It’s time to optimize our health human resources and develop long-range strategies for capacity planning
By Karima Velji
May 1, 2023
Editor’s note: Karima Velji is a former president of the Canadian Nurses Association. In this guest editorial, she shares her observations on the current state of Canada’s health-care system and the new, innovative role nurses can play in reshaping this system to provide high-quality care to patients.
The publicly funded health-care system in Canada and the five principles of the Canada Health Act are defining elements of what is considered Canadian. We should expect that in a country with our means, we should be able to fulfil the promise of accessibility, universality, portability, comprehensiveness and public administration. I became passionate about health care from a young age. When I was a child, my parents could not afford health-care services when we needed them most, and I lost my dad at a very young age. I became devoted to the idea of a publicly funded health system. I decided that I was going to advocate for this for the rest of my life: the idea that health care must be publicly funded and accessible to everyone, regardless of the ability to pay.
After a career of over 30 years as a nurse and health-care leader, I have now joined the Ontario Ministry of Health as the first chief of nursing and professional practice and assistant deputy minister. My division is responsible for strategies to optimize our health human resources (HHR) as well as developing long-range strategies for capacity planning for our health-care system, including an innovative and futuristic approach to HHR.
The COVID-19 pandemic has laid bare the gaps in our health-care system and HHR matters. We are experiencing a historical number of vacancies and absenteeism in nursing, extended wait times for health services, difficulties connecting patients to services, and long wait lists and times. In working to help address these challenges, I am keen to reimagine the scope and role of nurses in Canada.
Nurses have the enviable position of having the highest number among all health-care professionals who touch patient care. We are high holders of public trust. Nurses are more educated now than at any other time in history. We are often the first point of contact for people who need health care. We interact across all the sectors of health care, including hospitals, long-term care and home and community care, often around the clock, 7 days a week/365 days a year. If these strengths are leveraged properly, and we unleash the potential of nurses toward the gaps that currently exist in the health-care system, the opportunities for health-care transformation are boundless.
As nurses, we need to sharply understand and respond to the demographic shift toward an aging population; the rise in chronic conditions, including dementia; the growing prevalence of mental health and addiction issues; the high use of emergency departments and hospital beds; the inequitable distribution of health and social services in priority populations and communities; and the desires of our population to age at home. Nurses are desperately needed in upstream roles where they can take charge of the health of populations to prevent hospitalizations. Nurse-led practices need to take shape throughout the continuum of care, including hospitals and long-term care homes.
My vision is an expanded role for nurses who are positioned and supported not only to provide high-quality health care, but also to take their place as health leaders to reshape our health-care system, maximize its potential and guide it into the future. In Ontario, we are pushing our short- and long-term HHR solutions in six bundles of innovation. In so doing, we are looking to unleash the potential of nurses to drive transformation in the health-care system. We are looking to change the role of nurses to drive transformations, for example, in primary care and home and community care settings, within an integrated system of care.
An exciting area of innovation that Ontario is exploring is the expansion of education seats, as well as the tying of this expansion to new approaches to education. Beyond just increasing the number of nursing graduates, Ontario is looking to graduate nurses faster by compressing curricula and reimagining clinical faculty and placements. We are also looking to reform nursing curricula with significantly more content, for example, content about priority populations, primary care and community-based care.
2: Scope of practice expansion
Ontario is also exploring innovative ways to optimize the use of its health workforce by expanding the scope of practice of select health professions. For example, scope expansion opportunities are being explored for nurse practitioners (NPs) to work to the full extent of their training and expertise, for registered nurses (RNs) to prescribe certain drugs, and for registered practical nurses (RPNs) to initiate additionalprocedures without an order. With these scope expansions, we are hoping that nurses will embrace clinical leadership roles in areas such as primary care as they move to nurse-led models of care in all settings.
3: Expedited pathways for international HHR
Another innovation strategy that Ontario is exploring is to break barriers to enable internationally educated nurses (IENs), who have chosen to come to Ontario, to enter the workforce in an expedited time frame. For example, the College of Nurses of Ontario is allowing IENs to register in a temporary class with supervision to begin working sooner while they complete the requirements for full registration. Ontario has also removed Canadian work experience requirements and is accepting language tests approved under the Immigration and Refugee Protection Act (Canada) to reduce duplicate language proficiency requirements. We continue to embrace the ethical recruitment guidelines from the World Health Organization.
4: Team-based care
Ontario is also looking to explore directing its health-care system toward team-based models of care to bring health-care providers together as one to improve patient experience and access to care. We will be implementing a models of care innovation fund to find innovative ways of maximizing the skills and expertise of teams, such as building collaborative networks, expanding access to team models of care, and investing in digital and virtual care. We will continue to push team-based models of care in areas such as primary care and push for further expansion of nurse practitioner-led clinics.
Ontario is working to ensure that its current health workforce is sufficiently supported, incentivized and positioned to provide the best health care possible. For example, programs to retain and distribute Ontario’s health-care providers include the Learn and Stay Grant, which assists rural and remote communities in building their own health workforces by covering the costs of tuition, books and other educational costs for post-secondary students who enrol in high-priority programs in underserved communities and commit to work in those communities when they graduate, and the Community Commitment Program for Nurses, which offers RNs, RPNs or NPs a $25,000 incentive for a two-year commitment to practise in priority communities. We are starting initiatives to harmonize compensation structures between health-care sectors to remove barriers for nurses to work in the home/community setting. Our unions are bargaining actively to push for competitive compensation so that we can retain our precious nursing resources.
6: “As of Right” rules
Additionally, under new “As of Right” rules, Ontario will become the first province in Canada to allow nurses and selected health-care professionals who are registered in another Canadian jurisdiction to immediately start working without having to first register with one of Ontario’s health regulatory colleges. We are keen to catalyze interjurisdictional mobility and national licensure efforts across the country.
Already we are seeing positive and quantifiable returns from the above innovations:
- Since winter 2020, Ontario’s HHR programs have supported the addition of over 14,800 staff in the health system.
- In 2022, the College of Nurses of Ontario registered a historical number of new nurses; over 12,000 new nurses were registered and ready to work in Ontario.
- Between 2021 and 2022, the proportion of new IENs grew from 24 per cent to 46 per cent.
- Since 2018, over 60,000 nurses have registered to practise in Ontario.
- Today, 30,000 nursing students are studying at Ontario colleges or universities.
I am very proud of the innovative policies and solutions Ontario has pushed for nurses in a short period of time. We want to position nurses to deliver high-quality care and to take their rightful place as health leaders to reshape our health-care system, maximize its potential, and guide it into the future.
Karima Velji, RN, PhD, CHE, FCAN, is chief of nursing and professional practice and assistant deputy minister, Ontario Ministry of Health.