A nurse holds her head as nurses care for patients suffering from COVID-19 at Humber River Hospital's Intensive Care Unit, in Toronto, on April 28, 2021.COLE BURSTON/AFP/Getty Images
Susan Duncan is a registered nurse and a professor at the University of Victoria’s School of Nursing.
Canada is facing a critical shortage of nurses, a problem that was predicted for decades but is now having severe consequences on the country’s health care system. Pre-pandemic, the Canadian Nurses Association estimated it would have a shortfall of 60,000 nurses by 2022.
While we don’t have exact numbers for Canada’s current nursing shortage, the COVID-19 pandemic has affected the profession’s projected retention levels. In the two years between the fourth quarters of 2019 and 2021, nurse vacancies increased by 133 per cent in the health sector. We know anecdotally that vacancies have grown in number and will continue to grow if retention efforts are not scaled up, urgently and immediately. Just this month, a report by the International Council of Nurses warned that nursing shortages are a critical global health emergency.
While new recruits are needed to sustain our nursing work force, Canada is also not retaining the nurses it already has because of long-standing workplace issues that are eminently solvable.
Increasingly, Canadians are experiencing delayed or absent health care, sometimes with tragic results. Last summer, emergency rooms were visibly overwhelmed during a “tridemic” of COVID, influenza and RSV, but the impact has also been felt in the less visible sectors of home and long-term care. In response, governments across Canada have been seeking fast fixes to the problem, often in the form of prioritizing the recruitment of nurses from other countries.
The World Health Organization estimates that 81 per cent of the world’s nurses work in three regions: Western Pacific countries, the Americas, and Europe. This means the majority of the global population doesn’t have widespread access to nursing care. Now that Canadian governments are looking to fix their nursing shortages by prioritizing the recruitment of internationally educated nurses (IENs), we must ask – are we considering our obligations as global citizens? If we are called upon to answer for our recruitment practices, will we be proud of our answers? Surely the pandemic has put us all on notice that matters of health care transcend all national borders.
The WHO’s Global Code of Practice on the International Recruitment of Health Personnel acknowledges that this is a complex issue – we must consider that the human right to choose to immigrate remains paramount, but we are also facing global shortages of health personnel. In order to remain accountable, countries such as Canada should work fairly and transparently with smaller economic partners when recruiting. We should also compensate these countries in order to offset the considerable expense of educating a nurse who then moves. We cannot simply take from other countries – we must support their health care environments as well, for the global benefit of all.
Other countries, including Britain, have adopted ethical approaches to recruitment based on the WHO code, including transparent and fair agreements, and identifying those countries and circumstances where active recruitment should not happen. Despite being developed and published by recognized global nursing and health organizations, there is a glaring lack of evidence that these ethical considerations and guidelines have been applied to recent overseas recruitment initiatives by delegations from Canada.
Campaigns to recruit nurses who are undecided about leaving their home countries, families and support systems, or persuading health personnel to move to Canada without regard for the global health context is crossing an ethical line. In addition, if recruitment is successful, nurses who choose to emigrate will bring valuable and diverse expertise with them. They must be supported to the highest standard in their transition to a new country, including timely and affordable access to licensure, orientation, housing, career mobility opportunities, and support with the costs of living and working in Canada.
According to recent Canadian Institutes of Health Research data, only around 9 per cent of registered nurses in Canada are internationally educated. There are many IENs who have arrived in Canada but remain underemployed – stymied by the complex and expensive processes of attaining permanent residency and nursing licensure. In recent years, there has been some progress in addressing these barriers, but more urgent attention and actions are needed.
Before prioritizing international recruitment, Canada’s first order of business should be to retain the nurses it already has, and work on helping the nursing work force to recover from the pandemic. If and when international recruitment does occur, it must be done ethically. We have the expertise and the ability – it is time to do the right thing and create a model approach to shoring up our nursing work force that Canada can be proud of on the world stage.