How responsive are internationally educated nurses to an evolving Canadian Health Care System? Presented by: Ryanna Bowling & Xiaoqian (Maureen) Li Canadian Institute for Health Information cihi.ca @cihi_icis April 27, 2018 hhr@
Outline • About Canadian Institute for Health Information (CIHI) • Nursing Workforce data at CIHI • Setting the stage for analyzing workforce trends • Taking a closer look at responsiveness of internationally educated nurses • Trends to watch 2
Independent not-for-profit corporation About CIHI 27 data holdings Expertise in: • Data collection and analysis • Information standards • Education and outreach 3
Nursing Workforce Data at CIHI Regulated Nursing Contents Record-level supply and distribution information on RNs (including NPs), LPNs and RPNs Demographic, education, employment and geographic Aggregate data on nursing programs, including seats and graduates Data Source Provincial and territorial nursing regulatory bodies Canadian Association of Schools of Nursing, individual schools, Ministries of Advanced Education Data back to RN data: 1980 (NP data as of 2003 where legislation exists) LPN and RPN data: 2002 Nursing Education data: RN – 1997, NP – 2002 RPN – 1989 LPN – 2007 4
Setting the stage 5
Canadian health care system “…it goes without saying that health care in Canada today has evolved into a much more comprehensive and complicated affair. It encompasses a broad range of services across a continuum of every possible age, culture, gender and care need.” 6
Setting the stage • Fundamental paradigm shift for Canadian health care system • Focus on delivering care in community • Emerging roles in nursing profession • Integration, retention and mobility of health professionals 7
Nursing in the news… 8
IENs in the news… 9
Taking a closer look at IENs 10
Internationally educated LPNs more than quadrupled in the last decade 400.0% IENs LPNs Cumulative Growth 2007-16 CENs 6,706 350.0% 349.5% LPN 44.9% RN 8.6% 300.0% RPNs 5.1% 250.0% 200.0% 150.0% RNs 100.0% 26,710 21.9% 50.0% RPNs 0.0% 373 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 3.6% -50.0% RN LPN RPN 11
Proportion of IENs varies by nurse type, 2016 RNs LPNs RPNs Overall Supply 298,743 116,491 5,859 IEN Supply 26,710 6,706 373 % IEN 8.9% 5.8% 6.4% 12 Source: Health Workforce Database, CIHI, 2017
Variability by jurisdictions and nursing profession IENs – RN Canada = 9.0% IENs – LPN Canada = 5.8% IENs – RPN Canada = 6.8% 9.9% 7.7% † 1.3% † - 14.8% 2.6% 9.5% 9.5% 8.3% 1.5% 4.8% 1.8% 6.3% 11.1% 11.2% 9.4% 9.7% <1.0% 9.3% 1.1% 1.0% 10.3% 3.5% 5.3% 1.8% Notes † Digit suppressed in accordance with CIHI’s privacy policy; digit is from 0 to 9. 13 <1.0% Source Health Workforce Database, 2017.
Zoom in on registered nurses 14
CENs are more likely than IENs to enter the workforce during their early career 70% 60% 50% 40% 30% Career 20% 10% 0% Early Career <35 Mid Career 35-54 Late Career 55+ CEN IEN 15
Did you know…. IENs are 2x more likely to work in nursing homes/long- term care setting than CENs 16
A larger proportion of IENs are employed full-time, regardless of setting CENs IENs 10% 9% 23% 30% 60% Employment 68% Status Full Time Full Time Part Time Part Time Casual Casual 17
Emerging Roles for RNs Health Telehealth Genetics Informatics Care Patient Coaching Navigators Coordination Palliative Care 18
CENs higher retention in emerging places; 100% 90% 80% 70% 60% 50% 40% Place of Work 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 IENs more vulnerable to health care reform 100% Examples of emerging workplaces may include: • Telehealth 90% • Hospice care 80% • Blood transfusion centre 70% Cancer centre • • Children treatment centre 60% • Diabetes education centre 50% • Correctional facility • Mobile nursing station 40% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Clinical trials centre • • Spa Hospital Community Health Nursing Home/LTC Other 19 • Cruise ship
There is a movement away from institutional care to community-based care and other new delivery models (2016) Hospital (3,728) (514) 21 % (775) 44 % (225) CENs 28 % (145) 37 % (1,373) IENs 42 % (1,580) 28 % (144) 47 % (836) 60 % (133) 56 % (2,562) 50 % (181) 16% (56) 9 % (417) 22 % (404) 18 % (40) Nursing Home/LTC Community Health (1,793) (221) (4,577) (360) 34 % (123) 35 % (1,598) 22 % (48) 31 % (553) 55 % (2,321) 54 % (165) Other 36 % (1,535) 35% (105) 9 % (361) 11% (34) (4,217) (304) 20
Did you know…. 1 in 25 nurse practitioners are internationally educated 21
Decrease for CENs in traditional roles; increase in IENS in traditional roles Traditional Direct Care Emerging Direct Care AoRs AoRs 100% 100% 95% 95% 90% 90% 85% 85% Area of 80% 80% Responsibility 75% 75% 70% 70% Examples of emerging roles may include 65% 65% • Telehealth 60% 60% • Care coordination 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Health informatics • • Genetics and genomics CEN IEN CEN IEN • Patient safety • Disaster and emergency preparedness • Coaching 22 Palliative care •
Parallel stories Jennifer Neha 23
Trends to watch • Barriers in entry-to-practice • Bridging programs • IEN integration and retention • Demand and recruitment for emerging roles in nursing 24
cihi.ca hhr@cihi.ca @cihi_icis
References 1. Emerging Roles in Healthcare 2014: Awareness Exceeds Preparation in Building the New Workforce; AMN Healthcare Services, Inc. https://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Workforce_Solutions/Survey-Emerging- Roles-in-Healthcare-2014.pdf 2. Exploring New Roles for Advanced Nursing Practice; Canadian Nurses Association, 2005. https://www.cna-aiic.ca/- /media/cna/page-content/pdf-fr/exploring_new_roles_anp-05_e.pdf 3. Nurses Take on New and Expanded Roles in Health Care, January 20, 2015, Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/articles-and-news/2015/01/nurses-take-on-new-and-expanded-roles-in-health-care.html 4. New and emerging roles for nurses; February 11 th , 2013, Nurse.com Blog. https://www.nurse.com/blog/2013/02/11/new- and-emerging-roles-for-nurses-2/ 27
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