Human Resources Committee on April 25th, 2012

[Rachel Bard]

I don't have it with me right here, but we know that we do need to track better. Certainly with some of the changes that are happening in the United States, we are very concerned, and we would not want to see us losing more of our resources. But we do need to have some strategy to retain our Canadian nurses.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Are we getting any kind of indication why we're losing those Canadian-trained nurses?

[Rachel Bard]

Well, again, if we look at the 1990s, with the reductions that occurred, we lost a high percentage of our workforce at that time. We want to avoid having a similar situation happen, which is why we want a pan-Canadian approach in coordinating our human resources to make sure that we address where some the shortfalls are. We also want to have programs that better support the movement and mobility of nurses so that we can make sure that we use all of our resources, with full capacity, and they don't have to look across the border to secure full-time employment.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Yes, and that goes back to what Mr. Sweetman said earlier about the provinces being able to calibrate that a little more.

What is the average retirement age of a nurse in Canada?

[Rachel Bard]

It's 57, which is why our policy is recommending that we see how we can retain our nurses longer. They bring a breadth of knowledge and experience, and we need to look at models so that we can try to retain them much longer.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

As Mr. Mayes said, nursing is a stressful vocation. It's also stressful physically, and a person begins to show wear and tear from lugging and moving. Would that play into early retirement?

[Rachel Bard]

It certainly does.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Or is it because they're all independently wealthy?

[Voices]

Oh, oh!

[Rachel Bard]

We have nurses who want to work full-time much longer, but the working conditions at times do not necessarily encourage them to stay longer in the workforce. Looking at improving the working conditions certainly is an area to be addressed.

[Jean-Marie Berthelot]

There is clearly the issue of the challenging nature of the work, the fact that it's hard work. But we also need to acknowledge that most of the nurses in the country are unionized. Many in the current cohort of retiring nurses have diploma degrees. They started working relatively young and have probably acquired 35 years of experience, with a pension. One social phenomenon is that their husbands would be a bit older. Such social phenomena play a big role in the age of retirement of nurses. Most of the provinces, except Quebec, I think, are now requiring a bachelor's degree to be a nurse, so you would expect in the future that they would retire a bit later. But after 35 years of service and a full pension, why would you continue to work?

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

I still have a little bit of time.

[The Chair, Conservative, Ed Komarnicki]

Your time is up.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

I was saving the big one for the end.

[The Chair, Conservative, Ed Komarnicki]

We'll give you an opportunity after all is said and done.

Mr. Shory, go ahead.

[Devinder Shory, Conservative, Calgary Northeast, AB]

Thank you, Mr. Chair.

Thank you, witnesses, for being here.

Dr. Sweetman, we all know that education is within provincial jurisdiction. You talked about immigration. I'd like you to comment on whether foreign qualification recognition can play any role in addressing the issue of shortages, because we have a lot of professionals in the medical profession who have qualifications from other countries.

[Dr. Arthur Sweetman]

If I understand, you're asking if credential recognition is the issue. Is that really what you're focusing on?

[Devinder Shory, Conservative, Calgary Northeast, AB]

Correct.

[Dr. Arthur Sweetman]

There is a variety of issues. For the most part there is an excess of immigrants with credentials in most health professions relative to the number of spots available in provincially funded professions. In professions like dentistry, where it's more in the private sector, it's a slightly different issue.

Credential recognition is an issue. It's a manageable issue in the long run, but it's much more complicated. Don't forget that in almost every single health profession—nursing being a notable exception—the percentage of immigrants working is higher than the percentage of immigrants in the adult population.

In Canada, the percentage of immigrants in the population between the prime working ages of 25 and 64 is roughly 23% or 24%, and 33% of physicians are immigrants, and 29% of pharmacists are immigrants. I may be off by 1%, but it's more or less that. If you look at optometrists it's a similar thing. That applies to every group except nurses, which are close to the national average. So in almost every single regulated health profession, the percentage of immigrants is well above the national average.

There is a credential recognition issue for some people, but it hasn't stopped a very substantial number of immigrants from entering regulated health professions.

[Devinder Shory, Conservative, Calgary Northeast, AB]

Thank you for your comment.

When I was talking about foreign credential recognition, I was not only talking about immigrants but also about all of those who are foreign qualified, whether Canadians or new immigrants.

Ms. Bard, I have a question for you. You mentioned the shortage of 11,000 full-time equivalent nurses, which will potentially be 60,000 in 2022.

I was looking at the report, which looked at the impact of six policies in areas designed to reduce the current and projected shortages. I wonder if you can describe which measures will be the most effective, in your estimation, at addressing the issue of shortages today or in the future.

[Rachel Bard]

We've certainly looked at the six policy areas, and the first five are where we want to invest our energy. Evidently we know that by increasing productivity and removing some of the barriers and allowing full scope of practice is where we can reduce the shortage. Just increasing it by 1% would reduce the shortage to close to half of what the projection is right now. When you look at the absenteeism, if you reduce that from 14 day to 7 days then you would start to see an addition of about 7,000 FTEs. So you see each of them really provides some clear evidence. The first five are really showing the best investment.

[Devinder Shory, Conservative, Calgary Northeast, AB]

Are these projected shortages updated after the report?

[Rachel Bard]

Yes, we will continue to monitor these, and evidently the information CIHI is producing is helping us to try to take a range. We try to do an assessment about every four years to try to understand where some of the changes are and what they are.

[Devinder Shory, Conservative, Calgary Northeast, AB]

Another issue is that we have a huge aboriginal population in Canada and a large portion of that population is at an age where they can be a great workforce. How can we encourage young aboriginals to enter nursing studies and what are the biggest obstacles? Has any action been taken by your organization to encourage that group?

[Rachel Bard]

The Canadian Nurses Association certainly works with the Canadian Aboriginal Nurses Association to try to see how we can address that. There are some programs that dedicate some seats for aboriginal students, because we also believe that we need to encourage and train aboriginal nurses who can go and work in first nation communities. So there are some seats reserved and better support, and we've even developed some cultural diversity guidelines to better prepare nurses, even when they are entering nursing programs, so they are able to go and work among aboriginals and first nations, because evidently we want both. We want to train aboriginal students to become nurses, but we also want Canadian nurses who can work as well with aboriginal communities.