In Canada, nurses (registered nurses, nurse practitioners, licensed practical nurses, and registered practical nurses) represent the largest single group of health care providers. They are trusted practitioners, knowledgeable leaders, and agents of change. In rural and remote areas, they often deliver the majority of patient care. (FPT Committee)
And yet, the nursing profession is facing several serious challenges: exacerbated existing staff shortages, a system laboured by heavy workloads, and individuals overburdened by burnout and compassion fatigue. The Ford government’s Bill 124 suppressed wage increases for nurses to a maximum of 1% total compensation.
As an RPN and Professional Practice Manager at WeRPN, I know that nurses care deeply for their patients, but many do not feel cared for in this climate. Many are asking, why stay?
Nurses today are being asked to do more with less – and it’s taking a toll. A 2021 study found that nurses have experienced a significant increase in anxiety and depression over the last two years (Havaei et. al, 2021).
Amid this crisis, many RPNs feel forgotten. PSWs have made their pandemic pay permanent – an action supported by RPNs – but it has closed the wage gap between the two groups. In some cases, RPNs’ wages differ only by a few cents from the PSWs they supervise and support in practice.
RPNs’ voices tend to get lost, especially regarding their wages. Many are considering dropping their registration, working as a PSW, bridging to an RN, or leaving health care altogether.
To maintain a standard of care in this province, the biggest challenge Ontarians face is how to retain our current nurses while recruiting and educating new nurses quickly. As we transition the COVID-19 crisis from pandemic to epidemic,
the health care system must focus on recovery and, perhaps most importantly, rebuilding the nursing profession.
So what should the future of nursing look like?
There are a number of priority issues. In its report, “A Vision for the Future of Nursing in Canada,” the Federal/Provincial/Territorial Committee on Health Workforce states: “Transformation is required to develop new approaches that address the realities of changing patient and population health needs and escalating health care costs to support the evolution and sustainability of the health care system.”
It’s not only the general population that’s aging. In Ontario, 20.1% of nurses are over 55 and on the brink of retirement, according to the College of Nurses of Ontario’s (CNO) 2021 Statistics Report. With a significant portion of the nursing workforce soon leaving – and taking their skill and expertise with them – we must implement effective ways to recruit and educate new nurses.
Interestingly, what started as a quick response to changing pandemic circumstances has become a new opportunity for the nursing profession. Online education is being used more widely and makes learning more accessible to nursing students. Redesigning the delivery of nursing education will help expedite nurses through programs and into practice. With many nurses ready to retire or leave health care for other reasons, modernizing nursing education by expanding virtual offerings is an essential new solution.
Other policy initiatives seek to make the system more sustainable and effective. To achieve this end, the FPT Committee recommends creating an infrastructure that promotes greater intraprofessional unity.
There is a real opportunity to increase the collaboration among nursing programs, which would optimize the role of nurses in health care delivery and better serve the needs of individuals, families, and communities. Certain courses teach many of the same accountabilities to practice for RNs and RPNs – bringing them together would create role clarity and better utilize existing resources to educate nurses.
Variation in regulatory implementation and interpretation has led to an ill-defined and unclear scope of practice.
Looking forward, it’s important to focus on clarifying the roles of nursing groups. This would support the critical contribution of nurses and also foster a common understanding among other health care professionals and the public.
Nurses’ scope of practice is expanding and must be supported by the modernization and alignment of nursing regulation and education. The FPT committee recommends the “development of evidenced-informed models of care that optimize the role of the nurse to provide high-quality, cost-effective care.” (FPT)
Another key strategy will be shifting care out of institutions and into home and community settings across urban, rural, and remote environments. As nurses collaborate with diverse partners across the care continuum, expanding nurse autonomy will improve access to quality care. This can be achieved through an enhanced, authorized nursing scope of practice – as seen with registered nurses now prescribing in several jurisdictions (Pitman, 2019; CNA).
Care settings and scope of practice continue to expand and diversify. In this context, it’s crucial for the nursing profession to focus on intercultural competency, conflict resolution, human rights, and anti-racism, including Indigenous healing practices in line with the Truth and Reconciliation Commission, Calls to Action (Villeneuve 2020).
Over the last few years, the COVID-19 pandemic has strained an already taxed healthcare system. But despite these challenges, the future remains bright for nurses. As unwavering frontline workers, they have carried the healthcare system and continued to deliver quality care. Now is the time to focus on the nursing profession.
As nurses in Canada continue to improve patient care across health sectors, we must prioritize their voices, focus on implementing policies and strategies from which they will benefit and encourage new students to join the profession. This is what it means to consider the future of nursing in Canada. Patients and their families deserve better, and we must start focusing on taking care of nurses so they can take care of us.
Canadian Nurses Association (2019). Advanced practice nursing: a pan-Canadian framework [PDF]. Retrieved from https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/apn-a-pancanadian-framework.pdf
Havaei, F., Smith, P., Oudyk, J., & Potter, G. G. (2021). The impact of the COVID-19 pandemic on mental health of nurses in British Columbia, Canada using trends analysis across three time points. Annals of Epidemiology, 62, 7–12. https://doi.org/10.1016/j.annepidem.2021.05.004
Pittman, P. (2019, March 12). Activating nursing to address unmet needs in the 21st century [PDF]. Princeton, NJ: Robert Wood Johnson Foundation. Retrieved from https://publichealth. gwu.edu/sites/default/files/downloads/HPM/ Activating%20Nursing%20To%20Address%20Unmet%20Needs%20In%20The%2021st%20 Century.pdf
Schofield, R., Ganann, R., Brooks, S., McGugan, J., Dalla Bona, K., Betker, C., Dilworth, K., Parton, L., Reid-Haughian, C., Slepkov, M., & Watson, C. (2011). Community Health Nursing Vision for 2020: Shaping the Future. Western Journal of Nursing Research, 33(8), 1047–1068.
Villeneuve, M., Betker, C., (January 31, 2020) “Nurses, Nursing Associations, and Health Systems Evolution in Canada” OJIN: The Online Journal of Issues in Nursing Vol. 25, No. 1, Manuscript 6.