Nurseweek: Northern Exposure: U.S. hospitals become a magnet for Canadian nurses

Northern exposure
U.S. hospitals become a magnet
for Canadian nurses

By Curtis Pond
July 10, 2000

Canadian nurses are flocking to the United States in record numbers:Between 1990-97, the country lost 15 nurses to jobs across the border for every nurse it gained.

Illustration: Artville


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It takes about 20 minutes to drive from the LaSalle-Windsor area in Ontario, Canada, to Detroit. As soon as Windsor resident Sylvie Matté, RN, starts her new job at a Detroit hospital this month, she will join almost 3,000 Michigan-licensed nurses who call Canada home.

The ease of the commute has contributed to what Canadian health officials have feared for the past few years: Canadian nurses are flocking to the United States in record numbers.

But the reasons behind this nursing exodus run deeper than the Detroit River that the Ontario nurses must cross daily to work in U.S. hospitals.

Once the envy of many U.S. health care workers, Canada’s socialized medical system began reeling in 1995 when Canadian Finance Minister Paul Martin imposed drastic budget cuts in health care.

Since then, many Canadian hospitals have reduced their nursing staffs, while offering more part-time jobs for lower pay in an effort to meet Martin’s tight budget demands.

The effect has been drastic: A report released in May by Statistics Canada showed the country lost 15 nurses to the United States for every nurse it gained between 1990-97.

For Matté, a lifelong resident of Canada, the decision to seek employment outside the country was simple.

"I’m not going to wait here until I’m 60 looking for a full-time job," she said. "I’m going to the U.S."

New grads quick to leave
In 1998, the Canadian Nurses Association (CNA) estimated that the country would be short 113,000 nurses by 2011. Recent news articles confirm this nursing drain:

In Montreal, two hospital networks will close a combined 499 beds because of a severe nursing shortage.
In Victoria, figures released by the Registered Nurses Association of British Columbia show the government has not lived up to its promise to hire more nurses.
In Ontario, nursing organizations are asking the government to recruit as many as 90,000 nurses by the end of the decade.

A recent report commissioned by the CNA pointed to the loss of new nursing graduates as a major contributor to the nursing crisis. According to the study, nearly one in 10 nursing graduates migrated to the United States from 1995-1997, a ratio seven times greater than that of other Canadian professionals. But, the report speculates, had the nursing graduates remained in Canada, there would be minimal opportunity for them to secure a full-time position.

"When it was time to get a job after I graduated, I ran into a cement wall," said Nathalie Grenier, RN, who graduated from the University of Ottawa in 1992 and is hunting for a nursing job in North Carolina. "The job that I did get was on-call, but they only called once every two weeks. If you do happen to get a full-time job in Canada, you better make sure you hold onto it."

The CNA report echoes Grenier’s dissatisfaction with nursing job opportunities in Canada. According to the report, one in four nursing graduates from the Class of ’95 works part time; two-thirds of those say that it is not by choice.

"Because of government cutbacks, employers have caused 50 percent of the nursing workforce to work on a part-time or casual basis," said CNA Executive Director Mary Ellen Jeans, Ph.D., RN. "We’ve been working hard for the last three years to create more full-time positions. We want our nurses to stay and the ones who have left to come home. But we have to work on the government to get [them] home."

The American alternative
Canada’s greatest obstacle to curing its nursing crisis may be the nursing shortage in the United States.

Canadian nurses have discovered that some of the issues the CNA is fighting for in Canada, such as better wages, full-time employment and continuing education, are generally intact in the States. Because nurses are in such high demand on this side of the border, Canadians are welcomed with open arms.

Matté said the biggest difference she has noticed between nursing in Canada and the United States is the way experienced nurses treat younger recruits.

"It’s hard for new grads in Canada to get good experience," she said. "They don’t expect you to come in asking questions about what you’re doing."

Kevin Wall, RN, decided to move from Calgary to Forth Worth in 1989 once he realized he could do little in Canada to expand his nursing background.

"I wanted to further my education, but the hospital I worked for wasn’t too accommodating," he said. "The opportunities in the U.S. to improve your education are 100 percent better than in Canada."

After his move south, Wall pursued a career in the medical software industry while supporting himself by working as a nurse.

Grenier, who has had interviews in the United States, said she, too, finds the American system of promoting education appealing.

"I decided to go back into nursing after being out of it for a few years, so when I started looking for work in the States, I had this idea that it was going to be difficult," Grenier said. "But that wasn’t the case. [In America], they told me they would help train me for any specialty I wanted to pursue."

Jeans said improving working conditions in Canada is another CNA priority. "To retain nurses, we need to develop a high quality working environment. That means offering more continuing education in specialized areas."

Difficult to compete
Mention the phrase "Canadian nurse" and American recruiters begin to gush.

"Their critical thinking skills are awesome," said Julie Rey, a recruiter for Valley Children’s Hospital in California’s Central Valley. "They have to complete 2,000 practice hours while going to school, so they are very well prepared when they come here."

Rey just recruited 14 Canadian nurses to begin working at the hospital in September.

At a recent job fair in Toronto, she was bombarded with interest from about 100 nurses eager to work in the United States.

"The [Canadian] nurses who have been here awhile are now helping us recruit from Canada as well," she said.

Jennifer Dipple, an international recruiter for Nurses Rx in North Carolina, said recruiters in Canada would be happy to see the U.S. recruiters leave. "They tell us, ‘Don’t take any more of our nurses.’ "

American recruiters have been referred to as "poachers" and there is even talk in Canada about creating laws that will make it more difficult for nurses to work outside the country.

Rotting away
Still, it is generally easy for Canadian nurses to stay in the United States, according to Canadian nurse Carol Betabraham, RN, who recently completed a paper on the Canadian nursing shortage for her bachelor’s degree.

"NAFTA [North American Free Trade Agreement] highlights jobs that are in high demand, [and] RNs are in this category," she said. "Green card renewal is very easily done."

Finance Minister Martin said in June that funding for health care will increase in the 2001 federal budget. But nurses remain reluctant to take the bait.

"We’ve been hearing about improvements for a long time, but we haven’t seen any results," Grenier said. "It’s very repelling. As time goes by, I feel like I’m just rotting away in Ontario."

"A lot of people feel ashamed that you have to go to the States," Matté said. "But I feel good [about what I’m doing]. I feel like I don’t owe anything to my country."