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 health system.


Their goal: to finally put an end to a situation hostile to the deployment of nursing expertise in order to offer health care that meets the needs of Quebecers.

MONTREAL, September 16, 2021 / CNW Telbec / – The 2021 Commissioners of the Estates General on the nursing profession today published their report which offers the Minister of Health and Social Services and stakeholders in the profession an illuminating assessment of the situation, or perhaps a concrete action plan, submitting 31 recommendations established following a rigorous consultation process that brought together more than 1,200 nurses and called on all stakeholders in the profession. While Quebec faced with an unprecedented situation concerning the practice of the nursing profession, a situation aggravated by the pandemic, it is urgent to act in order to provide the population with Quebec the care to which he is entitled.

Directed by Francine Ducharme, honorary professor at the Faculty of Nursing of the University of Montreal, researcher and dean of this Faculty from 2015 to 2020, and by Robert Salois, former Commissioner for Health and Welfare, Government of Quebec (2006-2016), the Estates General of the nursing profession are the result of an approach that unites the entire nursing community.

This exercise included 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 of these consultations, the recommendations are supported by evidence.

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 of Quebec population and the future of the system“said the 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 truly consider it within the organization of care ”, she continued, adding that around 1,000 nurses left the public sector to join the private sector last year, 300 more than in previous years.[1] .

It is possible to make better use of nursing skills and to better take charge of the population, provided the following five principles are respected.[2] :

  • Care and nurses available everywhere in Quebec, especially in the front line, and not only in health establishments;

  • Nurses benefiting from working conditions which respect their health, safety and physical well-being;

  • Quality care provided by qualified nurses;

  • Independent nurses, placed in multidisciplinary teams that maximize their skills;

  • A more efficient health system and public facilities less dependent on employment agencies.

Review the context of the practice
The working conditions of nurses, in particular compulsory overtime and long shifts, must obviously be modified 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 the management of care, and at different hierarchical levels throughout the health system.

While a substantial majority (93%) of Quebecers trust nurses, the health crisis has highlighted the ignorance of decision-makers and managers of the health system regarding nursing expertise and its underuse. According to a survey of nurses, while the pandemic led to a reorganization of care and practices in the workplace for 96% of them, 54% felt that they had little or no influence on care, coordination and organization. [3] Being able to rely on managers with nursing training would have made it possible to act upstream rather than act in emergency in nursing homes during the pandemic.

Take on the role and responsibilities they deserve
of Quebec the legislative framework grants 17 activities reserved for the nursing profession[4] , which makes it one of the largest fields of practice in the health and social services sector, along with that of physicians.

This exercise clearly demonstrated that the skills and knowledge of nurses are not being used to their full potential.“, noted 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 the whole meaning given to their work that is affected. If the nurses really did what they are allowed to do and avoided the actions that others can do, the problem of shortage could be solved ”, she added, mentioning that Quebec has more nurses per 100,000 inhabitants than the rest of Canada.

Therefore, the commissioners recommend the immediate establishment of national standards and guidelines that will quickly make effective the occupation of the entire field of nursing practice. In addition, they recommend developing areas of specialization in nursing, as do other provinces, which reflect the needs of the population, in order to rely on cutting-edge expertise and to properly organize health care. New specializations mentioned by participants included nursing for the elderly, oncology, mental health and wound care.

Improve background training
All of the recommendations in the report include a review of the training goals for nurses. Currently, whether they have obtained a college diploma in nursing or a bachelor’s degree in nursing, to obtain their license to practice the profession, students must take the same exam that assesses the skills acquired during the college education. However, in a context where the needs of the population are increasing, where care is becoming more complex and where certain types of care are only taught at university level, the fact that the entrance exam is based solely on the knowledge acquired at the university level. college level is not sufficient. Indeed, certain areas of health, such as critical, ambulatory, community and specialized care, for which Quebec is in need, not covered by college education.

In Canada, Quebec is the province that requires the fewest years of training to enter the profession, and it is one of the few professions in the health sector that has not increased its initial training requirements, while observes a worldwide trend of increasing training.

For nurses to fully take their place and play their rightful role, having a university education that would put them on an equal footing with their colleagues in other health professions, for which university training is required, would certainly help, in addition to giving credibility to their know-how “, curatorial suite Robert Salois.

After having successfully completed this vast consultation exercise, it is therefore recommended that a baccalaureate be the only diploma giving access to an authorization to practice the profession, while retaining the choice between two training courses, namely the DSC- BAC which calls for cooperation between colleges and universities, or initial university training in nursing. It is absolutely not a question of calling into question the licenses of the nearly 32,000 practicing nurses (43%) holding a DSC, nor the training of students who have already started their academic career. However, transitional measures will have to be put in place and colleges are part of the solution.

The report can be downloaded by following this link:

[1] College of Nurses Quebec (OIIQ). (2021). List of members of the OIIQ. Employment sector.

[2] New World Institute. (2021). Opinion of the citizen jury on the use of nursing skills in of Quebec care provision, p. 2 (page 16 of the report).

[3] Light. (2020). Report. Approach towards the Estates General 2021. Discussion groups, p. 4.

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

SOURCE Commissioners of the Estates General on the Nursing Profession


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