Canada's nursing workforce has still not recovered from the massive cuts in the 1990s but it is making up ground quickly thanks to record numbers of graduates, newly released data shows.
There are now 348,500 nurses nationwide - up more than 27,000 in the past five years - according to the Canadian Institute for Health Information.
There were 789 registered nurses per 100,000 population in 2009, still shy of the 824 per 100,000 in 1992. In the mid-1990s, most provinces imposed hiring freezes and offered buyouts to nurses in a bid to cut spending.
"Despite reinvestments in healthcare over the past 10 years, the ratio of nurses to the Canadian population has still not returned to what it was in the 90s," said Michael Hunt, director of health workforce information services at CIHI.
"In contrast, the number of physicians relative to the size of the population is now at an all-time high," he noted. A report released earlier this month by CIHI showed there were 201 physicians per 100,000 population in 2009, up from 186 per 100,000 in 1999.
There are 68,100 physicians in Canada.
Rachel Bard, CEO of the Canadian Nurses Association, said the new data on nursing numbers is good news, particularly for patients who depend on nursing care.
"There's some progress but we still have some catching up to do," she said. The sharp reduction in the nursing workforce led to shortages, particularly in hospitals, where wait times soared for many types of surgery. Cuts in nursing school admissions, coupled with an aging workforce, also led to fears of massive shortages.
The principal response was a reinvestment in education programs. There are 135 schools of nursing in Canada and, in 2009, they graduated 9,962 nurses. That is more than double the 4,816 nurses who graduated in 1999.
Despite the big increases in admissions to nursing programs - there were 14,100 last year across Canada - Ms. Bard said there is still a need to open up more places because the nursing workforce is aging and will have to be replaced.
"There is catching up to do in the schools too. We don't have the ideal numbers yet," she said.
Ms. Bard said what is important ultimately is that the "public gets timely appropriate care" and that all health professionals - nurses, physicians, pharmacists and others - can function to their full scope of practice.
"We think nurses are a good investment but you also need the right mix of health professionals," she said.
About two-thirds of nurses work in institutional settings like hospitals while 14 per cent work in the community setting.
"We would like to see more opportunities in the community, with a focus on primary care, prevention and home care," Ms. Bard said.
She noted that there are 4.2 million Canadians who still do not have a regular primary care practitioner - a physician or nurse-practitioner.
"We think part of the solution to that problem is more nurse-practitioners," she said.
Nurse practitioners are registered nurses with additional, master's-level training that allows them to diagnose patients, provide some forms of treatment, refer patients to testing and prescribe some medications.
The CIHI report shows that the number of NPs has more than doubled in the past five years.
There were 2,048 licensed NPs in Canada in 2009, up from 976 in 2005.
There are three principal types of nurses in Canada: registered nurses (76.4 per cent), licensed practical nurses (22.1 per cent) and registered psychiatric nurses (1.5 per cent).
Only 28 nursing schools offer nurse-practitioner programs. They had a total of 379 graduates last year.
Some nurses (largely LPNs) graduate with a college diploma but, increasingly, provinces are requiring a baccalaureate for someone to practice as a RN or RPN.
Last year, there were also 786 nurses who graduated with a master's degree and 42 with a doctorate in nursing.
André Picard