Question Period Note: Nursing Shortage

• Indigenous Services Canada recognizes working conditions for
Nurses has a direct impact on the care received by clients.
• Nurses are the fulcrum of healthcare delivery to many First
Nation and Inuit communities across Canada, where access to
provincial services are not readily available.
• We are taking active measure to improve the working conditions
of nurses by introducing various improvements and initiatives.

In the vast majority of remote and isolated communities, nurses are often the only onsite
healthcare provider to respond to the full range of healthcare needs, including emergency care.
This work necessitates a highly trained resource with enough experience to be able to function
with confidence, which includes ensuring challenges encountered as a result of working
conditions are addressed.
ISC employees approximately 650 nurses across Canada in a range roles from front-line
service delivery operations to Senior Management. Approximately 85% of this workforce is
made up of part-time employees who commute from their homes in urban centres to remote
communities on a rotational basis to provide 24/7 primary care services. These nurses are
seeking access to the necessary clinical and technology tools and supports they are
accustomed to using as part of their standard practice in non-remote settings.
In order to meet the needs of nurses, ISC has implemented a number of strategies, including;
- Introduced a case management team (Nursing Services Response Centre –
NSRC) for nurses who encounter challenges in I/T, Compensation or other
work-related issues while in remote communities. This service offers VIP
service to ISC nurses and is available in both official languages.
- Support for newly onboarded ISC nurses, regarding IT account creations, cell
phone requirements, MyKey creation etc.
- Implemented policies in order to enhance the safety of nurses who work in
remote and isolated settings; and,
- Worked to include other health care resources into the models of care within
communities
Specific situation regarding nurses in Nunavik
Since the summer 2022, several media have been reporting on the alarming situation in
Nunavik concerning the lack of nursing staff and the disruption of services to the Inuit
population. The situation was so serious that several heads of Nunavik's healthcare
establishments asked for the army's help. Some also called for the Nunavik health network to
be placed under trusteeship, according to media reports.
ISC does not fund Clinical and Client Care nursing services in Nunavik because since 1975, the
provision of health and social services in Nunavik has been in accordance with the James Bay
and Northern Quebec Agreement. This agreement led to the transfer, from the federal
government to the provincial government, of most of the responsibilities concerning services for
Inuit communities, including notably health and social services.
The Quebec government has implemented several measures since summer 2022 to address
the nursing shortage in Nunavik, including improved attraction and retention bonuses, an
increase in the number of leaves granted to staff working in Nunavik, and easier access to
"northern leave", which allows a nurse to temporarily leave her position in the Quebec
healthcare network to work in Nunavik.
Meanwhile, ISC provides funding to support the delivery of health programs and services in
Nunavik which were created after the James Bay and Northern Quebec Agreement signature,
such as promotion and prevention programs. Clinical care programs such as nursing in
emergency and critical care settings are not eligible for ISC funding, with the exception of home
care services, because this program was created after the Convention was signed.. In addition,
, ISC collaborates to the Tuberculosis eradication plan upon request and has sent nurses from
the department to Nunavik to help fight tuberculosis in Inuit villages.
The Nunavik Regional Board of Health and Social Services informed ISC of the difficulty in
retaining and recruiting nurses due to the lack of available housing and difficult working
conditions. The lack of manpower and the exorbitant cost of construction in the North are major
obstacles to the development of additional staff housing. Local health professional or nursing
staff with Inuit background are rare.
The Nunavik Regional Board of Health and Social Services and ISC are currently exploring
various options to assist in nursing recruitment, including the use of the Nunavik Board's surplus
from ISC unspent funds.
Nursing in Nunavut
In the North, primary health care, including tuberculosis control, is the responsibility of the
territorial governments. Indigenous Services Canada supplements and supports territorial health
programs for First Nations and Inuit, as it does in the provinces, in order to ensure access to
health services, and to achieve a standard of health for First Nations and Inuit, which is
comparable to that of other Canadians.
Indigenous Services Canada and the Public Health Agency of Canada have provided nursing
supports, when requested by the territorial governments, either through an Operational
Framework for Mutual Aid Request (OFMAR) or submission to the Indigenous Services Canada
Public Health Surge Team. Recent examples include the urgent need for nurses in Nunavut to
address the tuberculosis outbreak in Pangnirtung.
In September 2023, federal nurses were deployed through the Indigenous Services Canada
Public Health Surge Team to support the tuberculosis community wide screening clinic in
Pangnirtung, which will operate until December 1, 2023.
Indigenous Services Canada also supports Inuit partners to build culturally relevant and safe
health resources through initiatives such as Indigenous Health Human Resources and the Anti-
Indigenous Racism in Health Care. In 2022-23, Nunavut Tunngavik Incorporated received
$2.6M in Anti-Indigenous Racism in Health Care funding to establish patient navigators and
advocates, address cultural safety and to bring birthing closer to home. The organization also
received $657,585 to support the first year of a laboratory assistant program. These initiatives
aims to create culturally safe working conditions in the health care system and alleviate
pressures by building the appropriate health human resources needed in the territory.

If pressed on nursing working conditions
• All Indigenous Canadians are entitled to quality healthcare
regardless of where they live.
• To ensure the ongoing delivery of quality healthcare in First
Nation and Inuit communities, we are:
o Introducing inter-professional teams to augment the
existing nursing workforce;
o Strengthening our promotion of nursing as a career
opportunity in Indigenous communities;
o Introducing various initiatives to assist nurses when they
encounter challenging conditions. For example, the
addition of Indigenous security guards to nursing stations;
and
o Supporting Indigenous partners to explore and develop
new and innovative ways of delivering healthcare services
to their communities.

If pressed on nursing in Nunavut
• In the territories, primary care services, including nursing, are
the responsibility of the territorial governments.
• Indigenous Services Canada works closely with Inuit partners,
the Government of Nunavut and Public Health Agency of Canada
to provide surge capacity in communities, when requested.
• For instance, eight federal nurses are being deployed to
Pangnirtung to support the tuberculosis community wide
screening clinic, from September through December 2023.
• Our government will continue to collaborate with partners
through the Nunavut Partnership Table on Health to address the
need for culturally-appropriate and safe health human
resources.

If pressed further on actions being taken
Together with Indigenous partners, we are:
• Incorporating community based paramedics and other
community health support roles into the health care delivery
model when applicable under provincial legislation;
• Focused on responding to the needs of this workforce by
including a case management service to address concerns
encountered in the work place; and
• Supporting the use of technology in the delivery of healthcare
service in community