Good afternoon. Thank you, Mr. Chair and members of the committee, for inviting the Canadian Nurses Association to appear today. I have worked in health systems for more than 40 years, 37 of those as a registered nurse, and I have had the honour of serving as the CEO of the Canadian Nurses Association since 2017.
I'd like to acknowledge that I speak to you today from my home in Mountain, Ontario, which is the flattest place in Ontario, I think, despite the name, and I speak to you from the unceded territory of the Algonquin Anishinabe people. CNA House in Ottawa also sits on this territory, and we're grateful to be invited to share this space.
There are more than 431,000 registered nurses, licensed practical nurses, registered psychiatric nurses and nurse practitioners in Canada, the largest number of providers in our health systems. The CNA is the national and global professional voice of Canadian nursing, and we represent 135,000 members across all 13 provinces and territories and, of course, many of our members also live in indigenous communities.
I wish I were speaking before you today about a less sobering topic, but that is not the world we live in right now and, as I saw expressed recently, we went to sleep in one world and woke up in another.
I know that the health and safety of the public and the nation’s health care workers are uppermost in your minds and certainly are in ours. The pandemic clearly escalated as broadly and as rapidly as brush fire, and we must maintain our guard in supporting Canada’s nurses and all health care professionals who are confronting and mitigating its impacts.
We are in a situation unprecedented for all but the few who can still recall the flu pandemic of 1918 to 1920, and we have all been scrambling in response. The Canadian Nurses Association appreciates the measures that have been taken by all levels of governments across the country to tackle this problem and minimize the spread of COVID-19, and we have particularly benefited from the incredible and courageous leadership of our public health professionals, including the nurses who are so integral to that sector.
We appreciate the strong communication from Dr. Tam, who leads the Public Health Agency of Canada, and we have had good communication back and forth with Health Canada, including with the minister and with Dr. Tam and her team at the Public Health Agency. We thank them all, as we thank you, members of Parliament, who are members of this committee.
We speak with nurses all the time and certainly very purposefully each week we talk with them and poll them. I want to take a few minutes to share with you highlights of a few ongoing issues, and then I want to spend the last five minutes talking about a larger system issue that I think we need to tackle.
What are the ongoing issues of concern for nurses? You've all heard about personal protective equipment concerns, and three months into the pandemic, that still remains a bit inconsistent across the country. It remains our position at CNA that those decisions around the use of personal protective equipment should be driven by evidence and the clinical judgment of the people using the equipment and not by availability or fear of shortage. That's been an ongoing issue that seems fine in some places and less so in others.
The second issue is around testing. The WHO has urged large-scale testing, but we realize that COVID-19 testing in Canada still falls behind some other nations, and nurses are concerned that, without this information, the recovery efforts will not be informed by evidence.
We're concerned about mental health right across society. This has been very scary. Nurses, in particular, are facing significant challenges to their mental and emotional well-being as a result of the COVID pandemic response and recovery. We are continuing to advocate for access for all health care providers to mental health services at no cost to manage their emotional and mental health coming out of this. We're particularly concerned that, just as many of us will have a chance to step back at some point when the pandemic settles, as we assume it will, or in waves, nurses, doctors and people in the health care system are then going to have to pick up the backlog of all undone surgeries and so on, and they will be really be very stressed during that time.
We're working with the Canadian Medical Association and the Canadian Institute for Health Information around determining the impact of COVID-19 on the health of health care workers. We urge governments to fund the tracking of that important data, which is a long-standing issue.
While they talk about concern for their own safety, one of the top issues that nurses mention is vulnerable populations. We're concerned about people who are more at risk for the spread and its impacts, including many indigenous people, particularly in remote settings, and people in congregate settings such as prisons and shelters and the homeless.
My final point, before I speak about long-term care, is that given the lessons of history, we urge a very guarded, evidence-informed, cautiously paced reopening of services across society. We are concerned that the virus is very much alive, still spreading, not well understood, and may sweep across society in successive waves. We understand there are huge economic implications, but that has to proceed very carefully.
Let me turn to a couple of larger issues that are really of concern to the Canadian Nurses Association and to nurses. Due, at least in part, to a very aggressive “flatten the curve” campaign, which Canadians by and large have taken part in, our hospitals have mainly been spared the devastation of our counterparts in China, Italy, Spain and the United States, for example. However, at the same time, the pandemic has laid bare the crippling lack of standardization, funding, strong leadership, appropriate staffing, training, equipping and so on, of people who deliver services in long-term and home care sectors. These vulnerabilities have been well known for 20 years. As a result, just 20% of COVID cases in Canada are in long-term care, but they account for 80% of the deaths. We understand this is the worst outcome globally.
While our health systems have many strengths, a series of robust investigations since 2000, such as the Romanow commission, have generated a now very familiar litany of places we need to shore up. We can all name them all: pharmacare, home care, mental health care, long-term care and primary health care, based on need and not on the ability to pay. We're seeing some of those weaknesses play out now.
The outcomes of COVID-19 in long-term care this spring are in part the result of decades of neglect of that sector and a growing mismatch between the level of care required by people who live there and the human resources deployed to care for them. I've been around for 40 years in the business. Many of the patients living in those nursing homes now with complex, ongoing conditions would have been in a hospital 20 years ago. It's hard for people now to imagine that in nursing homes 20 or 30 years ago, residents still drove their cars. Those people now are managed in home care.
As we've shifted really complex care away, the response in long-term care has not been concomitant with the demand going in there. The rising pace, volume and complexity of care that has been shifted from hospitals to nursing homes also has coincided perversely with a decline in the proportion of regulated nurses in that sector, fewer clinical educators, fewer social workers and fewer occupational therapists. It's a story of fewer and less, and it has a dramatic impact on the people working there, who are largely unregulated, and delivering 80% to 90% of the care. The workforce there is dominated by caring, loving, well-intended health care aides and support workers who are not backed up with the sorts of professional nursing and other resources they desperately need. The sector is heavily dominated by women, often racialized women, who are paid low wages and often are precariously employed. You've heard stories that they have to cobble together two or three jobs or work a lot of overtime to make a living wage. COVID-19 has really exploited those weaknesses.
In the final report of the national expert commission that CNA conducted in 2011-12, we laid out nine practical recommendations to address many of the same issues brought up by Commissioner Romanow, Senator Kirby and others, that could drive better health outcomes, better care and better value for taxpayer dollars. Many of them have gone unheeded.
If there's any silver lining in this, we have certainly seen that we can do things differently. We have flipped around primary care, for example, so that much of it can be done by telephone and virtually. We know that hospitals are partly empty because of cancelled surgeries, but we see the emergency room wait-list problem has declined. Hallway medicine has disappeared. We believe that we have the capacity to address those problems and sustain those results. We can't go back because we know now that we can do it differently.
Meeting demands of older adults requires major changes to the health system and some immediate attention to personal care assistants and nursing expertise in those facilities in particular. We must reimagine aging in this country, including home care, institutional long-term care and end-of-life care, and then put those bold changes in place we know are needed.
To wrap up, COVID-19 has shown us very strangely, in the year of the nurse, that nurses are an important force for delivering better health. They've certainly shown they're dedicated to the people of Canada, even when they're worried about their own health and safety. Clear information, adequate supplies, additional support for the health system and its workers are needed and are going to be needed in the long term. It's not going away tomorrow.
As the chair said, we meet today in the global year of the nurse and midwife, during National Nursing Week and on the eve of Florence Nightingale's 200th birthday tomorrow. Perhaps, ironically, after 200 years, we find ourselves talking like Nightingale saying, wash your hands; clean the environment; gather good information to make your decisions.
This week we've set aside years of planned celebrations, as you can imagine, out of respect for the tens of thousands of nurses who are out there working at points of care this very minute, some of them even coming out of retirement to do so. They've answered the call.
On behalf of the CNA, let me close by thanking you for including us. I ask that you place nurses in leading roles in the analyses of the COVID-19 responses lying ahead. Listen to them. They have practical, smart information. Know that we will work with you to identify and deliver the best evidence to help governments and health systems make the changes we need and implement real change.
Thank you very much.