Nursing Resources

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Most analysts agree, but there is no consensus on exactly why this is so or what solutions would best lead to an adequate supply of nursing personnel. Most analysts also agree that the issue is complex and involves differing stakeholder perspectives. These perspectives include the impacts of: health reform, restructuring, fiscal restraints, low numbers of new nursing graduates, an aging nursing workforce that will soon retire in large numbers, and an aging population that may dramatically increase the need for nurses and other health care providers. In addition, recruiters of nurses for positions in Canada must compete with recruiters from other countries, particularly the United States, that are also finding nurses in short supply.

Space limitations here do not allow for further exploration of these issues but many of the differing views can be reviewed by accessing the Related Resources, with references from government, academe, nursing associations and unions, and from the public at large as reported in the popular press. Many of those references are available on the Internet. We can, however, examine some nursing numbers that are associated with part of the nursing shortage problem.

Registered Nurses in Canada: A Statistical Profile

Selected characteristics of Canadian nurses that are presented here are for registered nurses (RNs) only. Standardized collection systems for data on registered psychiatric nurses (RPNs) or licensed practical nurses (LPNs - also known as registered nursing assistants or registered practical nurses) at the national level have not been put into place as yet. The data employed here were computed using the 1993 and 1998 Registered Nurses Database (RNDB) acquired from the Canadian Institute for Health Information (CIHI). The sources of supplementary information are identified but are primarily derived from CIHI, Statistics Canada, and from the work of Eva Ryten (1997).

Numbers of Nurses

In 1998, 254 964 nurses registered with their respective provincial or territorial associations. This represented a decrease of 3.4% from the previous year and, at that time, was the lowest number of registrants in the 1990s. Of this total, 227 651 were employed in nursing. The decreasing trend in the total number of nursing registrants and the flat to decreasing trend in the numbers actually employed in nursing can be seen in Figure 1.

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Figure 1. Numbers of Registered Nurses by Activity Status, 1988 to 1999

Education

In the past, the usual entry-level educational requirement to become a registered nurse in Canada was a nursing diploma offered by a community college or the older hospital-based nursing schools. A second, less common route was through a basic Baccalaureate of Science in Nursing (BScN) program offered at a university. Today, about 11% of RNs who are currently employed in nursing entered the profession with a BScN. Many other RNs have since upgraded their skills so that now approximately 23% of our current, employed RNs have attained a university degree (bachelors, masters, or doctorate) in nursing.

In 1982, the Canadian Nurses Association "adopted a policy to require a BScN for entry to practice by the year 2000" (Ryten 1997). This change in policy, not yet implemented throughout all of Canada, is reflected in recent significant decreases in diploma graduates compared to the increase in graduates from university programs (Figure 2). Joint college-university programs are emerging in response to this policy. However, the increases in university nursing graduates has yet to offset the decreases in diploma nursing graduates.

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Figure 2. Number of Graduates of Diploma and University Programs, 1988 to 1997

Work Environments

The majority of RNs work in hospital environments, which includes general hospitals and more specialized maternal, pediatric, and psychiatric hospitals. The next two most common places of work are nursing homes and community health agencies (Figure 3). Hospital downsizing and decreases in hospital length of stays are having an impact on these numbers. "... employment has been gradually moving out of general hospitals to community-based settings". In more remote and northern parts of Canada, the primary places of employment for RNs are nursing stations.

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Figure 3. Place of Employment

Of the registered nurses employed in nursing in 1998, barely half (51.6%) were working full time. Regionally, this proportion ranges from a high of 83.0% in the Northwest Territories to a low of 47.9% in Manitoba (Figure 4). Despite the acknowledged shortages in the nursing workforce, full-time employment of RNs continues to decline. Ryten (1997) argues that this trend "is a consequence of cost-cutting measures in the funding and organization of the health care system".

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Figure 4. Proportions of Registered Nurses Employed Full-time, 1998

Gender and Age

"Nursing is still a woman-dominated profession and will remain so beyond the foreseeable future" (Ryten 1997). Only Quebec and the Northwest Territories have made any substantial gains in recruiting males into the ranks of registered nurses (Figure 5). But even in those regions, the proportions of males are only 8.5% and 6.9%, respectively. In Canada, in 1998, men made up only 4.4% of the RNs employed in nursing.

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Figure 5. Males as a Proportion of Canadian Registered Nurses, 1998

Average ages for male and female RNs in 1998 were 39.7 and 42.7 years, respectively, up from 37.9 years and 41.1 years, respectively, in 1993. The variations, by province/territory, in average ages of registered nurses is illustrated in Figure 6. Taking males and females together, the average ages of RNs has increased from approximately 41 in 1993 to 43 years in 1998. A two year difference in such a short period of time for this relatively large population of individuals (in each year well over 200 000 nurses) is very significant. The age grouping comparisons for 1993 and 1998 (Figure 7) highlight this feature of an aging nursing workforce. There has been a sharp drop in intake, with nurses under the age of 35 decreasing from 28.9% in 1993 to 23.0% in 1998. The middle range, 35 to 44 years, has changed marginally from 35.4% in 1993 to 33.3% in 1998 while the proportion of nurses 45 years of age and older has jumped from 35.7% to 43.7% in 1993 and 1998, respectively.

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Figure 6. Average Ages of Registered Nurses, 1998

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Figure 7. Age Distributions of Registered Nurses Employed in Nursing, 1993 and 1998