The Minister of Health, Christian Dubé, is proposing a new action plan for an overhaul of the health and social services system. Another, will say the most cynical. However, if there is one issue that needs to be tackled quickly, it is certainly that of the training of nursing personnel. Nursing workforce issues have been the subject of much discussion since the start of the pandemic, and now is the time to refocus the dialogue around a pragmatic and open exchange on concrete solutions.
Quebec has never had so many nurses and compares favorably to other Canadian provinces. The number of nurses per 100,000 inhabitants in direct care was 762 in 2021 in Quebec, compared to a Canadian average of 662 in 2020. The problem of nursing care is elsewhere.
In Quebec, the nursing profession holds, along with physicians, the largest field of practice with 17 reserved activities. The scope of reserved activities with a high rate of harm to patients, including the assessment of the physical and mental condition of a symptomatic person and the follow-up of complex health conditions, is restricted due to a combination of missing elements or incomplete in college programs, such as basic science or critical use of scientific data.
The lack of uniformity in the training programs results in an occupation of only 50% on average of the nursing field of practice in Quebec. Our health system lacks university-trained nurses, in hospitals and CHSLDs, for ambulatory care and home care, for critical care, infection prevention and other more specialized care.
The solution is in training
The Report of the Commissioners on the Estates General of the Nursing Profession 2021 recommends making the baccalaureate the only diploma giving access to a permit to practice the nursing profession in Quebec within a five-year horizon. It also recommends maintaining two training paths to obtain the title of nurse, namely initial training in nursing sciences at university and the integrated DEC-BAC program.
According to this scenario, CEGEPs will continue to play a leading role in quality nursing education by providing the college portion of the DEC-BAC. In addition, all nurses will benefit from university-level learning that is necessary for the full deployment of reserved activities.
Technical training is no longer enough: the next generation of nurses must evolve in order to be able to better respond to the diversification and increasing complexity of the health needs of the population. In this context, an enrichment at the university level of the initial training is necessary in order to allow a complete deployment of the nursing expertise.
Tangible benefits
University education will ultimately have real benefits. Our health system will see the pressure greatly reduced on its workforce, record better performance and significant efficiency and financial gains. Moreover, no less than 67 international studies have concluded that a 10% increase in the proportion of university-educated nurses would reduce the risk of mortality by 4% to 14%. In addition, the length of stay for people with mental health disorders would decrease by 15% following a 20% to 40% increase in the proportion of university-educated nurses.
In Ontario, the new entry-to-practice standard allowed the province to record a 197% growth rate in the number of university graduates between 2015 and 2018, while in the same period, Quebec saw an increase only 8%. We are convinced that making the bachelor’s degree the sole entry standard to the profession for future generations of nurses is one of the necessary solutions to address the shortage of nursing expertise. Ultimately, a university education will allow better access to health care and a balanced offer that does not rely solely on doctors.