Nursing Practice in Rural and Remote BC: An Analysis of CIHI’s Nursing Database www.ruralnursing.unbc.ca Purpose
• To identify key characteristics of the regulated nursing workforce in rural/remote British Columbia (BC), as well as changes in the workforce over the last decade.
• An analysis of the Canadian Institute for Health Information’s (CIHI) Nursing Database (NDB). • Data from the 2003 and 2010 NDB from registered nurses (RNs), nurse practitioners (NPs), licensed practical nurses (LPNs) and registered psychiatric nurses (RPNs) were examined and compared. • The Statistics Canada definition of Rural and Small Town Canada was employed: communities with a core population of less than 10,000 people (remote communities with little or no metropolitan influence and northern regions are included).
Full time/Part time: In 2010, 40.4% of rural RNs worked full-time, compared to 43.2% in 2003. Rural LPNs working full-time decreased from 56.7% to 38.9%, and rural RPNs working full-time increased from 65.8% to 71.1%. Place of Work: Figure 2 shows who worked in rural BC hospitals, community agencies and nursing home/LTC facilities in 2010. The most significant changes since 2003: the proportion of RNs working in all settings has decreased, and the proportion if RPNs working in community health agencies and nursing homes/LTC has increased. Primary Area of Responsibility: Figure 3 illustrates nurses’ primary areas of responsibility in rural BC in 2010. The only notable change since 2003 is the proportion of rural RNs working in direct care, which has decreased from 92.5% to 75.5%. Figure 2. Primary place of work, BC, 2010 100%
1. Workforce Numbers
80% 95% 70% Percentage (%) of Rural Nurses
RNs have increased from 27,711 in 2003 to 30,919 in 2010. In 2010 6.2% were working in rural communities. LPNs have nearly doubled from 4,391 in 2003 to 8,235 in 2010, with 9.4% working rurally in 2010. RPNs have stayed nearly the same, with 3.4% of the 2,241 RPNs in 2010 working in rural BC. No numbers are available for NPs in 2003; however, there were 129 NPs in BC in 2010, with 11.6% in rural BC.
Percentage (%) of Rural Nurses
• • • •
Figure 3. Primary area of responsibility, BC, 2010
60% 50% 40% 30%
2. Nurse-to-Population Ratios
• Between 2003 and 2010 the nurse-to-population ratios have decreased for RNs and RPNs but increased for LPNs.
Community Health Agency
Nursing Home/ LTC Facility
Direct Care %
5. Education • In 2003 and 2010, more rural RNs (88.1% and 71.8%) than urban RNs (81.89% and 63.7%) in BC had a diploma as initial nursing education. See Figure 4 for details.
Table 1. Percentage (%) change in 2003-2010 nurse-to-population ratios
LPN Administration %
RPN Education %
Figure 4. Initial nursing education of BC RNs, rural and urban, 2003 and 2010 100 90 80
6. Migration • In 2010, few rural BC nurses were international nursing graduates (RNs: 6%), LPNs: %; RPNs: 13%).
Notes: †† - no urban/rural allocations of RNs were available for RNs in Quebec in 2003. Data were suppressed for the territories due to small cell sizes. The National jurisdiction for RNs and LPNs refers to Canada and Western Canada for RPNs.
Percentage (%) of RNs
70 60 50 40 30
Gender: • The proportion of males in the regulated workforce remains low, and is lower in rural areas than in urban for all nursing types (see Figure 1). o RPNs are the nurse type with the largest proportion of males. Age: • The average age of RNs and RPNs in BC continues to increase, especially in rural areas.
Figure 1. Proportion of male nurses in BC
7. Staff Mix in Community Settings
2010 Rural B.C.
2010 Urban B.C.
RN LPN RPN 2003 Rural B.C.
2003 Urban B.C.
Table 2. Average age (in years) of the regulated nursing workforce, 2003 and 2010
• We employ Wong et al.’s (2009) definition of community setting to analyze the supply and distribution of primary healthcare (PHC) nurses in BC. • PHC places of work include nursing station/outpost/nurse clinic; private nursing agency/private duty; business/industry/occupational health; self-employed/private practice; mental health centre; physician’s office; home care agency; and public health agency/community health centre. • The number of RNs working in community settings decreased between 2003 and 2010, the number of LPNs increased, and the number or RPNs stayed the same.
10 0 Urban 2003
Urban 2010 B.C.
Figure 5. Rural nurses working in community settings in BC by nurse type and year 600
Number of Rural Nurses
• In British Columbia, in comparison to the urban nursing workforce, the rural nursing workforce is aging more and its nurse-to-population ratio is decreasing. • There is a sharp decline in the numbers of RNs working in primary healthcare settings.
Martha MacLeod,1 Roger Pitblado,2 Jessica Place,1 Irene Koren, 2 Norma Stewart,3 Judith Kulig4 1. University
of Northern British Columbia; 2. Laurentian University; 3. University of Saskatchewan; 4. University of Lethbridge;
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