A nursing shortage in need of intensive care

Ian Pearson August 11 1980

A nursing shortage in need of intensive care

Ian Pearson August 11 1980

A nursing shortage in need of intensive care


Ian Pearson

Most of all, Cherry loved nursing itself Her dream was the dream of being a nurse, of helping people on a grand scale in the most important way there is.

— Cherry Ames, Senior Nurse

Cherry Ames’s dedication is still alive in the nurses of 1980. However, the dreams of modern nurses go far beyond the nurse-novel stereotypes of giggly passiveness, jealousy of redheads and heartthrobs for doctors named Lex. Today, Cherry would likely be caught up in hi-tech training and collective bargaining. But the image of the humble handmaiden continues to cling to nursing like a moist bandage—a constant irritant to an old-style “woman’s” profession that is having difficulty attracting new blood to fill the old white uniforms and trying not so successfully to hold on to the bodies it already has.

Nurse shortages that go beyond seasonal fluctuations are being felt in all provinces except Prince Edward Island, reports the Canadian Nurses As-

sociation. Even with the highest wages for registered nurses in Canada, British Columbia (where an RN’s starting salary is $19,488) has more than 500 vacancies in hospitals across the province. Canada’s largest hospital, Vancouver General,needs 122 nurses and about 200 beds lie empty, waiting for attendants. Alberta’s condition is even more urgent: more than 700 nurses are sought (last year at the same time there were 396 vacancies). And Grande Prairie General Hospital is recruiting in England and

New Zealand, offering to pay air fare to Canada. With building programs under way throughout Alberta to increase the number of hospital beds, nurses are wondering how the demand can be filled. One traditional supplier, Ontario, now faces the same shortages. The Ontario Hospital Association says that well over 500 nurses are needed in Metropolitan Toronto alone.

The most obvious explanation to these cases of missing nurses lies in the variety of careers that have opened up to women in the past decade. (And nursing is still a woman’s profession: only 1.37 per cent of Canadian nurses are male.) No longer is an 18-year-old woman’s career choice limited to the triad of nurse-teacher-secretary. Cherry Ames can become Rex Morgan, MD, Perry Mason or Barbara Walters if she so desires. In comparison, nursing can seem low status and out of fashion.

But while nursing schools may not have the luxury of choosing from as many applicants as before,

little problem maintaining enrolment levels. The shortages arise from a combination of factors: an attrition rate of 25 to 30 per cent in the schools, resulting in a lower number of nurses reaching registration every year (new registrations in Ontario dropped from 4,112 in 1975 to 2,919 in 1979); RNs who leave the profession because of family obligations or more appealing careers (17,649 of Ontario’s 94,057 RNs in 1979 were inactive); and the contingent of nurses that heads for the greener pastures of American nursing.

Nurses are beginning to speak out more, but one problem is convincing people that they’re serious. “At one point nursing was a vocation; now it’s a profession,” explains Maureen Powers, executive director of the Registered

Nurses’ Association of Ontario. “One of the things I’ve heard is that nurses are checking out employment contracts in institutions before they apply. If a health agency is backward, then nurses are choosing not to work there. It’s the sign of an increased awareness about one’s ability to make a choice, one’s rights and one’s satisfaction.”

The rights include the right to strike in all provinces except Ontario and P.E.I. Last April, Alberta nurses displayed a militant face that would have made Florence Nightingale blanch. Three days into a strike, the provincial government ordered them back to work. The nurses challenged the legislation and ended up with a 37.8-per-cent wage increase over two years. Obviously, nurses have grown beyond the stage of meekly answering the call of duty.

And there’s little compunction among nurses about leaving home. Faced with a devastating shortage of 100,000 nurses, the United States is casting covetous glances at Canada’s 220,000 RNs. A recruiting drive under way in Toronto by two California hospitals offers the carrots of sun and fun for Canadian nurses willing to sign up for two-year stints. Although the pay is roughly the same as in Ontario, fringe benefits include two months’ free rent in furnished apartments, free air fare to California and two months’ free cab fare to and from work. But the main selling point is the free continuing education programs, which are considered far superior to anything offered in Canada. “I’d say one out of five nurses who signed up was interested in the travel and the climate,” says Anne Stromberg of the California recruiting agency Fishers of Men. “Most wanted the specialization we offer so they could return to Canada in two years and get a better job.”

Kim Bush spent two years in Texas after graduating from a Toronto nursing school. After a brief return to Ontario, she has decided to trek to the Sun Belt again, this time to California. “In Texas, it was possible to get a degree by working part-time over two years,” says Bush, 23. “In Ontario, you can’t get a degree without putting in a year fulltime and losing your salary.” As well, in Texas she was promoted immediately to intensive-care work although it would have taken five or six years to reach the same level in Ontario. Toronto nurse Gabrielle Coe, who was tempted to make the jump to California but decided for personal reasons to stay in Ontario, is also dissatisfied with the opportunities for advancement through education: “As shift workers, we work evenings or nights. Yet there are no day courses available.”

Hospital administrators are sympathetic to the nurses and attempt to set up as many in-house training programs as possible. “But we just don’t have as many funds as we’d like,” says the di-

rector of personnel at Toronto’s Hospital for Sick Children, Fred Berg, who is trying to recruit 45 specialized nurses. Of course, American private hospitals solve the money problem by passing the increased training expense along to the patients.

Even if provincial treasuries opened the floodgates and pumped more money into socialized health care—creating easier access to specialized nursing

courses—nurses would still have to assert their independence as a profession in order to remain competitive in the careers marketplace. At least they would have to transmit their growing spirit of independence to potential recruits. A new role model is the nursepractitioner, a nurse who works independent of a physician, advising patients on health problems. Shirley Wheatley, who set up the first independent nurse-practitioner business in Toronto last year, believes she can complement rather than infringe on the physician’s responsibilities. “The nurse’s orientation generally is identifying those things in people’s lives which are keeping them healthy, as opposed to identifying and curing illness, which is. a physician’s role,” says Wheatley. “There are many areas of health where nurses could very easily do primary care or health assessment, such as well-woman care, well-baby care, pediatric and obstetrical care.” This increased autonomy requires higher education. At present, eight universities in Canada offer a master’s program in nursing but none offers a doctorate. Wheatley points out that only five per cent of nurses have even a bachelor’s degree. Yet advanced study programs would be crucial if recommendations forwarded by the Canadian Nurses Association to Justice Emmett Hall's Health Services Review are given any heed. The association is asking that provincial health insurance programs

recognize nurses as being capable of dealing independently in areas of primary health care and that nurses with proper training be allowed to perform certain medical acts that now are legally performed only by physicians. If nurses ever reach that degree of independence, they could probably kiss off the stigma of Cherry Ames forever.

But until then, nurses have to summon every last ounce of dedication to

cope with the pressures caused by staff and money shortages. “I think nursing is very attractive on its own,” says Marilyn Carmack, executive director of B.C.’s Registered Nurses’ Association. “What detracts from nursing is having insufficient time and insufficient staff to practise at the standard you would like.”