Finance committee  Yes, absolutely. They're running remote and rural stations, they're clinical nurse specialists. Yes, they're practising, often from those vulnerable circumstances.

Finance committee  I think citizens in Canada feel their care is often disjointed right now, because the information about them is not where it needs to be when it's needed. They need to repeat. They have their history taken ten times, every time they go through the health system. The electronic health record serves that purpose: all the information is in one place and it's owned by the citizen, which is important.

Finance committee  I'm an optimist, and we're going to get there. I think it takes the tremendous will of all politicians, because it's very easy to respond to what hits the front page of the media, which tends to be acute care and institutional-based issues. We need to have a concerted effort. Early in my career I worked in Papua, New Guinea, when the Alma-Ata Declaration was declared in 1978, and they are doing it, they are focusing on social determinants of health.

Finance committee  The staff at the CNA is certainly studying the cuts in terms of what the impacts are. We recognize that there are sometimes programs that are not effective, and we're very open to the issue of ensuring that everything we do is evidence-based. But clearly, on the issue of literacy, there is much evidence to demonstrate the importance of investing in it for all citizens of Canada.

Finance committee  The Canadian Nurses Association is very clear about the importance of investing upstream in terms of the health of Canadians, so we pay a lot of attention to the social determinants of health. Those include education, employability, housing, water, and all of those basic infrastructure supports, and literacy is a key one.

Finance committee  No, it's a PhD.

Finance committee  Health human resources is a key priority for nursing, but we really believe information technology is an infrastructure issue on which we are probably ten years behind. We have some evidence already that when you have appropriate technology in place, your actual utilization of health human resources will be different.

Finance committee  It could make the nurses more efficient or make better use of them as nurses. I think it will definitely add to the quality of care for citizens, because it creates a different level of safety and quality in the system. I think it becomes an attractive feature. I'm in education in nursing, and I'll tell you that our young people are very used to using technology for everything.

Finance committee  The Canadian Nurses Association fully respects the jurisdictional authority over health and education, but in particular in the area of health, we do have the Canada Health Act, which is federal legislation that requires a federal role in terms of ensuring that the Canadian health system is in fact that: a Canadian health system.

Finance committee  No. We belong to the International Council of Nurses, which has a position statement against unethical recruitment of nurses from developing countries, so I would defer to my fellow witness. We're not there to go and poach nurses or rob nurses from other places. But we clearly do have immigration into Canada, and we've actually worked with federal government funding in the past to look at how to facilitate internationally educated graduates coming into work in the Canadian health care system.

Finance committee  Thank you very much for the opportunity to outline the Canadian Nurses Association vision for a stronger, healthier, and wealthier Canada. My name is Marlene Smadu, and I'm the president of the Canadian Nurses Association, representing registered nurses from across the country.