Kisalaya Basu and Anil Gupta, both from the Microsimulation Modelling and Data Analysis Division, Applied Research and Analysis Directorate, Health Policy Branch, Health Canada
Where and Why
There is evidence of a worldwide nursing shortage—including in Canada. In fact, a new report by the Canadian Institute for Health Information (CIHI) underscores registered nurses(RNs) as “a shrinking and aging work force.” Yet, Dr. Ginette Lemire Rodger, past president of the Canadian Nurses Association, noted that the nursing work force is an element important to the sustainability of the future health care system.1 Further, the Association confirms that Canada will face a growing shortage of nurses over the next 15 years; specifically, it projects a shortage of 113,000RNs by 2016, reflecting both expected supply and the increasing demand of an aging population.2
anada’s current nursing shortage is expected to increase significantly in the next 15 years. This article explores both demand- and supply-side factors, and highlights the impact of demographic pressures and nurses’ working conditions. As well, it applies newly developed models to predict nursingspecialties where shortages will be the greatest.
Nursing shortages occur when the demand for nursing services exceeds the supply of nurses in the work force. Shortages cannot be measured directly, but must be estimated on the basis of complex models of demand and supply. Demand is determined mainly by the prevalence of diseases, available technology (including advancementof drugs/vaccinations) and public expectations. On the other hand, the supply of nurses is determined by the number of active nurses and the amount of time they work. A study of nursing in OECD (Organisation for Economic Co-operation and Development) countries summarizes the causes of current nursing shortages.3 As previous articles have shown, many are linked to working conditions: • increaseddemand for nurses due to aging populations • new technologies that increase the range of treatable conditions • greater consumer activism • a falling or slow-growing supply, due to fewer younger people entering the nursing work force • a greater range of professional opportunities outside nursing • the low social value given to nursing • negative perceptions of nursing conditions • an aging nursingwork force
Issue 13—HEALTH POLICY RESEARCH BULLETIN
Nursing Shortages: Where and Why
Arguments of Supply and Demand
Figure 1: Demand Forecasts for Full-Time Equivalent In-Hospital and Home Care RNs
per 100,000 Population, Canada, Selected Years, 2005-2025
FTE RNs per 100,000 population
To a large extent, the current shortage of nurses in the hospital sector is due to thefiscal restraint imposed on that sector in the early to mid-1990s. Other factors have also contributed to changes in nursing employment levels since then. According to supply-side proponents, deteriorating working conditions and stagnant wages have caused nurses to voluntarily leave for better employment prospects elsewhere, including the United States. By contrast, demand-side Source: Health Canada,Microsimulation Modelling and Data Analysis Division, RN Demand Model. proponents argue that hospitals have reduced staff levels in response to a Disease patterns of aging decline in inpatient use.4 As this article shows, both With an aging population, the prevalence of age-related perspectives have merit. diseases is expected to increase. For example, administrative data from Nova Scotia showsthat over the next 20 years—other factors remaining the same—there will be a significant increase in treatment requirements The demand for nursing services is determined by for diseases of the circulatory system (36%); neoplasm a number of factors, including both the size and (29%); endocrine, nutritional and metabolic diseases demographics of the population. Population aging is and immunity...