CIHI report monitors changes in regulated nursing trends over past 10 years

July / August 2017   Comments

The latest Canadian Institute for Health Information regulated nursing data shares new insights into how the nursing landscape has changed in the last decade.

Released in June, CIHI’s report Regulated Nurses, 2016 highlights trends in Canada’s nursing supply and workforce from 2007 to 2016, reflecting on some of the broader health-care and economic transformations taking place during the same period. Changes in characteristics of nurses across employment settings, age distribution and growth in the supply of nurses are among the trends that have traditionally been the focus of each annual report.

“These shifts, alongside changes in the delivery of care — including the introduction of other regulated and unregulated health care providers — and population needs, will be important to monitor to understand the emerging roles of regulated nurses in a health care system that is evolving,” the report states.

In 2016, the majority (58.6%) of nurses worked in hospitals, while 15.4 per cent worked in each of community settings and nursing home/long-term care facilities and 10.6 per cent worked in other settings. “Looking more closely at the role of each regulated nursing profession within these settings helps to better understand how nursing practice is changing as it adapts to new models of care and evolving population needs,” the report states.

Among nurses working in hospital settings, there was about a five-percentage-point shift from the proportion of RNs (including NPs) (down from 83.7% in 2007 to 78.8% in 2016) to licensed/registered practical nurses (LPNs) (up from 16.3% to 21.2%). CIHI relates this trend to Canadian hospital expenditures in 2014 (the most recent year of actual expenditure data available), which experienced the lowest rate of growth since the late 1990s, reflecting restraints of provincial and territorial budgets.

Among those working in nursing homes and long-term care facilities, a six-percentage-point shift from the proportion of RNs (down from 49.7% to 43.7%) to LPNs (up from 50.3% to 56.3%) was noted. The report points to Canada’s aging population as challenging health-care system planners to balance service demands with costs as causing the shift in employment, not only of regulated nurses but also unregulated providers. “With the increase in demand for care, the role of unregulated health care providers has expanded from being supportive to providing front-line care...Research indicates that up to 80% of the direct care to older Canadians living in long-term care facilities, or in their homes, is provided by unregulated health care providers.”

But the largest change was in community settings, with a 10.5-percentage-point shift from the proportion of RNs (down from 86.5% to 75.9%) to LPNs (up from 13.5% to 24.1%). While the proportion of regulated nurses working in each setting remained relatively unchanged, community settings had the largest average increase in growth (2.4%), which aligns with recent provincial and territorial efforts to move care into the community.

In 2016, 29.5 per cent of regulated nurses were under 35 years old, with 47.8 per cent being 35 to 54 and 22.7 per cent being 55 or older. While there has been an overall increase in younger nurses since 2007, there has been a decrease in those ages 35 to 54. “This shift is not unexpected; the supply trend of regulated nurses demonstrates the slowing of growth between 1993 and 2002, reflecting a period of fiscal restraint in health care spending across Canada,” the report states. “It is an important trend to monitor, as mid-career nurses play an integral role within the nursing workforce, often working autonomously while simultaneously supporting older regulated nurses and mentoring new nurses in the workforce.”

In total, there were more than 421,000 nurses with a licence to practise in Canada in 2016. The 1.3 per cent increase from 2015 was the second-slowest annual growth rate since CIHI began collecting this data in 2002. The supply of RNs grew by 0.7 per cent to nearly 299,000.

More than 28,500 nurses registered to practise in 2016 in a province or territory they had not registered in the previous year, representing an inflow of 7.3 per cent. Most in this group were under 35 years old (70.4%) or had graduated in the last five years (67.9%). Although there has been a 2.8 per cent average annual increase since 2007 in new RN graduates obtaining a licence to practise in Canada, there has been a 3.2 per cent average annual decrease since 2013. CIHI points to various factors influencing that trend, including changes to legislation, the number of seats and graduates from entry-to-practice nursing programs, and regulatory and licensure requirements, such as the introduction of the NCLEX-RN exam.

“While the cumulative growth in the supply of regulated nurses (17.8%) between 2007 and 2016 outpaced the growth of the general population (10.3%), it was lower than the growth of the labour force working in the health sector (23.2%),” the report states. “One of the key factors influencing the growth in the supply of regulated nurses is the number of new graduates obtaining a licence to practise in Canada.”

Virginia St-Denis

Virginia St-Denis is managing editor, Canadian Nurse.

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