Nurses are often under-appreciated, but few people realize they are also under-employed. As wait times in emergency rooms and appointment queues have grown, Canadians have readily blamed this on a perceived doctor shortage. According to studies conducted by Statistics Canada and the Canadian Nurses Association (CNA), the health-care service crisis is both systemic and global in scope, precipitated by shortages across the entire job spectrum from clerical staff to technicians to administrators.

The nursing profession has been hit hard by the health-care service conundrum. Since budget cutbacks in the 1990s and corresponding government cuts to nursing staff, nurses have complained of poor working conditions that have led to disinterest in the job, high rates of absenteeism and early career withdrawal. With the average age of nurses now 45, nursing organizations throughout Canada have begun banding together to discuss and attempt to remedy the situation.

The easiest place to put the blame is on the lack of nursing graduates, says Lynette Leesberg Stamler, president of the Canadian Association of Schools of Nursing (CASN). “That’s a very pat answer, and easily come by. And, it’s true — this actually was predicted a fair number of years ago. If we look strictly at the number of new graduates we need just to maintain the status quo, we need about 12,000 a year. We turned out 9,400 in 2007, and that’s the highest it’s been since about the mid-’70s.”

As Leesberg Stamler suggests, though, the problem runs deeper than certification and is also heavily affected by the number of positions available, job satisfaction and the way in which nurses are utilized within the health-care system.

“It’s not just a matter of the supply side being able to fix what’s going on,” suggests Dianne Tapp, University of Calgary interim dean of nursing. “Part of the problem is also the way health services are organized and the way that nurses sometimes don’t have the appropriate supports and practices and end up doing a lot of non-nursing duties.”

To combat this, CASN and other nursing organizations have been working with government and administrative officials to redefine the way that the health-care teams are structured and operate.

Lisa Little, CNA director of public policy, cites a study conducted by the Sisters of Charity Ottawa Health Service, an organization with over 1,000 health-care beds in several facilities. “They found that 30 to 40 per cent of what the nurses were doing was not RN work. They hired more clerical and administrative staff, they hired more porters and cleaning people, and those nurses were now freed up. There’s a real impact that can be felt from improving the efficiency or the productivity of the workforce.”

The issue of utilization is particularly pronounced in Alberta, where a massive population influx coupled with the diminished number of job positions and the creation of several new urban health-care development projects underscores the relationship between the lack of nurses and their complaints of deteriorating work conditions.

“You’ve got some new health facilities, the Heart Institute and a new southeast hospital in Calgary, and that means the number of required RNs will go up,” says Leeseberg Stamler. She says that the provincial government wants to increase the number of nursing program graduates to 2,000 a year by 2012. In 2008, the province produced just 1,375 nursing graduates. “There’s a kind of disconnect there,” she says. “The combined increase in the provincial enrolment is expected to be 27 per cent.”

The necessity for more nurses and nurse training highlights another important consideration: the mechanics of nursing education. “We aren’t creating enough faculty either,” points out Leesberg Stamler. “When you look at the average age of a nurse across the country, which is somewhere in the mid to late 40s, well, the average age of the faculty is higher than that. If you don’t have enough faculty, you can’t increase the number of seats.”

Studies suggest, however, that even with the recent attempts to beef up nursing graduate numbers, the problem will persist. “All indicators are, given the status quo in terms of the work environment, [staff shortages will be worse] in the next decade, even with all the good efforts that are underway,” says Tapp. “I think that is a message that is hard for the public and politicians to hear. The nursing shortage isn’t coming, it’s here, and it’s going to be around for some time.”

Despite their grim tidings, nursing organizations are surprisingly optimistic. “I don’t think it’s hopeless,” concludes Little. “I think there’s an opportunity to turn the nursing shortage around. I think we need to be innovative and creative. The old things we used to do are not going to solve this. This is a shortage we’ve never seen before.”