Nursing: Who Says There is a Shortage?

Nursing is, along with Medicine and other health care professionals, a major part of the backbone of the healthcare system.  A noble profession with roots in the image of Florence Nightingale.  The profession, in modern times, has grown into huge numbers as its public image has remained high.  And why not?  These professionals have helped deliver your children, assisted in the Operating Room, managed the Operating Room, cared for your dying mother, and have dealt with many patients who are not always the sweetest customers in the world!

I have a good picture of that; nurses trained me well many years ago at the bedside and in the Emergency Department as I learned how to deliver basic clinical care.

With much justification, there have been many reports published in recent years about the shortage of nurses in New Brunswick and around that there has been not a little controversy as government has financed additional training seats that apparently did not get filled.  Then there were the issues with the registration exam referred to as NCLEX in which there was, for a while, a high failure rate that kept some great students from obtaining the RN designation.

There have been several reports about the fact that while there may be an issue with RN numbers now and in the near future, the LPN profession has grown and developed in stature and skill-set without being recognized as essential elements of the nursing care team.  That is what the recent Labor Relations Board hearings were all about in which the professional members wanted to be members of a professional union that would not recognize them.

In a recent round of publicity early in the pandemic, it was announced that recruitment in the Philippines would be initiated.  Actually, some health care organizations had already been doing that in New Brunswick for some time with little to no recognition nor encouragement from either government nor the professional regulatory body.

At this time there are reported to be nearly 200 nurses in the province, graduates of foreign nursing training programs, who not only cannot work as RNs but who, although they have had nursing training in their own country, cannot see an efficient path to RN status in New Brunswick.  Why is that?  Are those non-New Brunswick training programs so sub-standard that they do not produce quality nurses?

Ask those who have employed nurses trained in some of the foreign countries and mostly they will tell you that those they hired perform admirably, have great nursing attributes, and have a solid work ethic.  That was certainly my experience and that of some of my colleagues when I was active as a health care CEO.

One expects the unions to be very protective of membership and of jobs; that is their role and they do it very well.  The nurses’ association, on the other hand, has a mixed duty which some would suggest places the association in a conflict-of-interest situation.  On the one hand, the association’s job is to advance the interests of the nursing profession by continuing to monitor and improve standards of service and education.  It also has the duty to provide advice and counsel to nurses on legal issues, professional legal counsel, group insurance, professional advice.  In addition, it performs what is a public policy role of regulating the profession, controlling who is registered to practice, setting standards for registration, administering registration examinations.

There are two very distinct and very important roles here, one being the duty to the professionals who are association members and the second being the duty to ensure the safety of the public through the registration process.  Some observers would say that those two roles provided by one association creates an inherent conflict of interest.

The public wants the standards of practice to be maintained at a level that is consistent with national standards; the public also wants, and needs, for there to be sufficient numbers of nurses available to meet the needs of employer organizations in the province, that being nursing homes, clinics, hospitals and many more.

Persons from abroad who wish to come to Canada and who have a nursing background in their country should not be met with immovable roadblocks on arrival in New Brunswick but should be met with open arms and a system that says: “let’s figure out how to get you from where we deem your qualifications to be to where the basic RN level is in our province as represented by our registry exams.”  In other words, the immigrant or potential immigrant should not be met with having to duplicate all the training they already have completed but need a respectful, professional process of transition and acclimatization to a new culture and professional regulations.

Some provinces in Canada have separated the Regulatory function from the Professional Association function by forming a Provincial College of Nursing.  In New Brunswick the New Brunswick College of Physicians and Surgeons is a body entirely separated organizationally and legally from the Medical Society which looks after advocacy, public relations, fee negotiations and more.  Similarly, the psychologists, pharmacists, dental hygienists, and counselling therapists all have “colleges” that regulate their respective professions.  These bodies are not intended to advocate for their professions but, on the contrary, are intended to regulate professional practice measured against peer-reviewed standards of practice.  As such, they afford a serious measure of protection for the public and, as well, a focal point for the public, when dissatisfied with a practitioner’s performance, can lodge a complaint.

Critics may suggest that even with a “college”, the profession looks after its own to which I would hasten to observe that normally in the legislation governing professional colleges there is a requirement for at least one member of the public to be appointed to the college governing body.  This is intended to ensure that due process is not only followed but is seen to be followed and that there is an outside witness to such practices.

Is it time for one of the largest, most influential professions in health care to have such an independent body to regulate the profession?  With all the controversy at so many levels, both public and in private in recent years, it is an idea whose time has come.  Actually, it would be good for the profession because it would de-mystify much of the regulations and the administration of them.  it would also contribute to the professional image of the profession, strengthening it even more in the public eye.  Currently, in its messaging one hears regularly about shortages of staff and other issues of major concern.  But that messaging is expected in the normal to and fro of the political process.  That is how public attention is influenced when collective agreements are about to be negotiated and when universities wish to negotiate for more funding for faculty positions and training slots.

The College of Nurses, however, would be a truly professional body that deals with facts, evidence, best practice without getting into the trenches of political processes.  It would be the body that really tests the waters regularly as to whether training methods are appropriate, clinical faculty have the background appropriate to educating nurses of tomorrow, whether technology is being fully embraced in professional practice, whether educational programs truly prepare graduates for the needs of the workplace, and much more.  These are just some of the profound issues that must be dealt with on an evidence-based basis without the debates degenerating into the political realms of compensation, attendance management, and more.  All this, of course, is in addition to the provision of an orderly process of bridging for persons with nurses training from other jurisdictions to eventually obtain registration status in NB.

These issues are of such importance to the public that they must be clearly segregated from the issues of professional advocacy, benefits, status, compensation, workplace issues and more.  The time has arrived and the profession will grow in stature as a result.

Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News and author of Health Care Reform in New Brunswick; e-mail:  [email protected]