nursing shortage in canada nursing shortage in canada there has been a nursing shortage in canada for decades. this became more acute in the period between 1943 and 1952 as canada's health services were expanding, and the number of hospital beds increased along with the number of hospitalizations. by the mid-1940s across canada the shortage, estimated at 8,700, led to a re-organization and re-conceptualization of nursing in canada, according to a 2020 journal article in bc studies. the nature of nursing was changing with new and time-consuming responsibilities, such as the administration of penicillin. during that period, there was no unemployment for nurses, especially if they were willing to be mobile. however, working conditions for nurses were very poor, with low wages combined with long hours; nursing force retention was challenging. as well, since almost all nurses were women, they had responsibilities at home they had to manage. in response to the shortage of nurses, women who had trained as registered nurses (rns) but had left the workforce when they married, were encouraged to return to work; volunteers were engaged; nursing courses were accelerated; and new categories of regulated nursing were added to registered nursing—"practical nurses" and "nursing assistants." at that time, a "utopia of nursing" referred to teams of nursing staff which included registered nurses and other regulated nursing and hospital worker support personnel. some of these auxiliary positions were also open to first nations women and other racialized groups. since at least 1998, the canadian federation of nurses unions (cfnu) have been calling for solutions to the nursing shortage in canada. in 2005, registered nurses worked an estimated 18 million hours of overtime—both paid and unpaid, representing the "equivalent of 10,054 full-time positions". the nursing force had among the highest rates of "burnout, injury and illness." along with a nursing shortage, there has also been a shortage of nursing educators, particularly nursing faculty in academia. the covid-19 pandemic in canada spotlighted and exacerbated the existing nursing shortage. the shortage in the nursing workforce is one of the main factors behind unplanned forced closures of emergency rooms, lengthy offloading times for ambulances, critical care bed alerts. intensive care units have been forced to refuse any additional patients, and hospitals have been working over capacity because of these staffing issues. during the seventh wave of the covid-19 pandemic, the lack of nurses, along with the health system's backlog and a resurgence of hospitalized covid-19 patients, has contributed to the health crisis. reports of those in the nursing profession who have the highest rates of "burnout, injury and illness" date back to at least 2008. there were 304,558 registered nurses who were licensed to practice in canada as of 2020. most had a single employer (84%) at the time of registration.. during the pandemic, health job vacancies had increased by 56.9% since 2019 in canada to a "record high of 100,300. the highest vacancy rate was experienced by hospitals. some of factors leading to the exodus of the nursing labour force included "workload, burnout, lack of structural value, the need for leadership and mentorship, and lack of flexibility, autonomy and voice laced with overt racism, discrimination, and gendered inequities," according to a royal society of canada-funded study. during the seventh wave of the covid-19 pandemic, the lack of health care personnel, particularly nurses, along with the health system's backlog and a resurgence of hospitalized covid-19 patients were some of the factors contributing to the overloading of emergency departments and lengthening of ambulance off-loading times. a 2022 report by the canadian federation of nurses unions (cfnu) and the canadian health workforce network (chwn) said that the "magnitude" of the crisis in nursing, which includes a 219.8% increase in nursing vacancies since 2017, has led to a paralysis of "overnments and employers at all levels and across all sectors." overview the nursing shortage is global according to 2022 world health organization fact sheet. of the estimated 27 million people comprising the global health workforce, which is currently experiencing a global shortage, about 50% are nurses and midwives. by 2006, the global nursing shortage was already described as an "unprecedented" as there was both a decreased supply of nurses along with an increasing demand for nursing staff. concurrently, there was also a global "shortage of other health professions and auxiliary staff". factors that contributed to a decrease in the supply side of the nursing workforce included "workloads, inadequate support staff, violence, stress, and burnout" that created an "unfavorable work environment", combined with problems with wages and management. there has been a nursing shortage in canada for decades. across north america during the post-world war ii years, there was a serious shortage of registered nurses. by the mid-1940s in canada, the nursing shortage was approximately 8,700 and it was increasing along with health services in canada and the number of hospital beds and hospitalizations. it was so severe that vancouver general hospital's newly built pavilion remained out-of-service because there were not enough registered nurses to staff it. the number of hospital beds across canada increased from 1943 to 1952 by 26% and the number of admissions to hospitals increased by 74%. the nature of nursing was also changing with new and time-consuming responsibilities, such as the administration of penicillin. during that period, there was no unemployment for nurses, especially if they were willing to be mobile. however, working conditions for nurses were very poor, with low wages combined with long hours and nurse retention was challenging. as well, since almost all nurses were women, they had responsibilities at home they had to manage. by january 1943, 50% of vancouver general hospital's registered nurses were married women who had returned to work as nurses when encouraged by the hospital's administrators. in response to the shortage of nurses, volunteers were used and nursing courses were accelerated, and new categories of regulated nursing were added to registered nursing—"practical nurses" and "nursing assistants." because of the mid-twentieth century nursing shortage, nursing labour was reorganized and re-conceptualized. to expedite entry into nursing, debates were held across canada about auxiliary nursing roles for assistants and practical nurses. at that time, a "utopia of nursing" referred to teams of nursing staff which included registered nurses and other regulated nursing and hospital worker support personnel. some of these auxiliary positions were also open to first nations women and other racialized groups. since at least 1998, the canadian federation of nurses unions (cfnu) have been calling for solutions to the nursing shortage in canada, according to a bmj article, by 2000 canada faced a "serious shortage" of rns and the nursing shortage was predicted to worsen, not improve. by 2000, canada was already experiencing an exit of nurses from the profession—20% of canadian nurses who graduated in 1990 had left the profession by 1995, and about 10% had emigrated to the united states. in one interview, a third of the nurses said, with hindsight, they would not choose nursing as a career. the article, which cited the canadian nurses association's (cna) "comprehensive" national study, predicted a shortage by 2011 of between 59,000 and 113,000 across most of canada. a 2002 cna study reported that, without new policies and direction, the projected shortage of registered nurses in 2011 would be 78,000 rns and up to 113,000 by 2016. the report also noted that there was a "shortage of nursing faculty". in 2005, registered nurses worked an estimated 18 million hours of overtime—both paid and unpaid, representing the "equivalent of 10,054 full-time positions". the nursing force had among the highest rates of "burnout, injury and illness." in 2018, organisation for economic co-operation and development (oecd) cautioned that canada would have a shortage of 117,600 nurses by 2030. in alberta, by 2019 nursing staff included rns, lpns, and health care aides (hcas). of these, 33% of rns worked full-time, 42% worked part-time, and the remaining 25% were casual workers. are part-time and 25% are casual. the ernst & young report cited a participant in the ahs review process who said that, "previously, nursing was a secondary family income in alberta, but this isn't the case anymore. we have the ability to rethink how we approach part-time nursing." in the same review, which was submitted just before the covid-19 pandemic, ernst & young listed a number of nursing workforce changes as one of the major ways of cost cutting. the report said that ahs could save from cdn$231 million to $322 million by optimiz "nurse staffing based on patient demand." other suggested changes included saving tens of millions in costs by reducing overtime and sick leave, shifting away from part time positions to increase full-time positions, removing provisions that require hiring of united nurses of alberta (una) members. according to a 2022 joint report by the cfnu and the canadian health workforce network (chwn), about 50% of nurses in canada who were working in 2022, were considering leaving their job. ninety four per cent of the nursing workforce had signs of burnout and 83% felt that understaffing issues negatively impacted on their quality of care. since 2017, nursing vacancies increased by over 219.8% based on statistics canada's july 2022 labour force survey. this nursing shortage has resulted in a paralysis at all levels of governments and health care worker employers. the report correlated the forced closure of health services to the nursing shortage and warned that increased privatization of health services is also a threat as it "diverts health human resources to the privileged at the expense of everyday canadians". measuring nursing shortage the 2019 international journal of health planning and management article paper said that concepts, such as—professional standards, projections, or supply and demand economics— were not being sufficiently used to measure nursing shortages; instead, most often, the indicator was "essentially the number of nurses per 1000 inhabitants". other measurement indicators include the nurse to patient ratio, and supple and demand in the nursing industry. based on various models used by employment and social development canada (esdc)'s occupational projection system (cops) team, some provincial governments, canadian nurses association (cna), and statistics canada on vacancies, the 2019 international journal of health planning and management article said that there was a shortage of nurses in canada. in 2012, it was 2.6% and the projection for nursing professional shortages across canada in 2022, was between 50,000 and 60,000. the article said that nursing shortages can be measured based on professional standards, projections, or supply and demand economics. nurse to patient ratio professional standards set the nurse to patient ratio. according to an ernst & young 2019 report, canada uses the same set of targets for nurse to patient ratios that is used by leading organizations internationally. for medical and surgical units during the day shift, one nurse for four patients is the standard. this change during the night shift, with one nurse for five patients, and represents "5.33 hours per patient day". in obstetrical units the ratio for both day and night shifts in one nurse to five patients which represents 4.80 hours per patient. day) according to the canadian federation of nurses unions (cfnu) in 2014 an average nurse to patient ratio for canada was 1:4. the 2019 commissioned ernst & young review of the province of alberta's health care reported that the province ranked seventh on access to nurses. one of the reasons given for canadian nurses leaving canada for the united states was unsafe patient ratios. in ontario, one nurse said she was responsible for caring for six patients at a time. in their report, ernst & young said that one way to measure the nursing staffing levels was to measure the number of "hours per patient day" per each patient on a given unit. they calculated this by dividing the total number of hours worked by rns, lpns, and unlicensed health care aides (hca), and "dividing it by the total number of patient days seen on the unit" which would translate into 6 out of 24 hours (per patient day) results in a 1:4 ratio. projection-based shortage according to projection‐based shortage, a 2009 canadian nurses association (cna) report, the shortage of rns in canada would be approximately reach 60,000 full‐time equivalent (fte) by 2022. supply and demand shortage the economic concept of nursing shortages considers supply and demand—how many nurses are available and what