The Canadian Nurses Association (CNA) is calling for a stronger mandate to allow nurses to work to their full scope of practice, arguing that this would help alleviate the congestion hampering Canada's healthcare system. During National Nursing Week, the CNA highlights the vast contributions nurses make to Canadians' well-being and their commitment to transforming healthcare.
Challenges Facing Nurses
A long-term care nurse arrives for a night shift only to discover they are the only registered nurse in a facility housing 300 people, four of whom are actively dying. In another scenario, a nurse must care for 40 patients in an emergency department after a colleague calls in sick. These situations cause moral distress, which is known to interfere with mental health, lead to burnout, and result in high turnover rates.
Kimberly LeBlanc, president of the CNA, explains that nurses are often forced to ask themselves: "Who do I give the extra care to?" These moral dilemmas contribute to a system that is antiquated and in need of modernization. Many challenges stem from shortages of healthcare professionals, primarily nurses, as the system has not kept pace with population growth or the rise of chronic diseases from an aging population.
Re-envisioning Care Delivery
LeBlanc emphasizes that simply throwing money at the problem is not enough. "We need to re-envision how we're actually delivering care because there's a lot of repetition, there's a lot of inequities in our system." In Canada, the kind of care a patient receives depends on the province, city, or town they are in. "We don't truly have universal health care," she adds.
The CNA believes that nurses need a greater mandate to transform health. "We're advocating to expand nursing scope across the board to allow us to have increased impact," says LeBlanc. As the largest workforce in the healthcare universe, nurses come into contact with most patients and are well-prepared to offer informed solutions. However, constraints in the system prevent them from working to their full scope of practice.
Innovative Care Models
LeBlanc calls for innovative care models where nurses lead initiatives that integrate care and streamline patient journeys, particularly in primary care in the community. Given a broader mandate, nurses could help mitigate and manage problems that reduce ER visits and ease congestion within the acute care system.
While the CNA does not rush to compare the Canadian system with the American one, LeBlanc notes that the U.S. model for primary care has nearly one nurse practitioner for every family physician. In Canada, there is about one nurse practitioner for every six family physicians. "Cost-wise, we could have three nurse practitioners for every two family physicians. It almost seems like a no-brainer. We can actually have more primary care providers for less money if we go this route," she says, pointing out that Canada's healthcare expenditures surged from $219 billion in 2015 to an estimated $399 billion in 2025.
Proposed Changes
Some of the bigger changes LeBlanc would like to see include establishing nurse practitioner-led clinics, enabling registered nurses to have wider prescribing rights, and allowing them to work collaboratively with nurse practitioners. "That will go a long way towards chronic disease management," she states.
LeBlanc points to a clinic in the Hamilton, Ontario, area run by a nurse practitioner out of a hospital. This NP helps people manage congestive heart failure and chronic obstructive pulmonary disease. However, there is no succession planning, so if the NP becomes ill or the clinic closes, patients have nowhere to go. Moreover, such clinics are not available in other cities like Ottawa.
Regulatory barriers are preventing nurses from working to their full potential, the CNA says. By expanding the scope of practice for nurses, Canada can improve healthcare access, reduce costs, and enhance patient outcomes.
