Planning for the Future: Nursing Human Resource Projections June 2002 The Canadian Nurses Association is the professional voice for registered nurses in Canada. As a federation of 11 provincial and territorial professional nurses’ associations, its mission is to advance the quality of nursing in the interest of the public. One of its key concerns is the supply of nurses in relation to the demand for nursing services by Canadians. Acknowledgments CNA would like to extend a sincere thank you to Mrs. Eva Ryten. Her expertise and analytical skills made this report possible. Mrs. Ryten provided all the data compilations and calculations, data analysis and projections regarding the future supply and demand of registered nurses in this report. She was particularly invaluable in collecting detailed data from provincial governments, provincial nursing associations and from the various nursing educational institutions. The names of people who helped provide data used in projecting the number of nursing graduates in the future are mentioned in the appendix. A thank you is also extended to the following people who provided information for this report: · Assessment Strategies Inc; · Ravi Prathivathi, Manager, Registration and Finance, College of Nurses of Ontario; · Ron Scriver, Ontario Universities’ Applications Centre. All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transcribed, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the publisher. © Canadian Nurses Association 50 Driveway Ottawa ON K2P 1E2 June 2002 Tel: (613) 237-2133 or 1-800-361-8404 Fax: (613) 237-3520 E-mail: [email protected] Web site: www.cna-nurses.ca ISBN 1-55119-882-7 Table of Contents Executive Summary .....................................................................................................................1 Introduction..................................................................................................................................2 Historical Perspective ....................................................................................................................3 Chapter 1: Trends in the Employment of Registered Nurses in Canada ...............................5 Trends in the Funding of Health Care in Canada ..........................................................................5 Number of RNs and Number of RNs Employed in Nursing .........................................................8 Trends in Full-time/Part-time, Casual & Multiple Employment .................................................10 Trends in the Gender Distribution of Employed RNs .................................................................15 Place of Work of RNs..................................................................................................................15 Summary of findings with respect to trends in the employment of nurses..................................16 Chapter 2: Demography of the Nursing Workforce: Age Composition...............................18 Analytical Framework..................................................................................................................18 Age Trends of Working Nurses ...................................................................................................19 Trends in Age at Graduation........................................................................................................25 Chapter 3: Estimating the Number of Nursing Graduates in the Coming Years ...............30 Background and Data Problems...................................................................................................30 Projections of the number of nursing graduates from 2002 to 2015............................................34 National projections of numbers of nursing graduates from 2002 onwards................................43 Chapter 4: Projections of Demand for RNs in the Years 2011 and 2016 .............................45 Underlying Assumptions .............................................................................................................45 Derivation of Future Demand in 2011 and 2016 .........................................................................48 Chapter 5: The Supply of Nurses in 2011 and 2016 ...............................................................50 Calculating Retention of Current RNs to the Years 2011 and 2016............................................50 Calculating New Entrants and Additions to the Pool of Nurses Between 2001 & 2011 and Between 2001 & 2016............................................................................................................54 Output of Canadian nursing schools and related issues...............................................................54 New registrations of RNs educated outside Canada ....................................................................57 Age at First Registration as an RN ..............................................................................................59 Calculations of new additions to pool of RNs, 2011 & 2016 ......................................................59 Data on new additions from nurses educated outside Canada and projections to 2011 ..............60 The 2016 Projection.....................................................................................................................60 Chapter 6: Will Supply of Nurses be Adequate in 2011 and 2016? ......................................69 Demand and Supply: The Projections..........................................................................................69 Effective Demand vs. Demand ....................................................................................................72 Dealing with Shortages ................................................................................................................74 i Recommendations ......................................................................................................................78 Appendix: Sources for material used in the projections of the number of nursing graduates from 2002 to 2015...............................................................................................79 References...................................................................................................................................81 ii List of Tables Table 1: Total Health Expenditures, Canada, 1975 to 2001 .................................................................. 6 Table 2: Health Expenditures by Use of Funds, 1975 to 2001 .............................................................. 7 Table 3: Trends in Total Number of RNs Compared with Number of RNs Employed In Nursing, Canada, 1966-2001 ....................................................................................................... 9 Table 4: Number of RNs Employed Full-time or Part-time in Nursing, Canada, 1985 – 2001................11 Table 5: Employment Status of RNs in Canada, 1992 – 2001 Showing Numbers with Regular Employment and Numbers with Casual Employment ...................................................................12 Table 6: Casual and Multiple Employment: Number of Nurses Engaged on Regular vs. Casual Basis and Numbers holding More than One Position, Canada, 1996 to 2001.......................14 Table 7: Employed RNs by Gender, Canada, 1985 – 2001..................................................................15 Table 8: RNs Employed as Nurses by Place of Work, Canada, 1994 to 2001 .......................................16 Table 9A: Age Distribution of RNs Employed in Nursing, Canada, 1966 – 2001 .................................20 Table 9B: Percentage Distribution Age of RNs Employed in Nursing, Canada, 1966 – 2001 ................21 Table 10: Change in Age Structure of RN Population, 1980 to 2001: Number of RNs in 1980, 1995 & 2001 by Single Year of Age ..................................................................................24 Table 11: Age at Graduation: Age of All First-time Examinees Educated in Canada RN Lic ensing Examinations of 1999 ................................................................................................................26 Table 12: Comparison of Age at Graduation of RNs who Graduated Before1980 and RNs who Graduated in 1980 or Later with RNs Who First Took Licensing Examinations in 1999..........27 Table 13: Age at Registration of Nurses Educated Outside Canada ....................................................29 Table 14: Number of Students Graduating in Nursing by Type of Initial Qualification, Canada, 1963 – 2001 .................................................................................................................32 Table 15: Number of Nursing Graduates by Province, 1999 to 2008 ...................................................43 Table 16: Derivation of Future Demand for Nursing Services in Canada .............................................47 Table 17: Comparison of Demand Projections for Year 2011 Made in 1997 and in 2002 ......................49 Table 18: Calculation of Number of RNs in 2001 Who Will still be Registered and Employed as Nurses in 2011 ......................................................................................................51 Table 19: Calculation of Number of RNs in 2001 Who Will Still be Registered and Employed in Nursing in the Year 2016........................................................................................52