The commissioners of the Estates-General of the nursing profession present 31 recommendations to improve the attractiveness of the profession and the retention of nurses in the healthcare system.

Their goal: To finally put an end to a situation which is hostile to the deployment of nursing expertise in order to provide healthcare that meets the needs of Quebecers.

MONTREAL, Sept. 16, 2021 /CNW Telbec/ - The commissioners of the 2021 Estates-General on the nursing profession publish today their report which provides the Minister of Health and Social Services and stakeholders of the profession an enlightening review of the situation, or perhaps a concrete action plan, by submitting 31 recommendations established following a rigorous consultation process which brought together more than 1,200 nurses and called on all stakeholders of the profession. While Quebec is facing an unprecedented situation regarding the practice of nursing, a situation intensified by the pandemic, it is urgent to act in order to provide the population of Quebec the care it is entitled to.

Led by Francine Ducharme, honorary professor at the Nursing Faculty of the University of Montréal, researcher and dean of this Faculty from 2015 to 2020, and by Robert Salois, former Health and Welfare Commissioner, Government of Quebec (2006-2016), the Estates-General of the nursing profession are the result of a process that unites the whole nursing community.

This exercise involved focus groups and surveys, a virtual forum on the recognition of nursing expertise, consultations, public hearings and Estates-General. In addition to being based on all these consultations, the recommendations rely on convincing data.

An urgent need for change in the nursing profession
"This exercise shows that the status quo is simply not possible and that substantial changes are needed to ensure the quality of care, the health of Quebec's population and the future of the system", said commissioner Francine Ducharme. "The reality and the health needs of the population are no longer the same and we must, more than ever, recognize nursing expertise and really consider it within the organization of care," she continued, adding that about 1,000 nurses left the public sector to join the private sector this past year, which is 300 more than during previous years^[1] .

It is possible to make better use of nursing skills and take better care of the population, provided that the five following principles are observed^[2] :

• Care and nurses that are available everywhere in Quebec, especially on the front line, and not only in healthcare facilities;
• Nurses who benefit from working conditions that respect their health, safety and physical integrity;
• Quality care from qualified nurses;
• Independent nurses, placed in multidisciplinary teams that maximize their skills;
• A more efficient healthcare system and public facilities that are less dependent on employment agencies.

Review the context of the practice
The working conditions of nurses, especially mandatory overtime and extended work shifts, must obviously be changed to provide a quality of life that makes the profession attractive. But other factors have a significant impact on the perception of work and the optimal organization of care. Therefore, the commissioners recommend involving more nurses in care management, and at different hierarchy levels throughout the healthcare system.

If a substantial majority (93%) of Quebecers trust nurses, the health crisis highlighted the lack of knowledge of the healthcare system's decision-makers and managers regarding nursing expertise and its underutilization. According to a survey conducted amongst nurses, although the pandemic brought about a reorganization of workplace care and practices for 96% of them, 54% felt they had little or no influence on care, its coordination and its organization. ^[3] Being able to rely on managers with a nursing background would have made it possible to act upstream rather than acting urgently in nursing homes during the pandemic.

Taking on the role and the responsibilities they deserve
Quebec's legislative framework bestows 17 activities reserved to the nursing profession^[4] , making it one of the broadest fields of practice of the healthcare and social services sector, along with that of physicians.

"This exercise clearly demonstrated that the skills and knowledge of nurses are not used at their full potential", said Francine Ducharme. "In practical terms, this means that they continue to provide procedural care that other members of the care team could provide. It is all the meaning given to their work that is affected. If nurses were really doing what they are authorized to do and avoided the acts that others can do, the shortage problem could be solved," she added, mentioning that Quebec has more nurses per one hundred thousand people than the rest of Canada.

Therefore, the commissioners recommend that national standards and guidelines be put in place without delay, that will quickly render effective the occupation of the entire field of nursing practice. Furthermore, they recommend developing areas of specialization in nursing, as other provinces do, which reflect the population's needs, in order to count on leading expertise and adequately organize healthcare. Among the new specializations mentioned by participants, we find nursing care for the elderly, oncology, mental health, and wound care.

Enhancing training in the background
All the report's recommendations involve a review of the training objectives of nurses. Currently, whether they obtained a college diploma in nursing or a University Bachelor's degree in Nursing, in order to obtain their licence to practice the profession, students must take the same exam that assesses the skills acquired during college training. Yet, in a context where the needs of the population are increasing, where care is becoming more complex and where some types of care are only taught at the university level, the fact that the entrance exam is based solely on the knowledge acquired at the college level is not sufficient. Indeed, some healthcare areas, such as critical, outpatient, community and specialized care, for which Quebec is in dire need, are not covered by college education.

In Canada, Quebec is the province that requires the fewest years of training to enter the profession, and it's one of the only professions in the healthcare sector that has not increased its initial training requirements, while we are seeing a worldwide trend towards increased training.

"For nurses to fully take their place and play their rightful role, holding a university education that would put them on equal footing with their colleagues from the other healthcare professions, for which a university education is required, would definitely help, in addition to lending credibility to their expertise," continued Commissioner Robert Salois.

After having completed this extensive consultation exercise, it is therefore recommended that a bachelor's degree be the only diploma that gives access to a licence to practice the profession, while maintaining the choice between two training paths, namely the DSC-BAC that calls for cooperation between colleges and universities, or the initial university training in nursing. This is absolutely not about questioning the licences of the nearly 32,000  practising nurses (43%) having a DSC, nor the training of students who have already started on their academic path. However, transitional measures will have to be implemented and colleges are part of the solution.

The report can be downloaded by following this link: https://www.oiiq.org/documents/20147/2943421/rapport-EG-2021.pdf.

^[1] Order of Nurses of Quebec (OIIQ). (2021). OIIQ's membership roll. Employment sector.

^[2] Institut du Nouveau Monde. (2021). Opinion of the citizen's jury on resorting to nursing skills in Quebec's healthcare offer, p. 2 (page 16 of the report).

^[3] Léger. (2020). Report. Approach towards the 2021 Estates-General. Focus groups, p. 4.

^[4]See table 3 of the report, p. 47.

SOURCE Commissaires des États généraux sur la profession infirmière

Simon Faucher, [email protected], 514 402-3873