Intended for healthcare professionals


Canada faces nurse shortage

BMJ 2000; 320 doi: (Published 15 April 2000) Cite this as: BMJ 2000;320:1030
  1. David Spurgeon
  1. Quebec

    Canada is in the grip of a serious shortage of registered nurses that by all accounts will grow worse in years to come. The most comprehensive national study, published by the Canadian Nurses Association, predicts a shortage in Canada (except Quebec) of between 59000 and 113000 by 2011.

    Quebec, which has a nurses association separate from the Canadian Nurses Association, predicts its own shortage of 11000 nurses between 2001 and 2015. The Canadian Nurses Association's study was based on figures up to 1997, and its predictions are now considered conservative.

    The latest (1998) figures—released by the Canadian Institute for Health Information (a national, not for profit organisation), the Canadian Nurses Association, and Statistics Canada (a federal government agency)—show that the country's nursing workforce is growing older and that the number entering it (especially young people) continues to drop.

    Of the 227651 registered nurses employed in nursing in 1998, 57966 were aged over 50 years compared with 48838 in 1993, a 19% increase. Over the same period those aged under 29 declined by 32% (from 33429 to 22778). Nurses aged over 50 now account for 25% of those employed, while those aged under 29 represent only 10% of the total.

    The number of employed nurses continued to decline, by 3% from 1993 to 1998; 48% of these worked only part time in 1998, up from 39% in 1993. Levels of unemployment and underemployment for nurses have become more pronounced in recent years. All Canadian provinces except Newfoundland saw a decrease in the number of registered nurses employed in nursing per 100000 population between 1993 and 1998. In 1998 there was one registered nurse for every 133 people.

    Their place of employment has changed over time also. In 1998, 62% of registered nurses worked in hospitals, down from 67% in 1993. Over the same period, the percentage of nurses working in community health and home care grew from 9% to 12

    More Canadian nurses are leaving the profession, and fewer are seeing it as a viable career option. Of Canada's 1990 nursing graduates, 20% had left the profession five years later, and nearly 10% of nursing graduates emigrated to the United States between 1995and 1997, mostly to find work. Almost one in three of those interviewed said that, giventhe opportunity, they would not again choose nursing as a career.

    The nursing population in Quebec is also ageing: Quebec's nursing association said that 39% were aged 45 or older in September 1998, up from 31% in 1991. And despite an expected influx of new nurses of 1350 to 1500 a year until 2015, the association expects what President Gyslaine Desrosiers terms an unprecedented shortage as early as 2005.

    Ninety one per cent of the 227651 registered nurses employed in Canada (except Quebec) in 1998 graduated from Canadian schools; 5168 (2.3%) came from the United Kingdom, 3679 (1.6%) from the Philippines, 1505 (0.7%) from the United States, 1020 (0.4%) from Hong Kong, and smaller numbers from other countries, according to the registered nurses database at the Canadian Institute for Health Information.

    Quebec has predicted that it will have a shortage of 1200 nurses this summer, so it has announced a plan to recruit 100 from France at the May meeting of a nurses conference in Paris….

    Embedded Image


    Quebec hopes to recruit nurses from France—yet France has one of the lowest rates of nurses per head in Europe