The present nursing shortage is a serious issue which poses a real threat to the future of the Canadian healthcare system especially on patients. Because of this patient safety is threatened and health care quality is deteriorating. This is because nurses are greatly responsible for the majority of patient care, as they perform the vital functions in a patient’s confinement in the hospital and thus providing more face to face services than doctors.
Nursing experts attributed this shortage to many different reasons. But according to the Canadian Institute for Health Information (CIHI), the Canadian Nurses Association (CNA), and Statistics Canada, there are three main reasons for this shortage. First, it is mainly due to age or retirement of older nurses. Second, many are leaving the profession due to overworked and some even migrated to other countries in search for high paying ones (Spurgeon et al., 2004). Third, the number (especially the younger generations) entering the nursing profession continues to decline as they see the lack of stability and thus tend to choose other careers (Canadian Nursing Advisory Committee, 2002).
The CareerJournal.com has surveyed that the best careers do not include nursing. Some of the respondents mentioned that the lack of fundings and facilities to train new nurses, poor working conditions in hospitals and poor salary scale make the nursing profession not a compensatory career.
While it is easy to blame the government for this shortage due to lack of fundings for nursing programs, however, equally important is career burn out. It can’t be denied that nursing is one among the many jobs that has a stressful work environment. So, the job itself is responsible for this shortage. Thus this has been an issue as CNA President Rob Calnan. (2003) says, “The reality is that Canada needs a comprehensive national health human resources strategy to address the nursing shortage. Research published last year by CNA predicts that Canada will have a shortage of 78,000 registered nurses by 2011 and up to 113,000 by 2016. We need to ensure that there are enough registered nurses to meet future demands.” What makes this issue even worse is that research studies have found the shortage is already having a proven, adverse effect on the ability to deliver quality healthcare in Canada. One important negative effect on patient healthcare is the increased risk of patient deaths as simply there are not enough nurses to safely care for patients. Another is the increased medical errors arising from many complications because of this shortage. All of this equates to the inadequacy to meet the future health care needs of Canadians.
Historically, about ten years ago, in 1997, CNA commissioned a study on the demand for and supply of nurses. It was completed in the summer of 1997 and issued under the title A Statistical Picture of the Past, Present and Future of Registered Nurses in Canada. The report created turmoil on health care delivery. For several years the rate of growth in the publicly created budget of health care had declined. With this, hospitals have no choice but to adopt policies to reduce costs. One is to reduce the number of nurses employed and another is to offer part-time positions. It is in this scenario of increasing lay-offs, reduced nurse employment, large-scale migration of Canadian nurses to the United States and other countries that ultimately creates Canada’s major crisis in health care delivery. That is due to increasing nursing shortage.
The Halifax Chronicle-Herald (1999) published a shortage of 2.5 percent registered nurses in Canada. But this slightly improved in 2000 with a rise of 1.7 percent, but still wasn’t enough for the growing population. Moreover, there were some provinces that lost 5 percent of their nurses from 1999 to 2000. The shortage has gone worse as the Canadian Nursing Association reported that in 2001, Canada produced only 4,600 nursing graduates compared to
10,000 nurses in 1971. With that there were 74.3 nurses for every 10,000 Canadians in 2001 compared to 76.0 in 1997. Last year, the Canadian Nurses’ Association, estimated the national health system could be short anywhere from 50,000 to 113,000 nurses by 2011. With this figures of shortages, the country have forced hospitals to close beds and cancel surgeries as reported in the Canadian TV news.
To address this shortage, solutions must be developed in several areas, such as in education, healthcare deliver systems, policy and regulations, and image. This shortage is not solely nursling’s issue and requires a collaborative effort among nursing leaders in practice and education, health care executives, government, and the media. Thus, the Canadian government, nursing agencies, and other concerned groups have taken some steps to alleviate the nursing shortage such as to increase the number of admissions to Canada nursing education and improving working environment to retain nurses. On the other hand, they are pushing for budget changes which they hope to address the lack of funding issue of the nursing program. Research has shown that quality of workplace environment and job satisfaction is correlated, which impacts on quality of care and patient outcomes. CNA (2003) urge governments to act swiftly to develop a national health human resource strategy.
But there are many barriers to the resolutions as addressing the shortage is really a difficult task. According to the Canadian Research Services Health Foundation (2003) the government itself lack a substantive commitment to the health of Canadians and that these barriers has increased due to the different views between policy making and health human resource planning. But if this issue has to be resolved, all concerned groups; nurses, hospitals, clinics, and the government should work hand in hand. Many concerned groups believed that an integrated health human resource strategy that includes the expeditious licensure and acceptance of those who wish to immigrate or who already reside in Canada is needed to resolve the nursing shortage.
Nurses are vital in the health care system, thus the government, nursing associations, employers, educators, and others have collaborated to address the nursing shortage issue. Nursing has been burdened with societal expectations of selflessness and devotion. Thus, a high ethical and legal standard should be met by all Canadian nurses. They are regulated to assure compliance with acceptable standards of performance. In Canada, all nurses are regulated by separate regulatory bodies within each province. A very strict assessment is set for Internationally-educated nurses (IEN`s) There are a number of ways the regulatory bodies assess the qualifications of IENs to determine if their competencies are equivalent to the Canadian standard and to identify if they will be able to meet the challenges that they will encounter when integrating into the nursing workforce.
The CNA (1993) has identified the impacts of government policy changes on the nursing workforce. For one, government decisions to decrease the share of Gross Domestic Product (GDP) to heath care caused the elimination of RN positions and conversion of full-time positions to part-time. As the demand for nursing services had not changed, workloads were increased, overtime was mandated, all of which led to nurses being frustrated, dissatisfied and burned out. As a result new RN graduates were only able to gain part-time or casual employment and many were forced to multiple employment. Some even left the country or profession. Thus, this political decision has aggravated the nursing shortage in the country. At the same time, the
effects of decreased budget reduced the number of graduates from nursing education programs from almost 9,000 in 1991 to less than 5,000 in the year 2000. With these, nursing candidates
saw there was no secure employment for them in nursing and chose other careers instead.
The economic analysis of this shortage is driven by the supply side of the supply/demand equation than the demand as more nurses aged or retire. On the other hand, increasing the
economic privileges of nurses will not increase the supply but will simply redistribute the supply of nurses (Nevidjon & Erickson, 2001).
The nursing shortage carries with it a lot of implications. Foremost, this has affected the quality and safety of the entire Canadian health care system as nothing is more critical to the health and well being of Canadians than safe, sound, and available health care. Thus, the federal and provincial governments, professional associations, educators, administrators and employers have accelerated their efforts to reduce the potential threat of this shortage and thus minimize the potential public risk. The healthcare workforce has been a priority in recent years for several government-funded projects and research programs (CHSRF, 2003). In fact, the First Ministers agreed in September 2004 on a 10-year plan to strengthen health care. It includes strategic investments to increase the supply of health care professionals (Office of Nursing Policy, winter 2004-05). In January 2005, the Health Council of Canada, in its first report, named the work force as its top priority, setting the stage for a national summit on health human resources in June 2005. All of these implies an attractive workplace to both new nurses and retain those who are already in the workforce. Hence, nursing education would flourish and nursing graduates would increase in number. With this, nursing shortage will have come to an end and nurses could provide the Canadians with a safe and high quality health care.
References
Canadian Nurses Association. (2002). Planning for the Future: Nursing Human Resource
Projections.. Available: http://cna-aiic.ca/CNA/documents/pdf/publications/
Planning_for_the_future_June_2002_e.pdf
Canadian Research Services Health Foundation (2003) “The Nature of Nursing Practice in Rural
& Remote Canada,”A national report. Available: http://ruralnursing.unbc.ca/reports/jkulig/
FinalReportweb
Nevidjon, B., Erickson, J. (January 31, 2001) The Nursing Shortage: Solutions for the Short
and Long Term Online Journal of Issues in Nursing. Vol. #6, No. #1, Manuscript 4.
Available: http://www.nursingworld.org/ojin/topic14/tpc14_4.htm
Ryten, E. (1997). A statistical picture of the past, present and future of registered nurses in
Canada. Ottawa: CNA.
Spurgeon, D. (2000). Canada Faces Nurse Shortage. British Medical Journal, 320(7241): 1030.
