Aging nurses spell trouble

A massive nursing shortage is in the making, as one out of three nurses in Canada is 50 years or older and eligible to retire in the next five years, according to a recent report by the Canadian Institute for Health Information (CIHI).

“This is continuing a trend that we’ve been seeing for a number of years,” said Paul Sajan, a consultant managing the nursing database at the institute, an Ottawa-based, independent, not-for-profit provider of health information.

The institute’s nursing workforce figures are derived from comprehensive data submitted yearly by the regulatory bodies from all provinces and include all the regulated nursing professions: registered nurses, licensed practical nurses and registered psychiatric nurses. Not counted in the database are aides and orderlies.

Sajan said the numbers do contain a couple of “good news stories,” including the fact that the overall supply increased by 4.5 per cent between 2002 and 2003, bringing the total number to 309,587 nurses.

A second reason for optimism is the rise in full-time employment during that period, from 52.5 per cent to 53.5 per cent. The proportion of nurses working for more than one employer also declined by six per cent, and the share of nurses in casual work slipped from 12.9 per cent in 2002 to 11.9 per cent in 2003.

At the Canadian Nurses Association, however, executive director Lucille Auffrey said the rise in full-time work from 2002 to 2003 has since been followed by a drop of three per cent.

“We know that we have to have 70 per cent (working full time) to ensure a stable workforce, but we’ve gone down.” What that means is that the next time Canada faces a communicable disease outbreak, the health system may not be able to cope, added Auffrey. “If we are not going to provide nurses with full-time jobs, do you think that they will show up or be available when the need is there?”

The “stark revelation” that one in three nurses is 50 years or older, said Auffrey, means “we have a very short period of time to really put some effort into correcting the problem that nurses are living every single day. There are just not enough nurses, the workload is just horrific, and apart from the workload, there are patients waiting for care. We’ve got to get a program in place quite quickly.”

More worrisome, she added, is the looming shortage of nurses in specialty areas. Among nurses with experience in operating rooms, 40 per cent are retiring in five years, as are 30 per cent of nurses in cancer care. “These are all the specialty areas that the government wants to address in terms of waiting lists. One can’t address wait times by decreasing the number of specialists.”

Auffrey said she sees the system trying to address the shortage but without cross-Canada co-ordination. As a result, some provinces have increased the budgets for training nurses (including a recent announcement by Ontario to inject $29 million to fund new graduate positions and support a nurses’ mentoring program), while “in the East, they’ve decreased the number of nursing students because they felt that other provinces were poaching their nurses.”

The CIHI figures also show that nurses entering the workforce today also tend to have more schooling. Forty per cent of registered nurses graduating in the last five years have a baccalaureate degree, and 28.6 per cent had a baccalaureate in nursing in 2003, an increase from 22.2 per cent in 1999.

If the nursing workforce needs a boost in numbers, it’s not getting it from foreign-trained nurses, as the share of these workers has remained constant in the last five years. In 2003, six per cent of nurses working in Canada were trained abroad, with the majority from the Philippines (26 per cent), the United Kingdom (26 per cent), the United States (seven per cent) and Hong Kong (six per cent). Foreign-trained nurses are on average older than nurses trained in Canada (49.4 years compared to 44.1 years, respectively).

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