With Canada’s ongoing nursing shortage, there is renewed attention on nursing schools and their role in helping to fill these critical gaps. Across the country, provincial governments have responded with targeted funding to universities and colleges to add more nurses into the workforce.
Last winter, the B.C. government released funding for more than 600 new program seats across the province; Saskatchewan earmarked 150 in its 2022-2023 budget; Nova Scotia funded 70 permanent seats at two different universities, and Ontario, more than 2,000. Initiatives like rural nursing placements in Alberta, or a mental-health specialization for postsecondary schools in New Brunswick have attempted to address the most pressing needs.
However, as welcome as the additional funding and places are, nurses and educators see issues – and solutions – that go beyond enrolment.
“Not only do we need to graduate more nurses, we need to make sure they stay in the workforce once they’re out there,” said Kristen Jones-Bonofiglio, director of Lakehead University’s nursing school, adding that the pandemic exacerbated a pre-existing shortage, and that more money for additional places is only part of the remedy.
Shortage impacts student experience
Issues like delayed care for chronic illnesses, longer wait times for procedures, and even closures of some emergency departments and clinics highlight the extent of the shortage. While COVID-19 infection among nurses has contributed to the staffing problems, much of the ongoing shortage is due to the early retirement of burned-out, late-career nurses, said Sylvain Brousseau, president of the Canadian Nurses Association. Whether they’re leaving for other forms of work or retiring altogether, colleagues across the profession have expressed a similar concern, he said: “[Nurses are saying] ‘I don’t want to stay in an environment that doesn’t welcome me anymore, that doesn’t go with my values as a nurse.’”
Increasing enrolment for nursing students is important, said Dr. Jones-Bonofiglio, but there’s the unavoidable fact that experienced nurses are needed to train students as well as oversee them during their placements and when they’re newly hired – and that’s difficult when nurses are already overworked.
“We want new students to be not just in the [nursing] program, but successful all the way through,” she said. A lack of resources and placement opportunities for students can also create a negative feedback loop, she points out. If a maternity clinic, for example, can’t accommodate students because of a lack of staff to supervise them, the clinic is less likely to get much-needed applicants upon graduation.
Graduate education gains popularity
Internationally educated nurses have been an overlooked part of the solution, advocates say. Ontario recently gave $1.5 million of additional funding to a consortium between Trent University, Toronto Metropolitan University and York University that helps train these nurses – but because of the shortage of nurses to instruct, a difficulty in finding practice placements, and the rush in demand, there’s been a backlog in licensing.
With the Canadian Federation of Nurses Unions reporting burnout symptoms in 94 per cent of working nurses, the demand for more support is high. Dr. Brousseau points to retention bonuses and robust employee assistance programs as options for employers, as well as more training opportunities. As one example, more and more nurses are looking to enrol in master’s or PhD programs to take a break from frontline work while gaining skills to move up in their careers, he said.
The University of Calgary recently became the second school in Canada (after the University of Toronto) to offer the Doctor of Nursing (DN) credential, a professional degree that differs from a PhD by combining a research project and practical training for nurses who want to advance to leadership positions in the field. Kathryn King-Shier, the program administrator, said nursing graduates often point to limited opportunities for training in leadership, politics, and management, which can limit career development. She said the continued nursing shortage is a sign that “transformational change” in health care is yet to come. “The doctor of nursing program [alone] is not going to solve all the problems that exist today,” she said. “What it will do is prepare a better, more creative kind of leader that can think differently.”
A place for local partnerships and innovation
Nurse practitioner programs at schools like the University of Regina, University of Saskatchewan, and University of British Columbia have also been targeted for more funding, as that profession has long been a solution for regions that struggle with recruiting and retaining health-care workers (a nurse practitioner is a nurse with advanced training who can diagnose and treat various illnesses and prescribe medications, making them a good fit in areas where physicians may be scarce).
Rural areas have been coping with shortages for years, and rural nursing programs have had to innovate as a result, said Raelene Marceau, a nurse practitioner and coordinator for the University of Northern British Columbia’s northern baccalaureate program. The program launched in 2021 and sends UNBC’s nursing students to the province’s Peace River region to train for health-care delivery in a remote setting.
The local community rallied for years to get the program, which Dr. Marceau sees as an example of how every community – urban and rural – is partly responsible for supporting health-care workers and students intent on a health-care career, such as through placement opportunities.
In addition to training new nurses, Dr. Jones-Bonofiglio said postsecondary institutions are also where the best research, data and innovations emerge to inform effective solutions. And despite challenges, interest in nursing seems higher than ever; Dr. Brousseau pointed out that many programs have seen a bump in applications. UBC saw a 31 per cent jump, McMaster University saw a 20 per cent increase, and across Ontario, applications were up eight per cent for university nursing programs since last year. Nationally, more than 12,000 students graduated from registered nursing programs in 2020, reported the Canadian Association of Schools of Nursing. That number has been on the rise for seven years straight (the record low was in 2000, at just under 5,000 graduates).
As in many sectors, the pandemic exposed that the status quo in health care is unsustainable – and Dr. Jones-Bonofiglio doesn’t want to see things go back to how they were. “In academic literature, they talk about it as an ideology of scarcity, and it becomes almost normalized,” she said. “There are opportunities to do things in different ways – and it’s not something one institution can do by themselves.”