The Shortage of Nurses in Canada: A Discussion Activity

I have been a Registered Nurse for more than a decade (since 2008 to be precise). One of the ongoing challenges that I have experienced is the nursing shortage. What does this mean? In supply and demand terminology it means that the supply of Registered Nurses, Registered Psychiatric Nurses (in provinces that have them), and Licensed Practical Nurses (or Registered Practical Nurses if you live in Ontario) is less than the number of positions that are needed. In practical terms, this means there are not enough nurses to provide the care needed for all people in Canada utilizing the healthcare system. Only recently have I learned that the nursing shortage is not unique to the 21st century, and it is a global issue. This is clearly a huge issue. Let's take a little journey to think through this issue with a focus on Registered Nurses in Canada.  

A Short Exercise in Thinking Through the Issue

Background and Overview 

There is a critical shortage of many health care professionals in Canada while at the same time many health care professionals are underutilized in their current scope of practice (White et al, 2008). Registered nursing is a regulated profession within Canada. All provinces and territories in Canada have specific legislation which outlines the specific scope of practice (Black et al, 2008; Nurses Association of New Brunswick, 2009). Nursing regulatory bodies are then responsible and accountable for public protection by maintaining the standards for scope of practice to ensure that registered nurses are safe, competent, and ethical practitioners. There is a challenge in educating undergraduate nurses about the scope of practice requirements and restrictions because of (1) limited time in the workplace clinical environment, (2) different emphasis on the curriculum in different university programs, (3) limited interaction with interdisciplinary team members.

What Does This Mean for Nurse Educators? 

Healthcare is not a single disicplined industry. In comtemporary healthcare in Canada nusres work on interdisciplinary teams with both regulated and unregulated healthcare professions. So, what does this mean for a nurse educator? The role of an educator is paramount in trying overcome barriers and challenges that occur because of the scope of practice requirements and restrictions. And, when we conceptualize and develop nurses are healthcare educators it is imperative that we transition out of the siloed system in which nurse educators only educate other nurses for nursing. A broad understanding of the healthcare system and the roles and scopes of all clinicians delivering care is necessary to transform the system. For example, one strategy to overcome the confusion that is caused by scope of practice restrictions and requirements is Interprofessional Education (IPE). 

The Interprofessional Education Model 

The IPE model is used to enhance the collaborative health care environment, in turn positively influencing patient outcomes (Reeves, Goldman & Oandasan, 2007).

Learning Objectives

• identify the main areas of this issue that act as barriers
• identify the philosophical influences on this issue and how this influences the teachers role and responsibilities
• Clearly articulate the challenges and responsibilities of teachers in the learning environment specific to the issue of the scope of practice responsibilities and restrictions
• identify and discuss the teaching and learner implications within your area of nursing practice
• identify how this issue relates to issues of interdisciplinary practice in health care settings
• brainstorm practical ways to overcome the challenges related to this issue

Learning Activities

Reflect back on your career as a nurse. Think about the issue and challenges that nurses were experiencing at that time. Think about examples from your own work experience to ponder the following questions:

1. Go to your Nursing College website and review your nursing discipline's scope of practice.
2. What are some challenges that you have encountered with restrictions of scope of practice in your workplace?
3. What are some challenges that you have encountered with respect to responsibilities?
4. Present an example from your practice that may not have been part of your Scope of Practice early in your career, but that now is within your Scope.
5. Present an example of a function that could be part of the scope of nursing, but also the scope of another discipline. Under what circumstances might there be an overlap and why?
6. Locate the area on your college (or other regulatory body) website where disciplinary decisions are addressed. How does this relate to the Scope of Practice?
7. Relate Scope of Practice to “Delegated Medical Functions.”
8. How does the scope of practice connect to your understanding of what it means to be a nurse?

References

Baranek, P.M. (2005). A review of scopes of practice of health professions in Canada: A


    balancing act. Toronto: Health Council of Canada.


Black, J., Allen, D., Redfern, L., Muzio, L., Rushowick, B., Balaski, B., & ... Round, B. (2008).


    Competencies in the context of entry-level registered nurse practice: a collaborative project in


    Canada. International Nursing Review, 55(2), 171-178. Retrieved from EBSCOhost.


Black, J., Allen, D., Redfern, L., Muzio, L., Rushowick, B., Balaski, B., Martens, P.,


    Crawford, M., Conlin-Saindon, K., Chapman, L., Gautreau, G., Brennan, M., Gosbee, B.,


    Kelly, C. and Round, B. (2008), Competencies in the context of entry-level registered


    nurse practice: a collaborative project in Canada. International Nursing Review, 55:


    171–178. doi: 10.1111/j.1466-7657.2007.00626.x


Nurses Association of New Brunswick. (2009). Entry-level competencies for Registered Nurses in


    New Brunswick. Nurses Association of New Brunswick.


Reeves, S., Goldman, J. & Oandasan, I. (2007). Key factors in planning and   

   implementing interprofessional education in health care settings. Journal of Allied Health. 36(4), 

   231- 235.

Ruth-Sahd, L.A., Schneider, M.A., & Strouse, A. (2011). Fostering cultural and


    interdisciplinary awareness with “low-tech” simulation in a fundamentals nursing course


    to prepare student nurses for critical care clinical rotations. Dimensions of Critical


    Care Nursing 30(5). doi: 10.1097/DCC.0b013e318227717e .


White, D., Oelke, N.D., Besner, J., Doran, D., McGillis Hall, L., & Giovanetti, P. (2008).


    Nursing scope of practice: descriptions and challenges. Nursing Leadership 21(1),


    44-57.