National Nursing Week highlights the essential contributions of nurses to Canadians' well-being and their dedication to transforming health care. The Canadian Nurses Association (CNA) is advocating for a stronger mandate to allow nurses to work to their full scope of practice, which could help alleviate congestion in the health care system.
Challenges in the Current System
A long-term care nurse arrives for a night shift only to discover they are the sole registered nurse in a facility housing 300 residents, four of whom are actively dying. In another scenario, a nurse in an emergency department must care for 40 patients after a colleague calls in sick. These situations exemplify the moral distress that nurses face daily, forcing them to ask, "Who do I give the extra care to?" according to CNA President Kimberly LeBlanc. Such moral dilemmas lead to mental health issues, burnout, and high turnover rates among nurses.
Systemic Issues
LeBlanc explains that Canada's health care system is antiquated and needs modernization. The system has not kept pace with population growth or the increasing prevalence of chronic diseases due to an aging population. While funding is important, LeBlanc stresses that "we need to re-envision how we’re actually delivering care because there’s a lot of repetition, there’s a lot of inequities in our system." The quality of care varies significantly by province, city, or town, undermining the principle of universal health care.
Expanding Nursing Scope
The CNA believes that expanding the scope of nursing practice is key to transforming health care. "We’re advocating to expand nursing scope across the board to allow us to have increased impact," says LeBlanc. As the largest workforce in health care, nurses interact with most patients and are well-positioned to offer informed solutions. However, systemic constraints prevent them from working to their full potential. Innovative care models where nurses lead initiatives could integrate care and streamline patient journeys, particularly in primary care and community settings.
Potential Benefits
With a broader mandate, nurses could help manage chronic diseases and reduce emergency room visits, easing congestion in acute care. LeBlanc points to the United States, where there is nearly one nurse practitioner for every family physician. In Canada, the ratio is about one nurse practitioner for every six family physicians. "Cost-wise, we could have three nurse practitioners for every two family physicians. It almost seems like a no-brainer," she notes. Canada's health care expenditures have risen from $219 billion in 2015 to an estimated $399 billion in 2025.
Proposed Changes
LeBlanc advocates for establishing nurse practitioner-led clinics, granting registered nurses wider prescribing rights, and enabling collaborative practice with nurse practitioners. These changes would significantly improve chronic disease management. She highlights a clinic in Hamilton, Ontario, run by a nurse practitioner that effectively helps patients manage congestive heart failure and chronic obstructive pulmonary disease. However, the clinic lacks succession planning, and similar services are not available in other cities like Ottawa.
Regulatory barriers are preventing nurses from working to their full potential. The CNA calls for policy changes to remove these obstacles and empower nurses to deliver more effective, equitable care across Canada.
