Hospital reform and nursing labor market trends in Canada.

OBJECTIVES: Trends in the Canadian registered nurse (RN) workforce during the past 3 decades are examined, and the implications of current hospital sector retrenchment for RN employment are considered. METHODS: A descriptive review using relevant literature and existing databases on the nurse workforce is presented. RESULTS: From the 1960s through the 1980s, the Canadian RN workforce grew exponentially, fueled by expansions in the health-care delivery system under Medicare, rising inpatient acuity and skill-intensive patient care, enhanced access to nursing education, and increases in the numbers of women entering the workforce. Acute care hospitals have and continue to be the predominant employer of RNs. However, the 1990s have witnessed considerable hospital retrenchment, and with that retrenchment the growth of the hospital RN workforce has slowed dramatically. CONCLUSIONS: The ultimate outcomes of hospital retrenchment for the RN workforce remain unclear. Some speculate that the quality of care and working conditions will deteriorate in hospitals, as hospital administrators replace RN staff with lesser trained personnel to reduce costs. Others see change in the hospital sector as an opportunity for RNs to expand their scope of practice and responsibility in outpatient settings. The need for national and international research on the outcomes of hospital restructuring on patient care and the work of RNs is critical to sound policy making.

Promoting nursing practice through nursing research.

ICN is convinced of the importance of nursing research as a means of improving professional education and practice and generating health policies and systems that assure cost-effective use of resources. To this end, ICN is investing heavily in programmes and projects that strengthen the capabilities of ICN and its members to exercise research leadership. Below, three dimensions of research leadership that are important in today's health environment: 1) Fostering research-based practice; 2) Documenting the work and worth of nursing: and 3) Enhancing public understanding of nursing work.

Quality through health policy: the Canadian example.

In Canada, as elsewhere, healthcare policymakers are being asked to make some tough tradeoffs between quality and cost. It is crucial that national nurses' associations take part in these discussions to ensure that nurses' and consumers' interests are well protected. The Canadian Nurses' Association has helped mould national health policy. In the process it has had all the advantages of influence and all the risks of being co-opted by the system itself. Below, an insight into the knowledge gained.

Social reform versus education reform: university nursing education in Canada, 1919-1960.

Nurses' struggle to attain educational parity with other professional groups is closely aligned with the struggle of women for social equality within Canadian institutions. The attempts of nursing educators to shift their perspective from social reform to educational reform and to develop nursing scholarship has been restricted by the cultural views of women. Consequently, nurses' gains in attaining higher education have been realized by reforms in social and health care policies thought suitable for women. With advancement in university nursing education closely tied to social reform, nurses were not expected, nor did they expect, to pursue scholarly enquiry or develop research endeavours. This paper suggests that the feminist movement offers nurses a social and psychological basis from which to complete the educational reform of nursing.