide. Surge capacity could be improved by delivering low-risk, frequent activities (e.g., colonoscopies, imaging) in outpatient or non-hospital settings. Encouraging self-screening and moving less-intensive non-oncology procedures such as cataract and hernia surgeries into ambulatory surgery centres would also help free up hospital rooms for cancer patients.

Solutions from across Canada:

• Integrated ambulatory centres: The Ontario Medical Association has proposed the creation of integrated ambulatory centres that would focus on specific day surgeries  — and are expected to deliver care 20 to 30 percent more efficiently than in hospital.
• NEW: Self-administered screening kits: In response to the pandemic, Alberta, British Columbia, Manitoba and Prince Edward Island are now mailing out “at home” fecal tests for colorectal cancer screening and/or HPV self-sampling kits for cervical cancer screening. This allows people to participate in screening from home — important for those who face barriers to accessing screening, including First Nations, Inuit and Métis and those facing geographic, systemic or sociodemographic factors — while minimizing in-person encounters in a highly constrained health system.
• NEW: Colposcopy risk stratification: Colposcopists in Alberta can now order the HPV Test of Cure for patients who received treatment for high-grade cervical lesions. The HPV Test of Cure is a tool for determining which patients need follow-up in colposcopy and which can be safely discharged to primary care for cervical screening. Put in place due to the pandemic, this approach helps avoid unnecessary colposcopy clinic visits, which in turn increases clinic capacity and reduces wait times.

3. Focus on training, recruitment and retention

The multi-year training requirements for technicians, nurses and physicians limit how quickly the system can onboard new cohorts of workers. Raising enrolment limits on Canadian nursing programs would give more people the opportunity to receive advanced training and grow the pipeline of highly skilled people available to fill vacant positions. Standardized approaches to workforce planning could also help ensure the right mix of skills and experiences are found on cancer teams across the country.

As well, modifying immigration policies to fast-track qualified cancer care workers from other countries could help rapidly grow capacity and prevent jurisdictions within Canada from “poaching” each other’s human resources, which shifts shortages around instead of addressing them.

Solutions from across Canada:

• Family doctors providing chemo: British Columbia (among other jurisdictions) has developed a General Practitioner in Oncology (GPO) program to strengthen the oncology skills of new GPs so they can enhance cancer care in their communities. These GPs can support diagnosis, deliver chemotherapy and manage follow-up care, reducing the reliance on medical oncologists.
• Nursing toolkit: Ontario has developed an advanced practice nursing (APN) toolkit, which includes a systematic approach for augmenting the role of APNs in cancer settings and in the community. This will help optimize the scope of practice for APNs, which in turn will reduce physicians’ workloads.
• Assistants for nurses: Quebec’s Ministry of Health plans to hire 3,000 administrative assistants to lessen the paperwork burden on nurses. It has also launched scholarships to entice approximately 2,000 potential new hires to become nursing assistants, and is designing pilot programs that will allow nurses to have more control over their schedules.
• Incentive pay: Ontario is providing a bonus of up $5,000 to eligible registered nurses to help retain nurses and stabilize the nursing workforce during this critical time.