Finance Committee on Oct. 11th, 2023

[Martin Théberge]

Thank you.

[Jenica Atwin, Liberal, Fredericton, NB]

I'll switch to Madame Richard.

We know that a part of the significant investment around health care in the last budget was around data collection. In New Brunswick, I've had many conversations with health care professionals, unions and representatives. We fell over this cliff without having the numbers to project what was going to happen.

Can you speak to some of the efforts that are being undertaken now to be better at data collection and how we can use that important information to improve health care?

[Maria Richard]

I can't speak for the efforts that the provincial government would be making here. I know the Canadian Federation of Nurses Unions has done research on mental health, retention and recruitment. That's where our recommendations come from. The federation realizes that for us to be able to make recommendations, we need to have the studies to prove them. That's why the first recommendation on tax benefits comes directly from our having surveyed our members and asking them what we can do to keep them here longer, and if they've left, what can we do to attract them to come back?

What we are doing is we've commissioned the accounting for the hypothetical federal tax. We're always doing research. We know about the mental health support for nurses and we're working with universities. On PSPNET, it was a university in Manitoba, I think, that spearheaded that through some federal funding from the government.

[Jenica Atwin, Liberal, Fredericton, NB]

Excellent.

I have some dear friends who work in health care in the province. I don't know if “disturbing” is the word, but I've seen the trend that people are leaving the profession to pursue medical aesthetics or other avenues that will allow them to have more freedom, perhaps, or have more of a work-life balance and increase their compensation rates.

Is this something that you're also seeing quite a bit of?

[Maria Richard]

Yes, we are seeing it.

I was talking to Ms. Thompson before we started. The reality is that for young nurses now, maybe we've been doing it all wrong. I'm a mature nurse and what we call a “seasoned” nurse. The thing is that maybe we were doing it wrong; they want work-life balance. The decisions they make are geared toward that. For them, they come in to work, and after a year or two they say, “Look, it isn't work-life balance when you get here in the morning and you don't know when you're going home at night.”

I have a code of conduct. It's called “patient abandonment”. If I am not replaced at work, I have to stay there. When you have family responsibilities and you're trying to balance that, what we're seeing is that nurses are leaving the profession or going to aesthetic work or training to do all sorts of other careers. That's why we're seeing the shortage that we're seeing.

[Jenica Atwin, Liberal, Fredericton, NB]

Chair, do I have time for one more question?

[The Chair, Liberal, Peter Fonseca]

Sure. You have time for a quick question.

[Jenica Atwin, Liberal, Fredericton, NB]

Okay.

Just quickly, under the national nursing retention strategy recommendation, there's a piece about mentorship and paid preceptorships. Can you speak to the importance of that?

[Maria Richard]

The reality we're seeing is that young nurses are coming into the profession, and yes, they have had some experience, but they need that support. Because there's such a nursing shortage all across Canada—and if I'm going to speak, I'm going to speak about New Brunswick—where nurses have retired, the nurses are so overworked on the floors that they don't have the time to give that support to these young nurses.

There are different types of preceptorships. When a nursing student is studying, they do a preceptorship. If we had tax incentives for nurses to not be taxed to the roof if they choose to come back from retirement—as we saw, a lot of them came back during COVID to support health care—it would mean that we would be able to support these nurses.

There are also paid preceptorships for nurses. What's happening is that when a doctor is training to be a doctor, they get paid to be interns. Nurses don't get paid to go in and work side by side. That's the reality of it. Why not reimburse them? That's what we're saying. It probably would encourage more students to go into nursing.

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Atwin.

Now we will go to the Bloc with MP Ste-Marie.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you, Mr. Chair.

Quebec now has a scholarship program for nursing students.

Mr. Théberge, you were talking about core funding for Acadian organizations. As we know, inflation has been super high over the past two years. This means that the government is generating much more revenue through taxes.

As everything costs more, it would be normal for transfers and core funding for organizations to be adjusted for inflation. Is this the case?

[Martin Théberge]

It is necessary. This is a demand that organizations and, even more broadly, official language minority communities have been making for years.

At the Société nationale de l'Acadie, for example, last year we had to go from four permanent employees to three. All costs are going up, whether it's electricity, heating, rent or travel. We have an agreement with Wallonie-Bruxelles International and with France, so we have to work on these agreements. I don't know if you've bought a plane ticket lately, but the prices make me want to pull out the few hairs I have left. The only place where we have any flexibility is in human resources. We can't decide to pay only half our rent this month. We can't decide to have an Internet connection only on Tuesdays, Wednesdays and Fridays. So we have no choice but to cut back on human resources. I work full time as president, I have a low salary and my own business suffers as a result. That's the situation we're in. Inflation has not been recognized at all, not to mention past delays. What we're going through right now is major. It's even worse these days.

There are also societal changes on top of this. Statistics show that the number of hours people devote to volunteering is declining. Yet we need volunteers more and more, as we can't afford to pay our employees. Something has to give eventually, and the solution has to come from funding. We need to have that support. It's an unbelievable situation.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

That's very clear. Thank you very much.

I'd like to remind you and my colleagues of one thing: When there is inflation, the government sees its revenues increase proportionately. So I find it deplorable that support is not automatically adjusted.

The latest version of the Official Languages Act does not provide for an automatic mechanism to take inflation into account when it comes to support for Acadian organizations like yours. Is that what you're saying?

[Martin Théberge]

The act does not take inflation into account, but we were hopeful that it would be part of the action plan for official languages 2023‑2028. However, we're still waiting for official confirmation of funding for the current year. From what we've heard, it would be a 12.5% increase, but this has yet to be confirmed. What's more, it would not be a general increase. So there are a lot more questions than answers right now.

A 12.5% increase won't even enable SNA to rehire another employee. Instead, it will be used to pay down the deficit. In the current year, we've had to make a number of changes, otherwise we'd be facing a $95,000 deficit. It's clearly and simply because of the increase in the cost of living. That said, a 12.5% increase in our core programming budget won't solve this problem, as there will still be a shortfall.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

We will follow up with Randy Boissonnault.

[The Chair, Liberal, Peter Fonseca]

Thank you, Mr. Ste‑Marie.

Now we'll go to the NDP and MP Blaikie.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Thank you very much.

Ms. Richard, you used the word “poaching” earlier. I come from Manitoba, and I think smaller provinces are especially concerned that when you invest a lot more in training health professionals of whatever kind, larger provinces with bigger tax bases are going to scoop up folks, either with signing bonuses or with other things like that.

I wonder if you could speak to the importance of trying to have a national strategy. This is not to say it's a strategy developed in Ottawa, but for the federal government to use its convening power to bring provinces together to talk about what their health human resource needs are and then develop a plan to be able to train them. This is so that everybody has what they need, instead of having 10 different plans, some of which include taking from some provinces and giving to others.

I wonder if you might elaborate a bit more on that.

[Maria Richard]

That's why we think it's vital for the bilateral health agreements with provinces and territories to be anchored in a holistic national nursing retention strategy. We don't have a choice.

When we talk about poaching, the reality is that when nurses are tired, when nurses are frustrated and when they're not getting their needs met, they're going to go and look somewhere else. The reality is that we're seeing poaching happening. Apparently, India has now told organizations going into that country to recruit nurses that they have to stop, because India needs its nurses there.

We saw what happened here in New Brunswick when Nova Scotia came out with retention bonuses or retention incentives to keep its nurses. For us, that's another story, but nurses were so frustrated and felt so disrespected. Everybody needs to work together. All of the provinces need to work together so that we can find a balance.

If we're going to do this, we need to support nurses throughout their continuing work. If we have a licensed practical nurse who wants to become a nurse practitioner, having a pan-Canadian nurse workforce plan will help with that, because we'll be able to treat everybody the same way.

By improving retention and recruitment in each province, hopefully we will encourage nurses who have trained in Manitoba to stay in Manitoba and work there and not go somewhere else because they feel the working conditions are better or the salary's better.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

One of the things at stake for New Democrats, certainly in the 2015 election, was the idea of using a national health accord approach. I'll speak for myself. I was disappointed to see the bilateral approach. I'm glad that funding is flowing, but I felt it would have been much better to pursue the health accord model whereby the federal government uses its convening power and its financial power to get provinces talking to each other about what the needs are.

Do you think it would be useful—and I recognize that the bilateral agreements are in place for a certain amount of time, and there's not a lot to do about them between then and now—to try to get back to a health accord model, as opposed to signing individual bilateral agreements with provinces in order to be able to get people on the same page?

[Maria Richard]

If having what you just said means that provinces will work better together, by all means, but what we've come to realize with the federal transfers of money is that if there's no accountability, the money is not going where it should be going. The only way....

If money is going to come from the federal government, it should be the one that is steering the how and the where, or at least asking the right questions: “You had a certain amount—a billion dollars. What are you doing with it?” I'm not going to be nice. “Did you buy lawn mowers or tractors with the money we gave you for health care in New Brunswick, or did you put it where it was supposed to be going?”

[The Chair, Liberal, Peter Fonseca]

Thank you.

Thank you, MP Blaikie.

Go ahead, MP Duncan.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

Thank you, Mr. Chair.

Ms. Richard, if I can, I'll build on where we left off in the last round with the recognition of international students, nurses and health care workers, and some of the challenges.

I take your point as well of the apples to apples education and the standards here, with our post-secondary situation being different based on the country. However, I think one of the challenges that come from this is when new Canadians or immigrants arrive with a health care background who are given express entry and so forth because they have a health care background, yet at the end of the day they're not able to practise, or be on the path to be able to practise, between having none of their credentials recognized or no standard test to at least be able to be given entry.

The bottom line, I'd say, is it's like making a sausage. You'd never eat it if you saw it get made, in terms of how a person gets there.

Can you speak a bit about this, maybe from a New Brunswick perspective? There's obviously a gap, because there's always the intention of having express entry, but with the number who are actually able to go through and practise and have a proper path to be tested to get to a “yes” and get there, can you elaborate a bit more on some of those gaps?

I think it is important from the federal level to tie the intention with the actual frontline results at the end of the day.

[Maria Richard]

With nurses, what happens is that each province governs its regulations. Here in New Brunswick, there's an act called the Nurses Act. I think they've just opened it and it needs to be updated, because I think it hasn't been updated since the 1970s, so they're looking at different ways that....

They know there's a nursing shortage and they're trying to expedite the process. At the end of the day, yes, we need nurses, but we need to have qualified nurses who are able to do the job safely. The reality here in New Brunswick is that a nurse will be vetted by the association here in New Brunswick. Once that happens, they don't need to write what we call the NCLEX exam across Canada. They get to work. However, what nurse managers are telling us in the province is that while some of these nurses function very well, some of these nurses....

How you nurse in India or how you nurse in Croatia is different from how you nurse in Canada, so some of these nurses have a huge nursing shock when they come in. That's when we talk about preceptorship, it's not only preceptorships for nursing students, but we need.... If we could have nurses come back—because we can't spare the ones who are on the floor now—to help these internationally trained nurses to get used to how we do nursing, they'll stay in the system.

You're right in saying that we need.... The reality is that we have nurses here right now in Canada who are not practising as RNs because they weren't vetted, so they need to go through the process, and it needs to be expedited.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

I appreciate that. It goes back to the “blue seal” program pitch that we make that way as well. We do have the Red Seal, which is a voluntary program that all the provinces opted into over 50 years ago to deal with skilled trades. Everyone opted in and maintained it. It's actually a very good best practice.

I agree about the standardization by province, and the voluntary opting in, but that could be replicated in that certain part. In agreeing with you, if somebody comes in as a doctor or an RN, for example, at least being able to be in a health care setting, perhaps doing PSW functions or something in there would help provide that. They could work their way up, being in there.

Again, I would just go back to the chaos. We all hear the stories about a doctor driving a cab or about the number of nurses who have some sort of health care background. Getting in and having some sort of organized, coherent process varies by province. A lot of times, for a number of those I've met for whom nothing is recognized, it goes back to the cost of living. In my area of eastern Ontario, I met a woman working at Tim Hortons who had a nursing background as an RN in India. None of it was recognized when she came into the area. She was working full time just trying to pay rent, and could only afford to do one or two courses at a time at St. Lawrence College. She figured it would be six or seven years for her to get retrained to work in a health care setting. Many just walk away because of how that works.

I appreciate the further context from a federal lens of what we can do to make it better organized and have a better outcome for the health care setting, keeping the quality, but also what we can do to have the people for whom the intention was express entry actually practising in health care in some form, working their way to that full form and their full potential.

Thank you.

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Duncan.

Now we're moving to our last questioner. That will be Liberal MP Thompson.