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Nursing Strategy for Canada - Executive Summary

Advisory Committee on Health Human Resources
October 2000

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Advisory Committee on Health Human Resources

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 theNext link will take you to another Web site 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.