They breathe. Their skin feels real. They have seizures and go into cardiac arrest. And, if you're a nursing student and you're doing something wrong, they let you know.

Angela Closter with a patient simulator in BCIT's nursing program.

Angela Closter with a patient simulator in BCIT's nursing program.

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The use of High-Fidelity Human Simulators in state-of-the-art simulation labs is one of a few innovative solutions designed to provide more nurses with the experience they need to get educated and, more importantly, get to work.

Why the rush?

Canada's nursing shortage has reached what many are calling critical proportions, with all levels of government, educational institutes and professional associations throwing money and time into creative solutions.

According to Rachel Bard, CEO of the Canadian Nurses Association (CNA), colleges and institutes have responded to the issue. "They've increased the output of nursing programs from 4,833 graduates in 1999 to 9,447 in 2007. That's an increase of 95.5 per cent."

Despite these efforts, Ms. Bard says the predictions of a 2002 CNA study — anticipating that Canada will be short 78,000 registered nurses by 2011 and 113,000 by 2016 — still hold true.

Research suggests that 12,000 graduates per year are needed to address the projected nursing shortage. To reach that number, the amount of entry-to-practice graduates would need to increase by an additional 27 per cent beyond the 2007 results.

In an effort to reverse this trend, colleges across the country are getting creative.

Nursing student Angela Closter is taking advantage of the Vancouver-based British Columbia Institute of Technology's (BCIT) fast-tracked, three-year Bachelor of Science in Nursing (BSN).

"I'm 27, so when I finally figured out what I did want to do, I'm glad to be able to get done earlier and get going with my career," says Ms. Closter, who understands the effects of the nursing shortage first-hand after working at a medical office for nine years.

Currently in her first year of the three-year BSN, Ms. Closter says she would have gone into nursing regardless of the high demand, but it is nice to know she's going to be needed when she graduates with the first three-year nursing degree graduates in 2011.

Pamela Adams, associate dean of Baccalaureate Nursing at BCIT, says the institute will be graduating 96 students twice a year from the newly revamped program. This will amount to a 50-per-cent increase in capacity.

"We used different time frames, such as having the students go through the summer, distance learning, online aspects of courses and the introduction of a simulation lab in order to increase our intake," says Dr. Adams, adding that her faculty of about 55 was also instrumental in re-working the curriculum.

Dr. Adams says the provincial government supported the three-year degree following its Conversation on Health public consultation, which led to the dedication of $2.85-million over six years in operating funding. In addition, BCIT received $1-million from the Ministry of Health Services and $395,000 from the Ministry of Advanced Education and Labour Market Development.

Yvonne Moritz, associate dean of Specialty Nursing at BCIT, says many specialty areas of nursing, such as critical care, are experiencing a great shortage.

"Nurses are able to return to BCIT to complete a certificate in their chosen specialty area," she says.

Durham College, in Oshawa, Ont., was chosen through a competitive process by the Ontario Ministry of Health and Long-Term Care to address the province's critical-care nursing shortage.

Durham's new Critical Care Nursing E-Learning graduate certificate program received a boost of $1-million in provincial support. It graduates its first class in October, 2008, and currently has almost 400 students working through the program, more than tripling its size since it began.

"With the nursing shortage that we are facing right now, especially in intensive care units, there is more of a need for programs like this than ever," says Sandra Goldsworthy, co-ordinator of the innovative critical care e-learning program.

Students participate in six interactive e-learning courses, a critical-care simulation course and 120 hours of supervised clinical experience.

Ms. Goldsworthy says providing nurses with access to specialty nursing is an important consideration for hospitals seeking to attract and retain nursing staff.

"Their favourite part is the simulation lab," says Ms. Goldsworthy, describing the 39-hour simulation course. "The High-Fidelity Human Simulators are placed in a realistic looking intensive care unit. The students can apply all of the skills that they learn in a safe environment, which is a great way to learn and build confidence."

Edmonton-based NorQuest College, Canada's largest educator of practical nurses, opened its state-of-the-art Health Education Centre in September 2008. This will allow the college to expand its practical-nurse diploma program to graduate 800 nurses a year.

"The new centre has also enabled us to open a patient simulation centre," says Wayne Shillington, president and CEO of NorQuest. "The sim patients are critical, allowing students to make errors and learn from them."

Dr. Shillington says other innovations at NorQuest, such as varied delivery models through satellite campuses, community-based partners and distance learning, have also allowed the college to increase its number of graduates.

"With the critical shortage of nurses, many hospitals are bringing in internationally trained nurses. We provide the practical nurse re-entry program for international students to transition them into the Canadian work environment," says Dr. Shillington.

Another innovation is NorQuest's work with the Saskatchewan Indian Institute of Technologies. "We've also created an aboriginal enhanced stream to attract aboriginal students who want to work in their community," he says.

Ms. Bard says that the education component is only part of addressing Canada's nursing shortage, and the solution can't be one-sided.

"We need an integrated approach involving government, employers, educators and professional organizations to provide incentives for innovative education programs, create new models of care and stabilize the work force."

Special to The Globe and Mail

THE NURSING SHORTAGE

THE PROBLEM

1999: the potential supply of new registered nurses was 4,833; a 29-year low.

2007: the number of registered nursing graduates reached 9,447; a 95.5-per-cent increase over 1999.

2007: the first time in 30 years that the number of registered nursing graduates exceeded 9,000; in the same 30-year span, the Canadian population grew by approximately 30 per cent.

Research suggests that 12,000 graduates a year are needed to address the projected nursing shortage; requiring a further registered nursing-graduate increase of 27 per cent over 2007 numbers.

In 2006, Ontario and British Columbia had the lowest registered nurse-to-population ratio. In 2007, these two provinces also had the fewest registered nursing graduates relative to population.

In 2006-2007, 12,877 students were admitted into registered nursing programs, an increase of 7.9 per cent from the 11,936 admitted in 2005-2006.

THE SOLUTION

Fast Tracking

Fast-track nursing programs are becoming increasingly popular, as evidenced by a growth of 18.7 per cent in their number in 2006-2007 over the previous academic year.

All provinces except PEI offered one or more fast-track registered nursing programs during 2006-2007.

Ontario reported the highest number of fast-track registered nursing programs with 12; Quebec with 7, Alberta with 6 and British Columbia with 5.

Distance Education

In 2006-2007, 62 nursing programs were offered electronically in full or part.

Continuing Education

Continuing education is an important influence in nurse retention. In 2007, 1,934 registered nurses graduated from post-RN baccalaureate programs; a 54.8-per-cent increase over 1999.

Investment in technology

The use of high-tech simulation labs, using High-Fidelity Human Simulators, is a recent advance in nursing education that is increasing the capacity of educational institutions as well as increasing nursing graduates' levels of expertise.

Source: Canadian Nurses Association