Good morning. My name is Cynthia Baker, and I am the executive director of the Canadian Association of Schools of Nursing.
CASN—ou l'ACESI en français—is the national voice of nursing education in Canada. On behalf of CASN, I would like to thank the health committee for inviting us here today to speak to this very important and timely study.
We are pleased to have the opportunity to present our views on this subject.
First, I will begin with some information about CASN. Second, I would like to take a quick look at my crystal ball and share with you some health care issues we see coming down the road—well, actually we see them just around the corner. We believe they have important implications for scopes of practice, health team collaboration, and nursing education. I will conclude with an area where we see the federal government playing an essential role.
First about CASN, we are a national and bilingual organization of the 91 schools of nursing offering baccalaureate and/or graduate programs of nursing in Canada. Our mandate is to promote high-quality nursing education across the country.
Currently there are a total of 53,184 students in our member schools: 48,962 of them are in baccalaureate programs, 2,776 in master's programs, 999 in nurse practitioner programs, and 447 in doctoral programs for nurses. Nursing faculty currently number 8,192 across the country.
I would like to point out that our Quebec members and francophone nursing schools outside Quebec— in New Brunswick, Ontario and Alberta—are very engaged and active.
We also have member schools in rural and remote areas of Canada, for instance, Aurora College in the Northwest Territories and Arctic College in Nunavut. Many schools of nursing have adopted special measures to ensure that aboriginal communities access their programs, and CASN works closely with the Aboriginal Nurses Association of Canada to improve the recruitment and retention of aboriginal nursing students.
What does CASN do? As part of its mandate, CASN is the national accrediting body for baccalaureate nursing education. We have formal memoranda of understanding with a number of regulatory associations linking provincial regulatory approval to pan-Canadian educational standards. Accreditation is important in ensuring pan-Canadian educational standards.
I would like to take this opportunity to add that Canadian nursing education is widely acclaimed internationally. Many actually consider it to be the best in the world. CASN is currently assisting governments in Bangladesh,
and also in Haiti,
to strengthen the quality of their respective nursing programs through accreditation and curriculum evaluation.
We develop educational guidelines, frameworks, and resources to promote high-quality nursing education across the country. For example, we have guiding principles and essential components for nurse practitioner programs and guiding principles and essential components for bridging programs for internationally educated nurses.
Other initiatives target areas of health care needing greater curricular emphasis, such as interprofessional collaboration. With help from Health Canada we develop national competencies in teaching and learning resources to build faculty capacity to teach palliative and end-of-life care. Similarly, we have created competencies and teaching toolkits to assist faculty in preparing nursing students to deliver care in technology-enabled environments.
Our methodology ensures that the frameworks are well developed, but I think that more importantly, the pan-Canadian process we use mobilizes the targeted curriculum change by engaging our membership,
including our francophone members,
building consensus nationally and producing momentum to shift education for nurses.
As a national organization working in nursing education, we often find this challenging, because education and health are largely provincial and territorial matters. However, time and time again CASN has seen the importance of a national harmonization of nursing education. A nurse may be educated at the University of Alberta but may find employment in northern B.C., rural Saskatchewan, or downtown Toronto. These environments present different nursing demands, but our nursing graduates should be prepared for all of them. CASN sees an important role for the federal government in the scope of practice, skills training, and curriculum development for health care professionals.
As to future trends—my crystal ball—the burden of disease and health care delivery is shifting as the population ages and obesity rates rise. The health care issue facing the largest number of Canadians today, we believe, is how to live with or support someone living with multiple, complex, interacting, and often incapacitating chronic conditions. Cases of dementia are also rising rapidly, and the need for palliative end-of-life care is increasing as a result of the aging of the population. As the very first baby boomers are only 67, we are seeing only the tip of the iceberg. We believe that these issues are likely to grow exponentially in the next three decades.
I know that the health committee studied chronic disease in 2012 and I have read the report with a great deal of interest. There has already been a 100% increase in home care in Canada, but the demand continues to surge. The need for long-term care facilities and hospice care is also likely to grow, even with an increase in home care. While a team of health care professionals needs to be involved, the core services are provided by registered nurses, practical nurses, and personal care workers. CASN also sees a growing role for nurse practitioners in these areas.
There is an urgent need to support community-based long-term management of chronic illness with a much better collaborative system of care in which continuity and coordination are emphasized. There is an associated need to remove scope-of-practice barriers for nurse practitioners, to support registered nurses and practical nurses in working to their full scope of practice, and to align nursing education curricula in support of this.
Notwithstanding a shift to community-based services, I would like to stress that the acute care hospital is likely to continue to be a major employer of nurses. People are hospitalized for trauma and episodic illness, but the majority have chronic conditions requiring surgery or requiring the management of symptoms that have become life-threatening, such as heart attacks.
The complexity of hospital nursing care has increased significantly because patients are much sicker than they used to be, they stay for a much shorter time, and managing the technology and the treatments, which typically falls to the nurses, is far more complex than in the past. Actually, this is true of home-based care as well.
Many well-designed studies have shown irrefutably that the education of nurses is critical to patient safety and patient outcomes. The most recent, published in The Lancet in February 2014 was conducted in nine European countries and reported that an increase in the proportion of nurses with bachelor's degrees was associated with a significant decrease in patient deaths, whereas a decrease in the share of nurses with bachelor's degrees was associated with a significant increase in patient deaths. Researchers concluded that reducing the number of appropriately educated registered nurses is often tempting but is not a wise place to cut costs.
To speak to the federal role, the federal government has supported national initiatives to promote change in health professional education in the past, and these are currently improving health care. Interprofessional education promoted by Health Canada is now incorporated in the accreditation standards of eight Canadian health professions, including ours. Palliative and end-of-life care is another good example in which it has been promoted in medicine, in medical education, in nursing education, and in the education of social workers. I think we are seeing the fruits of this.
CASN recommends that the federal government continue to improve health care by supporting national initiatives that will influence health professional education and the preparation of new practitioners. In light of the growing burden of chronic disease in Canada, we believe there is a critical need to develop a national framework to guide the future of nursing education based on an examination of the scopes of practice of nurse practitioners, registered nurses, and practical nurses, as well as intraprofessional and interprofessional collaboration as part of this framework.
Thank you.