Hot (News) Flash: The Under-recognition of Menopause as a Nursing Workforce Issue
~ Ashley Holloway
There are three groups of regulated nursing professionals in Canada, the distribution of which varies across the provinces and territories. These regulated members include Registered Nurses (including Nurse Practitioners), Licensed Practical Nurses (known as Registered Practical Nurses in some provinces), and Registered Psychiatric Nurses, the total combined supply of which exceeded 431,000 professionals in 2018. Despite a 17.1% increase in male nurses joining the profession between the years 2013-18, nursing remains a predominantly female profession, and in 2021, the Canadian Nurses Association reported that 91% of regulated nurses were female.
One of the realities of having a female-dominated profession includes workforce disruptions due to maternity leaves. Due to the frequency with which this occurs, pregnancy and maternity leaves within the profession are normalized, highlighting the importance of having a multigenerational workforce. In Canada, the average age of a Licensed Practical Nurse is 41, while the average age of Registered Nurses, Nurse Practitioners, and Registered Psychiatric Nurses are between the ages of 43-44 in 2021. This average has decreased over the past several years, indicating a trend towards a younger workforce within the regulated nursing professions.
With that in mind, the median age of retirement for Registered Nurses in Canada, which make up the majority of the regulated nursing professionals, is 63. Likewise, Canadians are living longer than before, and for many reasons such as financial need and obligation, continue to work longer than their counterparts from previous generations. This is evidenced by only 44.9% of individuals aged 60-64 reporting being fully retired in 2023, as compared to a strong trend towards early retirement in the 1980s.
While it’s difficult to calculate the rate of attrition of regulated nursing professionals in Canada, Statistics Canada reported a 24% increase in job vacancies for Registered Nurses and Registered Psychiatric Nurses between the first quarters of 2022 – 2023, the highest increase across all jobs in the labour market. Licensed Practical Nurses were not far behind with a 20.2% increase in job vacancies for the same period. Combined, these statistics reveal a proverbial staffing tug-of-war of the regulated nursing professional workforce today in Canada. As such, retention strategies of these healthcare workers are a common theme across all provinces and territories in Canada.
With more than 50% of Canada’s nurses aged 40 and over, the nursing profession is further dominated by perimenopausal women. Additionally, it is anticipated there will be a 27% increase in working women aged 45-55 by the year 2040 in Canada. While pregnancy and maternity leaves are normalized within the nursing profession, there is little recognition or support for navigating perimenopause, menopause, or post-menopause, the symptoms of which can be debilitating.
On average, Canadian women spend up to half of their life in a menopausal state, be it perimenopause, menopause, or post-menopause. While most women reach menopause between the ages of 45-55, in some cases, this can begin as early as age 40. Further, nearly one-quarter of women will suffer with severe symptoms. Menopause is more than simply hot flashes and night sweats. The significant decline in estrogen leaves menopausal women at risk for several serious health conditions, including osteoporosis, heart disease, and genitourinary issues, the unmanaged symptoms of which cost the Canadian economy an estimated $3.5 billion annually.
Along with hot flashes, night sweats, and muscle and joint pain, the symptoms of menopause also include mood changes, depression, memory loss, insomnia, and genitourinary and sexual problems. Further, 44-62% of women also report experiencing an increase in cognitive decline as a result of these symptoms. Within the context of a profession that is physically, emotionally, and mentally demanding, the symptoms of menopause, combined with the stigma associated with discussing its challenges, presents a significant workforce issue within the nursing profession in Canada.
In a recent exploratory study that examined the effect of menopause on the caregiving abilities of regulated nursing professionals, authors Vanderzalm, et al., (2023) found that participants reported experiencing a significant amount of anxiety related to their ability to provide patients with safe, effective care due to the symptoms of menopause. In addition, the Menopause Foundation of Canada recently released a report titled Menopause and Nursing in Canada which highlights some of the barriers that women-identifying nurses face in relation to managing the symptoms of menopause at work. These barriers include the inability to consistently practice symptom-alleviation habits due to shift work. Moreover, Vanderzalm, et al. (2023), also supported by the Menopause Foundation of Canada report, found that nurses were often reluctant to speak with their co-workers and managers out of a fear of negative consequences, a lack of trust in leadership, and the entrenched workplace culture of “pushing through,” no matter the cost. The mental and emotional impact of the symptoms menopause can also be equally as debilitating, leaving some nurses feeling a lack of self-confidence, shame, and low self-esteem. Further, absences from work often result in an increased workload for staff, thus perpetuating the cycle of absenteeism and promote turnover, which may compromise patient care.
The safe and effective management of the symptoms of menopause is a nursing workforce issue. Coupled with the current trajectory of the healthcare system and the demographics of this population, if left unaddressed, it will only worsen in the coming years. The federal government recently developed the Nursing Retention Toolkit, which focuses on overarching strategies to create a positive and supportive workplace environment, safe staffing practices, professional development and mentorship opportunities, as well as other key areas of improvement. While these macro-level strategies are a move in the right direction, more focused attention to this unique issue within the regulated nursing professions is required.
The Menopause Foundation of Canada calls for more specific measures to be taken, such as starting with normalizing the discussion around this topic and its effects in this particular context. In their Menopause and Nursing in Canada report, recommendations are separated into four broad “buckets:” Work to Change Nursing Culture, Education, Better Working Conditions, and Better Benefits. These recommendations emphasize the need for educating managers and colleagues about the detrimental effects of these unmanaged symptoms and promoting dedicated actions to reduce the stigma around menopause and its symptoms. Creating supportive working conditions, including more balanced and flexible shift schedules and leveraging the experience of older nurses through the development of mentorship roles are also recommended. In addition, further recommendations include tailoring the design of the physical spaces and break rooms to create more comfortable workspaces and the provision of specific resources and mental health supports for menopause, such as counselors who are familiar with this population, and the introduction of dedicated sick time.
To some, the implementation of these recommendations could be interpreted as misspent tax dollars. However, the Covid-19 pandemic exposed major flaws in an already-stressed healthcare system in Canada, and introduced several negative unintended consequences, such as increased rates of substance abuse and self-harm, as well as a higher prevalence of mental illnesses. The shortage of family physicians across the country, the changing health needs of Canadians, the large number of healthcare workers nearing the age of retirement, and severe workplaces stress all demand the full attention of Canada’s regulated nursing professionals.
Supporting Canada’s regulated nursing professionals is paramount to creating a sustainable healthcare system for today and for the future. Without them, there is no system.
About the author
Ashley Holloway teaches healthcare leadership at Bow Valley College in Calgary, AB, and is a nurse with a Master of Public Health.
