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Latest nursing workforce report raises flags for population health

Ottawa, June 23, 2015 — The Canadian Nurses Association (CNA) says a new nursing workforce report from the Canadian Institute for Health Information (CIHI) gives reason for concern about whether Canada can meet its populations’ health needs.

In 2014, 293,205 registered nurses (RNs) were licensed to practise in Canada — a loss of 2,824 (from 296,029 in 2013). A number of factors contributed to the decline in supply of RNs, such as retirements, changes in careers, decisions to leave Canada and recent regulatory changes in Ontario. This is the first decline in two decades and is of significant concern.

“The nursing workforce report should be treated as a cornerstone document by any government or organization involved in the planning and delivery of health care in Canada,” said CNA president Karima Velji. “Health-care decisions must be well-informed and grounded in this kind of data — not just be based on budgets. As the largest group of health-care professionals and the backbone of the system, a robust and effective registered nursing workforce is essential to a healthy Canada.”

Reading the numbers
It is important to examine where nurses are working (or not), in addition to overall workforce levels. Hospitals remain the predominant practice setting, employing 62.4 per cent of RNs in 2014. While this figure has remained relatively stable over the past decades, 4,400 fewer RNs are now working in nursing homes and long-term care facilities than in 2005.

This reduction in RNs outside acute care settings needs to be reconsidered given that fourteen per cent of Canadians are now 65 or older, a number expected to double by 2036. Research has shown that age-related conditions, especially chronic diseases, are better managed in the community. Yet, on any given day in Canada about 7,500 hospital beds are occupied by an “alternative level of care” patient — that is, someone approved for hospital discharge who cannot access the appropriate post-hospital care. More than half these people are waiting for home care or a spot in a long-term care facility while being needlessly exposed to hospital-acquired infections and risking more rapid deteriorations in their health. Canadians themselves believe our approach to seniors care must change, overwhelmingly confirming in a recent public opinion poll that they want to age at home.

“Health human resources need to be distributed with a clear understanding of what the population needs,” said Velji. “Today, Canadians are living longer but with more chronic diseases, sometimes several at once. Our health needs are more complex than in previous decades, and the health-care system needs to catch up. Investing in RNs is an astute investment in better health for our populations: RNs have a direct impact on the health of patients, families and communities — reducing mortality and morbidity, preventing complications, averting hospital visits and improving overall health.”

Across the country
In addition to a loss in the number of RNs licensed to practise in Canada, four jurisdictions — Newfoundland and Labrador, Prince Edward Island, Nova Scotia and Northwest Territories/Nunavut* —saw decreases in the number of working RNs. Because these jurisdictions have some of the highest numbers of people living in rural communities and some of the most senior populations, RN reductions there will mean greater challenges for health care and its delivery.

“The sum of all the numbers is a tightening nursing labour market,” said Velji. “Immediate action is needed to stave off the potentially long-lasting trend of a shrinking RN workforce and its consequences for population health. CNA and Canada’s RNs are working to renew the system’s focus on primary health care so it will support patients at the centre of accessible care and emphasize health promotion and illness prevention. This workforce report is a valuable tool for getting governments and health administrators to collaborate with us on these actions.”

Recommended solutions

  1. Grow the RN and NP workforce to more appropriately meet the growing and changing health needs of Canadians — such as age-related conditions and chronic diseases. Develop recruitment and retention strategies that would improve the inflow of new graduates into the profession and slow the outflow of existing RNs and NPs.
  2. Realign RN resources between acute and community-based care to better meet the health needs of existing and future populations and relieve pressure on overburdened hospitals so they can focus on critical care needs.
  3. Improve data collection to better understand why RNs leave the profession, whether they change careers, move out of the province or country, or retire. A national unique identifier for RNs and other health-care professionals would provide more details about inflow and outflow as well as better data to inform meaningful recruitment and retention strategies.

* Northwest Territories and Nunavut are a combined nursing jurisdiction.

CNA is the national professional voice representing 135,000 registered nurses in Canada. CNA advances the practice and profession of nursing to improve health outcomes and strengthen Canada’s publicly funded, not-for-profit health system.


For more information, please contact:

Kate Headley, Manager of Communications
Canadian Nurses Association
Telephone: 613-237-2159, ext. 561
Cell: 613-697-7507
E-mail: kheadley@cna-aiic.ca