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Starting today, a delegation of Ontario nurses -- led by the Registered Nurses of Ontario (RNAO) with the support of the Ontario Ministry of Health and the Ontario region of Human Resources Development Canada -- is holding a job fair in Houston, Tex. The RNAO is asking Canadian nurses employed in the United States to "Come home to Canada" and help solve Canada's nursing shortage.

At the same time, B.C. nurses are negotiating to try to keep nurses from heading South. Led by the British Columbia Nurses Union, 25,000 RNs and registered practical nurses are seeking a 60-per-cent pay increase (This would increase the top rate for frontline RNs to $42 an hour from the current $26.50). If salaries aren't competitive with those in the United States, BCNU members argue, Canadian nurses will continue to leave the country.

Clearly, the United States plays a role in Canada's serious nursing shortage. Over the past few years, U.S. market-based restructuring models have helped erode the working conditions of Canadian nurses. To make matters worse, some advocates of turning Canada's medicare system into a facsimile of the for-profit U.S. health-care system are using Canada's nursing shortage as another symptom to prove their alarming diagnosis of your medicare system.

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What advocates of privatization ignore, however, is the fundamental reason Canadian nurses are being wooed by American hospitals: Market models have driven nurses away from their profession and created a significant nursing shortage in the United States as well.

At the behest of private insurers and the employers who pay their workers health-care premiums, U.S. hospitals and other health-care institutions have spent the last decade cutting costs by replacing registered nurses with poorly paid, poorly trained nursing assistants. Caseloads for RNs have increased dramatically -- to as many as 12 patients on the day shift, and 14 to 20 on night shift. Currently, the United States has the shortest length of hospital stay in the industrialized world, with 40 per cent of patients leaving hospital within 24 hours of their admission.

American patients are more intensely ill when they are in the hospital and radical cuts in length of stay produce a cumulative workload that can almost double over the course of only five or six hours.

As well, nurses now spend as much time talking to home-care agencies, rehabilitation facilities, nursing homes or family members negotiating the hand-off of the patient, as they do providing direct patient care.

Earlier this month, the American Nurses Association released the results of a survey on declining quality of care. Of those RNs surveyed, 75 per cent reported that the quality of care in their institutions had declined in the past two years, and 56 per cent reported that the time they have with patients had decreased.

While U.S. hospitals, Don Juan-like, are trying to seduce Canadian nurses with signing bonuses and money for post-graduate education, they are punishing their own already employed RNs by forcing them to work mandatory overtime. An exhausted nurse who has just finished a 10- to 12-hour shift may be told she has to work another one. If she insists that this is unsafe for her patients -- or that she has child care or other caregiving responsibilities of her own -- she may face charges of "patient abandonment." This accusation can lead to disciplinary action by state boards of registration for nursing and potential suspension or licence revocation.

These conditions aren't only pushing nurses out of their profession; they are leading demoralized nurses to actively discourage family members and friends from entering it. Nursing school enrollments across the United States continue to decline. Just last week, the U.S. Health Resources and Services Administration released its 2000 National Sample Survey of Nurses. In 1980, 52.9 per cent of RNs were under the age of 40. In the year 2000, only 31.7 per cent were under 40. While the U.S. population increased by 13.7 per cent between 1990 and 2000, the rate of nurses entering the work force did not keep up with the needs of an aging population.

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In the United States and Canada, nursing shortages result from society's persistent failure to pay what it costs to provide care -- what it costs to give nurses well-paid, full-time work and the working conditions that allow good nurses to feel confident they are providing good nursing.

While some Canadians think the grass is always greener south of the border, the nursing crisis in the United States may, in fact, be harder to resolve than Canada's. Having a publicly funded, universal health-care system gives nurses (and the patients they serve) several important advantages. In a publicly funded system, nurses have one primary party to deal with, the government, when problems arise. The fact that more than 85 per cent of Canadian nurses are in unions -- and that nurses in each Canadian province are generally represented by one major union -- also gives RNs greater leverage to help protect patients.

Working within the medicare system has also encouraged greater co-operation between nursing unions, professional organizations, staff nurses, academics, managers and researchers. This results in more media coverage of problems and solutions and more pressure on political representatives.

In the United States, a fragmented health-care system has led to a fragmented response to the nursing shortage. To solve their problems, U.S. nurses are forced to bargain with or put public pressure on more than 6,000 hospitals, about 1,000 private insurers, as well as thousands of nursing homes, home-care agencies, clinics, and hospices. Nurses' wages have been stagnant. Only about 16 per cent of U.S. nurses are in unions and they are represented by about 100 labour organizations, most of which compete against, rather than co-operate with each other. And nurses and their organizations spend more time fighting with each other than with the system that is eroding patient care.

If Canadians can resist the siren call of importing cheap nurses from countries like the Philippines -- a move that only exports the nursing shortage to poorer countries -- and support nurses in their efforts to get full-time work with higher wages and better working conditions, Canada can be a world leader in helping to resolve a nursing shortage that is becoming global in scope. This won't only keep nurses in Canada, it will encourage the United States and other nations to stop stealing RNs from other countries and to pay what it costs to care at home. Suzanne Gordon, who lives in Massachusetts, is author of Life Support: Three Nurses on the Front Lines and co-author of From Silence to Voice: What Nurses Know and Must Communicate to the Public .

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