Nursing Strategy for Canada - Executive Summary
Advisory Committee on Health Human Resources
October 2000
Help on accessing alternative formats, such as PDF, MP3 and WAV files, can be obtained in the Alternate Format Help section.
(Full Report) (231KB)
Canada is experiencing a crisis in nursing. This is a view expressed
across the country, both in the health system and among the general
public. While there are many different perspectives on why this
is and what the most promising solutions are, there is significant
agreement that the current shortage of nurses is getting worse and
that left unchecked, this situation will lead to a deterioration
in the quality of the nation's health care system.
In response to these concerns, the Conference of Deputy Ministers/Ministers
of Health directed the Advisory Committee on Health Human Resources
(ACHHR) to develop a pan-Canadian strategy for nursing. Recognizing
the complexity of the issue, they also directed the ACCHR to ensure
meaningful consultation with the relevant stakeholders.
The initial document, Towards a Nursing Strategy for Canada: A
Consultation Paper for Stakeholders, was developed by the Working
Group on Nursing Resources and Unregulated Health Care Workers (WGNR),
a sub-committee of the Advisory Committee on Health Human Resources,
in March, 2000. The purpose of this document was to solicit advice
and feedback from the many nursing workforce stakeholders prior
to developing a nursing strategy for Canada.
This consultation paper identified that the goal of a Canada-wide
nursing strategy is to achieve and maintain an adequate supply of
nursing personnel who are appropriately educated, distributed and
deployed to meet the health needs of Canadian residents. The document
identified the key nursing workforce issues related to this goal,
including: the need for detailed and accurate information and relevant
research to support the development of improved human resource planning;
increased educational capacity; improved opportunities for clinical
experience and work place support for students and new grads; significant
changes in the work place to improve the quality of nurses working
lives; and better utilization of all nurses.
This initial paper explored the many different perspectives held
on these issues by the various stakeholders to establish a common
understanding of the complexity of this issue. It also posed twelve
action strategies, developed by the WGNR, for consideration.
Ninety-four formal responses were received from a wide variety
of stakeholders, including professional regulatory bodies, associations
and unions representing all three nursing groups[1],
educators, employers and government. These responses guided the
development of the final document, A Nursing Strategy for Canada.
Feedback from the Stakeholders
Stakeholder responses included wide support for the development
of a unifying and multi-stakeholder advisory committee to address
the most pressing nursing workforce issues and to provide support
for provinces and territories as they address these issues within
their respective jurisdictions. As well, there was support for the
development of similar bodies in provinces and territories where
such integrated planning and policy development does not already
occur. Stakeholders throughout the health care system recognized
the need to increase and improve nurse workforce planning. To do
so, there was support for the collection of more comprehensive data
on nursing groups. As well, there was support for ensuring a strong
and coordinated national research agenda to ensure evidence on which
to develop needed policy.
While the provincial/territorial jurisdiction over health and education
was recognized, there was also support for the federal government
to take a lead role in the development of better health human resource
data to establish improved future projections for nursing supply
and demand. Many respondents noted that it was time to expand beyond
the simple supply models that have guided health human resource
planning to date.
While there was strong support for increases to education and training
capacity for all three nursing groups, the majority of respondents
suggested that the recommended 10 percent increase across Canada
in registered nursing seats over two years may be too conservative.
Many respondents also commented that increases to nursing education
capacity should be determined through improved human resource planning
that includes the full spectrum of nursing practice and takes changes
in health care practice, population health and demographics into
consideration. There was a strong message from the associations
representing licensed practical nurses and registered psychiatric
nurses that these planning activities need to be inclusive of their
Many respondents also emphasized the need to ensure that this increased
nursing school capacity be supported by adequate clinical placements
and that both post-grad support and full-time employment be ensured
for these new graduates in order to retain them in the profession
and within the health system.
Registered nursing professional regulatory bodies and many groups
representing registered nurses offered strong support for the introduction
of the new competencies. However, there were also concerns expressed
that the impact of the introduction of these polices must be assessed
and care taken to avoid unintentional short-term reductions of registered
nurses. Also, it was emphasized that the educational needs of the
existing workforce must be addressed, particularly for continuing
education to increase competencies and for specialty training.
While the professional regulatory bodies expressed the need to
respect their statutory responsibility for scope of practice and
competencies, there was strong support for the need to examine the
full spectrum of nursing practice. It was widely recognized that
all nurses should be utilized to the fullest extent of their competencies
to meet the health needs of the public and that there is a need
to determine optimal nurse-mix and use of non-nursing personnel.
Many stakeholders suggested that solutions to the current shortage
of nurses needed to be both pragmatic and innovative. Even with
concerted efforts, the social, demographic and fiscal realities
of this new century are resulting in a major structural change to
the nursing workforce that cannot be resolved by traditional supply
strategies. Accordingly, many respondents emphasized the need for
better management of the current workforce. Many jurisdictions report
serious difficulties in recruiting nurses, although their individual
needs range widely, from casual to specialty trained nurses. Retention
of nurses, both in positions and in the profession itself was also
identified as serious problem.
Improving the quality of the work life of nurses was identified
repeatedly as key in addressing these issues. Improving the quality
of the work life has many different aspects, and given the diversity
of the nursing workforce there is no single solution. However, strong
support was offered for increased continuing education that includes:
- portability and laddering opportunities;
- flexible scheduling;
- increased nursing management leadership and support at the clinical
level;
- improved nurse/patient ratios to address workload concerns;
- reduction in non-nursing duties; and
- reduced "casualization."
Finally, there was a call for action: there is a strong belief
that thecurrent shortages in nursing and the dissatisfaction of
nurses will not improve without quick and decisive and unified action
from policy makers and funders.
Strategies for Change
As a result of this stakeholder feedback, the initial document
was revised to create The Nursing Strategy for Canada. Eleven strategies
for change were proposed, organized according to the following key
issues:
- unified action;
- improved data, research and human resource planning;
- appropriate education, and
- improved deployment and retention strategies.
These strategies were proposed with the understanding that further
development and implementation of each strategy would require the
unifying efforts of all stakeholders. Lead responsibility and suggested
timelines were identified for each strategy.
Strategy 1
The federal government and provincial/territorial governments immediately
establish a multi-stakeholder Canadian Nursing
Advisory Committee (CNAC) to address priority issues as identified
by the Advisory Committee on Health Human Resources (ACHHR) and
the Working Group on Nursing Resources and Unregulated Health Care
Workers (WGNR). The key focus for CNAC for 2000/01 will be improving
the quality of work life for nurses and providing advice to support
the implementation of other strategies of the Nursing Strategy for
Canada.
Strategy 2
A Nursing Advisory Committee (NAC) be established (where an equivalent
body does not exist) by each province and territory to support the
development of strategies for improved nurse human resource planning
and management within each jurisdiction.
Strategy 3
The federal/provincial/territorial governments encourage the efforts
of the Canadian
Institute for Health Information (CIHI) and other organizations
to develop the information required for the effective planning and
evaluation of nursing resources.
Strategy 4
The ACHHR work with major research funders to identify gaps in
current research, to profile workforce planning issues for new research
funding, and recommend improved mechanisms for the dissemination
of these research results to policy makers and managers.
Strategy 5
The federal government provide leadership to ensure the development
of improved projections for nursing supply/demand requirements to
the year 2015.
Strategy 6
A communications strategy be developed with the goal of increasing
the public's awareness of nursing as a positive career choice and
increasing the number of qualified applicants to nursing schools.
Strategy 7
The number of nursing education seats be increased Canada-wide
by at least 10 percent over 1998/1999/99 levels over the next 2
years (2000/2002), and increases in following years be based upon
improved demand projections and provincial/territorial need and
capability.
Strategy 8
Each provincial/territorial NAC or equivalent body develop a comprehensive
strategy to determine what types of nursing human resources are
required and for which practice settings, based on an analysis of
the needs of the population, of the health system as a whole, and
the skills and capacities of all types of nurses.
Strategy 9
Each provincial/territorial NACs or equivalent body develop a five-year
provincial/territorial Nursing Education Plan based on the comprehensive
strategy proposed in Strategy 8.
Strategy 10
Provincial/territorial NACs (or equivalent body) identify and support
the implementation of retention strategies for their respective
workforces that focus on improving the quality of the work lives
of nurses.
Strategy 11
Provincial/territorial NACs (or equivalent body) examine opportunities
to encourage nurses to re-enter the workforce.
[1] Registered Nurses (RNs), Registered Psychiatric
Nurses (RPNs), Licensed Practical Nurses (LPNs), also known as Registered
Nursing Assistants and Registered Practical Nurses.
|