The strategic plan and work has been funded by the Office of Healthcare Professionals Recruitment Community fund provided funding to help the Musquodoboit Valley recruit, welcome and retain healthcare professionals. The Musquodoboit Valley Health Foundation provides the oversight of the funds and the work is carried out by Wendy Robinson, Project Manager.

Our Strategy

THE SETTING:

Middle Musquodoboit is located in the Musquodoboit Valley, in central Nova Scotia. The area is about 80 kms/ 45 minutes from Metro Halifax. “Middle” is home to a post office, 24-hour maned fire stationed, RCMP detachment, elementary and high school, and several businesses. The iconic Musquodoboit Valley Bicentennial Theatre sits in the heart of the village and is a hub of activity.
Middle Musquodoboit is also the home of the Musquodoboit Valley Memorial Hospital and the Musquodoboit Valley Home for Special Care (Braeside). The hospital opened its doors in
1976 to service the approximately 5,000 residents of the area defined by Dean Settlement, Meaghers Grant and Dutch Settlement. It has approximately 135 employees, including 5 doctors, a nurse practitioner, a family practice nurse, nurse educator, registered nurses, CCAs, CTAs, a physiotherapist, rehabilitation assistant, occupational therapist, social workers (in and outpatient), laboratory technicians, dietitian and diabetic educator, spirometry technician, in addition to the environmental services, administrative, and managing staff. The hospital originally offered12 inpatient beds and emergent care but transitioned to urgent care in 2022 and retaining the inpatient beds. It is home to a family care practice.
Breaside opened in 1991 directly adjacent to the hospital. Its close physical proximity allows for the sharing of staff and services with the hospital. Braeside houses 29 beds, in 9 single rooms and 7 double rooms.
In 1995 the Musquodoboit Valley Health Foundation (MVHF) was created to secure funds for the Musquodoboit Valley Memorial Hospital, the Musquodoboit Valley Home for Special Care, and other community healthcare needs. Their priority is to work collaboratively with the healthcare teams by offering support and resources to improve the functioning of the hospital, long-term care centre and the lives of the residents that call it home.

THE ISSUES:

Many things have changed since the early days in the staffing situation. The problem of a lack of a qualified hiring pool is a result of many factors that have culminated in a dearth of potential new hires. It is well known that COVID-19 has had a huge impact on the number of people available for work but there was a predictable shortage well before 2020 that could not be solved. Between 1991 and 2021 there have been significant changes in the Nova Scotia demographics with a difference of 102,000 people between the ages of 18 and 24 years in 1991 old to a drop to 86,000 people in 2021. The median age increased from 25.4 to 46 in the same time frame (www.novascotia.ca/finance/stats.div/papers/demograf/demo4.htm. ) With fewer people in the typical age bracket for post secondary education, there has been fewer and fewer people to enter that segment of the workforce and thus fewer to hire. There second issue is that fewer potential parents meant fewer children to replace aging workers. The third issue is the aging population is increasing the demand on the healthcare system. This is not something that can be addressed within the scope of this plan, other than to mention that immigration recruitment may be a partial answer, but it is a huge topic in and of itself.
This population issue is not localized to this are, the province, or even our country. The 2010 book “Hollowing Out the Middle: The Rural Brain Drain and What It Means for America” by Patrick Carr & Maria Kefalas details the systematic drain of young people from middle America by the unintended consequences of supporting those who sought higher education in other regions and ignoring those left behind who fill the everyday jobs required to “keep a town running”. While the book is about middle America, much of it applies to Middle Musquodoboit and can have an impact on the choices youth make going forward.
As mentioned, COVID-19 created an even greater concern about the availability of staff. According to Carolyn Ray, there were 2,165 healthcare jobs unfilled in Nova Scotia listed. (CBC News, Oct. 13, 2021). This snapshot in time is indicative of the overall healthcare professional shortage globally. Nova Scotia Health is quoted in saying “recruitment of professionals across many disciplines is particularly challenging in rural areas.” (AllHands. A Community Resource for Physician recruitment in Nova Scotia) In light of the difficulty in finding staff, the government of Nova Scotia offered funding to communities to support their efforts in recruitment and retention of healthcare professionals (Office of healthcare Professionals Recruitment/Health and Wellness, November 14, 2022).
The Musquodoboit Valley Health Foundation (The Foundation) saw the need to help their community with the staffing issue and applied for the funding which they received in 2023. The Foundation felt that “building a healthcare team with local roots will improve our ability to fill vacancies and to retain workers. Local employees who live in the community and whose family are in the community are strongly connected and engaged in their work because they are invested in the health of their community since it is their home. This “grow from within” strategy will be a part of an overall recruitment strategy that allows us to seek out and grow the skills we need in our local healthcare facilities and spend less time hiring and training new staff.” (Tom Parker)
The Foundation believes that local people are just as capable as those from elsewhere and are far more likely to stay. The also recognize that “When you understand your patient personally, you’re better able to care for them and provide them with everything they need to feel safe and comfortable walking into your business.” (www.textline.com/blog/customerservice-in-healthcare) After all, the people coming through the doors at both facilities are most likely family members, relatives or neighbors of the staff and have a connection with them. This creates a deeper sense of trust and comfort.
It is also true that it is more effective to lay out an easier path to a healthcare career for locals than to convince someone to “pull up stakes” and move to an unfamiliar area that is a fair drive to major centers. The rural way of life is far different than urban living. These days it is cost prohibitive for a long commute to and from work. The best solution seems to be having a sustainable supply of healthcare professionals is to create a culture of “staying in community” for long term success.
As in the above mentioned book, there are things that can make a difference in retaining youth in our community. There are other ways of encouraging those who stayed to continue to stay; or enticing those who left to come back. It is no easy feat, but the final strategy to come from this project should make an impact on the hiring pool and in the lives of those who currently work in the local facility.
Many of the residents may require further education to enter the healthcare filed. However, the rising cost of education for healthcare professionals creates barriers for some to embark on new career paths. Some folks may not have considered a career in the health services or known what choices they are for careers in the facilities.
To further exacerbate the need for an increased number of local employees, on November 30th, 2023 the government of Nova Scotia announced they would open a new long-term care facility in 2023 with 48 single rooms. (New 48 room long-term care facility to be built in Middle Musquodoboit – The Laker) this will have a tremendous impact on the area, in terms of access to long-term care opportunities within the community, but also on the levels of staff required to operate the facility. The current facility has 22 rooms so an increase to 48 will more than double the staffing levels of healthcare providers.
The Foundation felt that the provincial funding for recruitment provided an opportune time to create a strategic plan to lay out a pathway to address some of the concerns about maintaining current staff levels and the increased needs of the future when the new facility comes on stream.

IMPLEMENTATION:

Wendy Robinson was hired as the consultant and Coordinator to create some events, formalize procedures for running a CCA program in Middle Musquodoboit, engage Community to envision goals to push the project forward. In addition to liaising with the Nova Scoita Health Authority (NSHA) staff, the Nova Scotia Community College, the YMCA Nova Scotia works, local schools, organizations, and Community. She felt running some of the events would allow her to gauge how they were received by the public and Staff. The coordinator created a brochure to distribute to Community to raise awareness of the project and to garner some volunteers (See Appendix I). She was able to better understand the work it takes to do the projects laid out and created a step-by-step action plan that makes the job of recreating the events easier for community volunteers. (See Appendix II) She felt it was less intimidating for people to follow a template, rather than asking them to start from scratch each time.

THE GROW WITHIN STRATEGIC PLAN:

The Grow Within Strategic Plan was developed as a practical way forward with a step-by-step roadmap. Timelines and actions are laid out for ease of replication. The plan is broken down into 4 pillars: 1- Encourage youth to explore healthcare careers, 2- Increase awareness of local healthcare jobs and opportunities for advancement, 3 – Celebrate healthcare professionals and their commitment to our community and 4- Improve communications between the community and the healthcare providers. The plan begins with some of the work that has been undertaken in each of these pillars as a jumping off point for a place to pick up and move forward.

INITIATIVES UNDERTAKEN TO DATE:

Pillar 1: Encourage youth to explore healthcare career

⦁ An initial connection was made with the high school and is promising for future collaborations.
⦁ The government of Nova Scotia has a tuition-free program for Continuing Care Assistants for 2024/2025 and Eastern College has agreed to offer a 37-week training in Middle Musquodoboit, beginning March 25th, 2024. This has been met with enthusiasm and will see 9 students from this area taking the course. Students will
train in a lab in Middle Musquodoboit and do their hands-on work in either Middle Musquodoboit or Sheet Harbour. It is a combined effort that should result in several new hires for both facilities in January 2025.

• NOTE: The high school guidance counselor has 3 students wanting to take the course after their graduation in June. Eastern College has agreed in principle to running another course, starting in late summer.

Pillar 2: Increase awareness of local healthcare jobs for advancements
This pillar requires a collaboration with the Nova Scotia Health Authority, the Coordinator, and the Community.
Pillar 3: Celebrate healthcare professionals and their commitment to our community
This pillar was easier to work through as coordinator was able to do some work herself on the following programs:
⦁ Monthly calendar was created that that lays out the professional days each month and reminders of upcoming events. (See Appendix II)
⦁ Staff was celebrated with cards and token gifts. (See Appendix III for Policy)
⦁ The 12 Days of Christmas campaign (See Appendix IV)
⦁ Christmas cards that were created for each department (See Appendix V). – Valentines were given to each staff member along with candy bouquets for each department.

Pillar 4: Improve communications between the community and the healthcare providers seeks to find ways to improve communications between the community and staff
-A data base for community organizations and community leaders was created that requires continual updating.
As work is being done by Community through the above celebration techniques so is staff encouraged to complete the communication by being a part of community events. They undertook the following:
⦁ An information table at the July 1st
⦁ Exhibition presence also took place. Several staff members attended the booth from 2:00 pm to 4:00 pm, ready to discuss the change to urgent care from the traditional emergency care model.

A review of the events can be found in Appendix VI

A breakdown of these initiatives into steps was created with an implementation timeline is included in the Strategic Plan Actionable Items List. (See Appendix VII)

The Grow Within strategy was developed as a way to help encourage locals to enter the healthcare profession and join the workforce in the two facilities. Many endeavors have been undertaken as mentioned above, that have raised awareness in the community of the project goals. As a result of some of the work done, research and discussions, the following is a list of recommendations and actionable items to use to more forward with a well thought out campaign.

OUTCOME MEASUREMENTS:

The Grow Within strategy success will be measured by the number of new hires that are a direct result of this strategy. The CCA classes should result in at least 6-8 new employees by the end of 2025, with the first class finishing by January 2025 and the second by the end of 2025. Each class should see 6-8 students from the area, and most will likely stay in the area.
The success of the other pillars will be more difficult to measure in terms of the emotional impact on employees. The rate of staff turnover may be an indication of whether it has lowered it significantly. However, a staff survey is the only way to determine if the efforts have had an impact on their work life. Exit interviews could also give some indication of whether more effort would make a difference between a staff member staying or leaving the facility.
Success will also look like a group of community volunteers who take on the proposed activities and/or create more/others. As for the staff members, seeing more of them participating as NSHA staff representatives at community functions will mean success for the program. Having them take the initiative, rather than being asked to participate in a planned event, will mean the project has done its intended job.
Vacant NSHA staff positions posted where the public can view will be another success. Currently the postings happen in a bit of seclusion, amongst the staff themselves or on the NSHA website. If you are new to the community, you may not have the “connections” to the information via other staff members. It can be tedious to repeatedly go to the website in hopes of openings. Casting a wider net for new staff may breathe new life into the facilities.
Rumors of happy staff members will be an indicator as well. People entering the facility should notice the happy atmosphere and feel more welcome and connected to the staff. People
talk and the optimal situation would be that “they” say how nice an experience it was despite the circumstances that took them to the facility.

RECOMMENDATIONS:

More work needs to be done in the recognizing staff as “recognition connects people to their organization because it helps them feel appreciated, valued, and more inclined to stay. Unfortunately, only 66% of healthcare workers feel appreciated at work. And 38% of healthcare workers say their situation at work is hurting their ability to be happy in other aspects of their lives. Research from our 2023 Global Culture Report uncovered more frequent recognition can be more powerful than once-a-year recognition efforts alone. So, although Nurses Week and
Hospital Week are a critical time to thank employees, it shouldn’t be the only time. It’s vitally important to integrate appreciation into everyday moments throughout every week of the year.” (www.octanner.co/insights/articles/2023/1/24/ways-to-thank-healthcare-workers.html) Thus the plan includes other opportunities to further connect community with staff through various methods.
The first recommendation would be to take a survey of the current employees to gauge how the few initiates have impacted their attitudes towards the community.
⦁ Did what was done change anything?
⦁ Was it the type of recognition that would have an impact?
⦁ What would they like to see in the future?
⦁ How often would they like to receive something?
⦁ What community events would they be willing to take part in as a staff member: July 1st picnic, Exhibition and parade, etc.
⦁ What events would they like to see happen in Community to be able to assist in the organization and execution?
⦁ Would they like to see more interaction with local students?
The survey answers must be kept anonymous so the employees can feel free to answer honestly.

Secondly, the Musquodoboit Valley Health Foundation has a mandate to garner the funds for the Musquodoboit Valley Memorial Hospital, the Musquodoboit Vally Home for Special Care (Breaside) as well as other community health care needs. The Foundation is taking a roll in offering financial support for the students entering the CCA. The Foundation agrees that students should have some financial support so they too can reduce/eliminate the financial barrier to going through the program and feels that access to education should be equal for all. They are also in the process of setting up a bursary for staff wishing to upgrade their education to a Licensed Practical Nurse.

In addition to the student support, it is recommended the Foundation support the recognition program for the staff. This includes the cost of the cards and token gifts, as well as the 12 Days of Christmas program. This would be approximately $1000. It is recommended that a recognition of years of service program from the community be implemented to augment the current NSHA program. Many of the current staff members have been employed for multiple years. New hires should also be recognized as they are more likely to move on to another facility. Marking their professional recognition days and Christmas are a given. Individual recognition may be more meaningful and be the reason for staff to stay.
Organizations such as the Family Resource Centre, Sew What Group in Carrolls Corner, or the Musquodoboit Valley Entrepreneurs Association may be engaged to help with donations, creating and delivering cards, and organizing/running events. The local Lion’s Club may be willing to help. Many of the churches have diminished congregations but may be interested in taking on small projects such as cards that they can do from home.
That said, the pandemic changed volunteerism across the country and the levels have not rebounded since the major shutdown. Statistics show that the number of volunteers has decreased but the need for them has increased. I suspect that this health catchment area is no different. Research indicates that people tend to volunteer to help neighbours though informal channels, rather than formal settings. If we can tap into the sentiment of neighbours helping neighbours, there may be more volunteers at the ready for the proposed projects. VolunteerHailfax has the MVMH on its list (volunteerhalifax.ca/place/musquodoboit-valley-memorial-hospital)
With this dearth of volunteers and given the success of the projects undertaken to date are a direct result of a dedicated paid person it is strongly recommended that a permanent position be created. The position may be combined with other program efforts, such as a development officer for the Valley. The CCA program coordination took a huge effort to coordinate all the stakeholders. Eastern College is a tremendous partner, as well as the Foundation, and the YMCA Nova Scotia Works. But it took the Grow Within Coordinator to bring everyone together and to sort out offsite lab details. Rental space funding had to be secured as well. Advertising the program through physical poster placed throughout the catchment area raised the awareness level enough to draw 9 students into the course. The hospital administration is far too busy organizing their part of the program to take on the additional responsibilities required to sort through all the details. A dedicated paid staff person would be able to ensure the course was able to continue to run in the future.
One of the actionable items pertaining to youth, with respect to the aforementioned book, would be to create bursaries to be given to those who are choosing to stay. Clearly, they do not need the huge financial support those attending university for several years do but a few dollars and recognition could go a long way in making them feel valued by the community. We will always need young people to keep the community alive. Some may eventually turn to healthcare careers. The hospital needs workers in all departments and exposure to the various professions within the hospital may spark an interest in courses they might not have otherwise thought about.
Once inside the “door” they are easier to reach than outsiders.
It is not up to the Foundation to fund all the solutions. Local businesses and individuals could offer financial support though donations for the cards and BBQ, breakfast, etc. Much of the work is relativity inexpensive, such as giving their time to make and address the cards, token gifts and helping put on events. Staff also need to become more engaged in the community, spending their off time helping with all aspects of community events.
Additional public meetings should take place to disseminate the strategic plan and to engage the community to take on these initiatives and to create their own. As noted, volunteerism is ebbing and recruiting volunteers is difficult. More one-to-one conversations may be the way to gather ad hoc groups to complete individual projects that are coordinated by a paid staff member. A central office is needed to ensure that duplication is eliminated and to ensure that someone has their eye on the big picture. More opportunities may be available, and someone needs to be aware of them and to apply for the funds.

BARRIERS, LESSONS LEARNED, AND REQUIREMENTS TO MOVE FORWARD:

This project has a wide scope. When it is broken down into its components, it becomes easy and doable. The piece that has become the easiest to accomplish is the one that encourages a good relationship between the community and the healthcare workers. The campaign to celebrate professional recognition days and the Christmas campaign have fostered a positive feeling of staff towards the community. Having a local group working the campaign will increase the ownership of the campaigns and perhaps inspire other initiatives.
Nova Scotia Health Authority (NSHA) staff, the high school staff, as well as the public have busy schedules and taking on one more project can be overwhelming. Finding a way to engage the NSHA staff to come out into the community is challenging since COVID 19 changed the world. There is a history of healthcare staff participating in community events which was mentioned by members of the public at the July 1st picnic and the Exhibition. Older staff remember fondly the fun they experienced and are interested in recreating that in the future. The newer staff do not have that familiarity and may not be aware of the feeling you get from participating in these things.
Part of the project was to formalize the steps to create a CCA program running in Middle Musquodoboit. Luckily, Eastern College has brought a turnkey operation to the table and as mentioned before, it will begin March 25th, 2024. There is some discussion about a Licensed Practice Nurse course to run in Middle Musquodoboit as well. That will take more research and planning.
The YMCA Nova Scotia Works Employment Centre is eager to become a partner in the CCA program and can offer funding for students who meet the Employment Insurance criteria. They have access to YMCA employment funding for things such as uniforms and medical requirements. Every bit of financial assistance is imperative to ensure everyone has an equal opportunity to participate.
Access to the local high school was hampered by changes in their staff but it is anticipated that this coming year will see doors opening. Eastern College has agreed to participate in conversations with students about their CCA program in the coming year.

CONCLUSION:

Time and money are the two main barriers to the execution of the initiatives that have been suggested: money to pay someone to complete the proposed initiatives and the time to be able to wait for meetings with stakeholders. Lack of community engagement is also a barrier to getting the easy items completed.
The scope of this mandate does not include any impact on salaries as a way to incentivize people to join the workforce or stay with that employer. However, as indicated previously, money is not always the issue. The emotional support offered by the community can be very impactful for staff. This leads to a sustainability component of that type of support moving forward. The public is becoming less and less “volunteering oriented”. Organizations struggle to keep their current members as they are aging-out and younger people do not tend to volunteer as much. The businesses are called upon to donate to many good causes already. Therefore, moving forward on a long-term basis may be more difficult without ongoing funding. The province may offer such funding, but it cannot be guaranteed. Finding a way for the Health Foundation to be more involved on that level may be the answer.
The activities laid out in this plan are by no means the only way to achieve the desired outcomes, but rather a jumping off point for others to take and run with. Some of the suggestions came from public input so once more volunteers are involved, it is believed that many additional and varied initiatives will come to light. The plan is merely a catalyst to spark discussion and creativity amongst Staff and Community.
The impact of the strategic plan will see a workforce that is made up of as many residents that want to work in the facilities who feel well supported by the community as much as possible. It also means that a position at the facilities is sought after for many years to come. In addition, the thought of working in the healthcare field is top of mind when young people are considering a career path. Furthermore, the staff at the facilities feel they are lucky to be employed in the community in a wonderful workplace. The staff feels that they can easily upgrade their education while still working and have a position when it is finished. An appreciated staff should lead to a welcoming experience for visitors and maybe even better care.
It will also lead to a staff that feels connected to the wider community and a community that feels connected to them. Both parties will benefit greatly from this kind of relationship.

Updates

As the Coordinator of the Grow From Within Project, I am pleased to provide the following update.
One of the main pillars of the strategic plan is to celebrate the current staff and let them know they are appreciated by their community. COVID 19 saw many public jesters, such as signage. As those things dropped off, the project has picked up the torch and is making the jesters more personal. The goal is to help create a workforce that feels connected to the community and the community connected to the staff. These will go a long way towards retention of the current staff and making it a desirable place to join the team.

On behalf of the Community of the Musquodoboit Valley to date we have been able to:

Staff members were recognized through the year on their professional day with a thank you card and a token gift.
We ran the 12 Days of Christmas Campaign for all the staff of the Musquodoboit Valley Memorial Hospital and Breaside (Musquodoboit Valley Home for Special Care) in December 2023. This saw staff to have a chance to win a small gift over the 12 days between December 11th and the 22nd. Every member’s name was put in a draw and on day 1, one name was drawn, and they won a prize; day 2 two names were drawn for the 2 prizes and so on. Each day one of the prizes was a gift certificate for a local business. A total of 78 prizes were won by the 120 staff members.
In addition, we provided Christmas cards (with a Lint Chocolate attached) were distributed to everyone.
In February, several gift bags of candy and chocolate were left at the nurses’ stations for their enjoyment.
In April of 2024, we celebrated the 1-year anniversary of the change over from an Emergency Department to one that offers Urgent Care. We celebrated this milestone by hosting a pizza and cookie party for the staff to say thank you for all the hard work and to get through the change.
On behalf of the Community, we delivered pizza and sweets to the Braeside staff in recognition of Special Care week.
The professional days recognition continues.
As many people know, Continuing Care Assistants (CCA) are the backbone of Braeside. Recent years has seen a drop in the number of folks entering the profession, which left a Breaside short staffed over the past few years. In light of this, we were able to run a CCA course right here in the Valley, thus allowing students to study and practice in their own area. From the graduating class, Braeside will benefit from a couple of new CCAs joining their team.

Funders

The Musquodoboit Valley Health Foundation was created in 1995.  Its purpose is to secure funds for the Musquodoboit Valley Memorial Hospital, the Musquodoboit Valley Home for Special Care, and other community health care needs.  
When a donation is made in memory of a loved one, a plaque is made with their name and placed on our “Memory Board” in the entrance of the Musquodoboit Valley Memorial Hospital.  Your support and contributions can help us to meet our goals and improve conditions.