TORONTO - The number of nurses has been rising in Canada, says a new report, but associations that represent the profession say their distribution is uneven across the country, leaving patients in some areas with inadequate access to care.
In its annual report on the nursing workforce released Thursday, the Canadian Institute for Health Information (CIHI) said there were more than 360,000 regulated nurses employed across the country by the end of 2011, a jump of eight per cent since 2007.
While this rate of growth was nearly twice the rate of the increase in the population, the number of registered nurses per 100,000 Canadians remains below the peak reached in the early 1990s, the report said.
CIHI also found that more than 56 per cent of nurses were working full time in 2011, and more than half of younger nurses found full-time employment within the first five years of entering the workforce after graduation.
Rachel Bard, CEO of the Canadian Nurses Association, said that while the overall increase in nurses is heartening, there continue to be underserviced areas, particularly at the community level.
"There is a decrease of nurses going into the community right now, so we have to try to understand what's happening there," Bard said from Ottawa.
To transform the health-care system, the national association believes there needs to be a shift in how human resources are deployed.
"We need to move outside the walls of ... hospitals and really move to primary health-care services so we reach people where they're at in the community and in their homes," said Bard.
"It is critical that we increase the underserviced areas in the community and the vulnerable populations," she said, noting that the CIHI report shows the number of community-based nurses dropped to 33,729 in 2011 from 36,227 a year earlier.
The report found the proportion of nurses under age 35 made up almost 24 per cent of the nursing workforce in 2011, up from 21 per cent in 2007.
CIHI also found that the average age of nurses in Canada was 45 in 2011, with those 50 and older representing more than 40 per cent of registered nurses and registered psychiatric nurses. Those 50 and older made up just one-third of licensed practical nurses.
Nurses closest to retirement age — 60 or older — were more likely to work outside the hospital sector, CIHI said.
When it comes to younger nurses, Bard said 10,827 RNs graduated in 2011, but only 2,212 were employed.
"There's a gap there. ... So where are they going? Is it because they're not in full-time positions, because we know (casual employment) is increasing."
While some nurses choose to work part time, "we also know that some of our young graduates need to have sometimes three to four jobs to make a full-time job."
Within Canada, the top three destinations for graduates who moved after graduation were British Columbia, Alberta and Ontario, the report said.
The Ontario Nurses’ Association said even though the number of nurses in Canada has risen by eight per cent, it believes the ratio of RNs to the population has not grown because some provinces — including Ontario — have reduced the number of registered nurse positions.
The ONA, citing data from the College of Nurses of Ontario, says that between 2011 and 2012, 844 RN positions were cut in the province.
“Ontario continues to lag behind almost every province in the country in RN-to-population ratio,” ONA president Linda Haslam-Stroud said in a statement.
“The RN-to-population ratio is key to safe patient care because historically, registered nurses are the professionals who are there on the front lines for patients 24-7," she said.
"Ontario is falling behind in terms of the number of direct-care RNs as well, relative to the rest of the country, as health-care employers continue to cut RN jobs and look for short-term savings by hiring less-trained, lower-paid staff.”
The average Canadian ratio is 785 registered nurses per 100,000 residents; Ontario employs 668 per 100,000, says the association, which is calling on the province to increase RN hiring levels.
The CIHI report said where RNs work remained largely unchanged between 2007 and 2011: almost two-thirds practise in hospitals, while 13 per cent work in community settings and 10 per cent are long-term care nurses.
Between 2007 and 2011, the number of nurse practitioners — who have advanced training and certification, including the right to prescribe drugs and order tests — more than doubled, from 1,344 to 2,777.