Canadians are, by and large, satisfied with their health care system. It is for them a symbol of their community and distinguishes them from the United States. Unlike the health system of that country, it is universal, comprehensive, and accessible, and it costs less as a percentage of GNP to run. The difference between the two systems is rooted in differences in funding. By providing coverage of medically necessary care under a single nonprofit payer (the provincial governments, with guidance and some funds from the federal government), the Canadian system avoids the large overheads and profit incentives that make a fragmented private insurance industry so expensive and inequitable. Whereas health insurance in Canada is socialized, care is not: patients are free to choose among providers, physicians are primarily in private practice, and hospitals are independent, nonprofit institutions overseen by boards of trustees. Canada and the United States view the challenges confronting the Canadian system differently. To Canadians, the real issue is how to improve the management of a popular, effective, and heretofore affordable system, so as to preserve it in a more hostile economic environment. The specific areas of concern are common to all health care systems in the developed world but bear little resemblance to the misleading images of Canada fabricated in the United States for internal political purposes. For Canadians, the proof of their system is that it works, while millions in the United States go without.
The global nursing shortage and statistics indicating a steady increase in the cancer patient workload suggest that the recruitment and retention of oncology nurses is and will be a serious problem. The purpose of this research study was to examine oncology nursing work environments in Canada and to determine the presence of workplace and professional practice factors. A total of 615 oncology nurses responded to a national survey in 2004. The majority of nurses indicated that positive nurse-physician relations and autonomy in clinical decision-making were factors that contributed to job satisfaction and the desire to remain in oncology nursing. However, the findings identified that nurse staffing, the lack of nursing leadership and inadequate opportunities to participate in policy decisions were areas of concern. Differences in work environment perceptions were seen most often when responses were compared across provincial regions. While the findings support previous research reports that the key to the nursing shortage is attention to nursing work environments, they also emphasize the need for organizations to act now. A follow-up survey was conducted in 2006; analysis of these data will be presented in a future report on nurses' perceptions of their work environments and job satisfaction over time.
Today's globalized economy creates opportunities for health professionals but corresponding challenges for countries facing significant shortages of these professionals. The uneven playing field between developed and developing countries hampers the latter in recruiting and retaining trained professionals to oversee and maintain their health systems. Given the salary differentials and variance in working conditions between developed and developing countries, developing countries may lack the pull factors to keep their nurses and doctors from emigrating. However, many developed countries have made significant investments to address this challenge.
Notes
Comment On: Nurs Leadersh (Tor Ont). 2009;22(1):24-5019289910
