Are there enough nurses in rural Canada?

"41,502 registered nurses (RNs) are located in rural and small town Canada. 17.9% of all RNs employed in nursing in Canada work in rural areas, where 21.7% of the Canadian population live. As in Canada as a whole, the absolute number of RNs working in rural Canada has decreased while the absolute numbers of people living in rural and small town Canada has increased.

"Over the past decade, the decreases in the absolute numbers of RNs accompanied by the increase in the absolute numbers of Canadians have led to decreases in nurse to population ratios in both rural and urban areas of Canada. Currently, the overall nurse to population ratio stands at 75.6 nurses per 10,000 population, down from 82.0 in 1992. The prevailing ratios of 62.3 nurses per 10,000 (rural) population in rural Canada and 78.0 nurses per 10,000 (urban) population in urban Canada show rural/urban differences but may not be directly comparable, as they do not take into consideration the differences in nursing services provided in those areas. In general there is an east to west trend in nurse to population ratios with the higher ratios being found in eastern Canada.

"The RN workforce is aging. In less than a decade (1994 to 2000) the average age of RNs who live in rural and small town Canada has increased from 40.6 to 42.9 years. Currently, the average age of urban nurses is 43.4 years.... In this initial analysis of the RNDB (Registered Nurses Database), 22 rural communities in Canada are each served by one RN aged 60 years or older. Another 93 rural communities are each served by a sole RN aged 50-59 years.

"Despite the fact that there are more male RNs in the workforce than in the past, fewer than 5% of all RNs are male (4.4% in rural Canada; 4.8% in urban Canada).

"Increasingly, RNs are entering the profession with a bachelor degree in nursing: in rural Canada, 9.2% in 2000 compared with 6.4% in 1994; in urban Canada, 12.3% in 2000 compared with 8.8% in 1994.... In rural areas of Canada in 2000, 18.0% of RNs had attained a bachelor degree in nursing as their highest education in nursing compared with 12.5% in 1994. The equivalent figures for urban RNs are 17.6% in 1994 and 23.8% in 2000.... There is an apparent contradiction between the expanded role of practice demanded of RNs in rural areas and the comparatively lower level of their formal education.

"The majority (53.8%) of rural RNs work in hospitals but increasingly higher proportions of rural RNs are employed in long-term care and home care compared with RNs in urban areas of Canada.... In 2000: 49.6% of RNs in rural and small town Canada were employed full time (56.1% in urban Canada); ... it is apparent that overlapping roles tend to be higher in rural areas of Canada.... Multiple employment (RNs with more than one employer) tends to be higher for males, younger RNs, and RNs located in rural and small town areas of Canada.

"International nursing graduates working in rural and small town areas of Canada come from a very small number of countries, principally the United Kingdom and the United States. Only 5.6% of the foreign-trained RNs in Canada work in rural and small town areas of the country compared with 18.7% of Canadian-trained RNs; only 1.9% of rural RNs in Canada are international nursing graduates. These numbers likely reflect overall immigrant settlement patterns or trends for Canada as a whole. If so, recruitment of foreign-trained nurses would probably have little impact on the numbers of RNs in rural Canada."

From: Canadian Institute for Health Information (2002). Supply and Distribution of Registered Nurses in Rural and Small Town Canada, 2000. Ottawa: Canadian Institute for Health Information. Written by Roger Pitblado, Jennifer Medves, Martha MacLeod, Norma Stewart and Judith Kulig as part of the Nursing Practice in Rural and Remote Canada Study.