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5.5: Summary

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    Nurses pioneered the provision of holistic health care to Canadians, starting as early as 1617 with Marie Rollet Hébert, who provided care to the early settlers and the Indigenous people. Over the next four centuries, the societal attitudes displayed toward nurses, and their subsequent working conditions, led to nursing shortages. These shortages resulted in the emergence of auxiliary health personnel within the health care workplace.

    As nursing education transitioned to universities, nurse researchers and leaders created a unique body of nursing knowledge designed to be used by nurses within their individual practices. This nursing knowledge requires modern nurses to deliver evidence-informed care. Nurses are expected to analyze “practice problems and identify the research that will help them answer questions about how they should go about delivering care” (Lieb Zalon, 2015, p. 425). As holistic practitioners, nurses appraise research and make rational care-provider decisions based on their knowledge of the patient and the health care environment (Rycroft-Malone, 2008).

    Many issues identified in the early history of Canadian health care continue to have a significant impact on Canadian nurses today. Understanding nursing’s past will help today’s nurses move forward as they deal with current issues, such as nursing shortages/supply-and-demand issues; health care funding cutbacks with hospitals replacing nurses with lesser skilled workers; blurring of distinctions between licensed practical nurses and registered nurses; implementation of extended nursing practice that allows nurses to realize their full potential; implementation of primary health care; increasing employment of nurse practitioners; development of nursing informatics; focus on self-regulation; reform of nursing curriculum and education delivery; and finally, the constant need to pay close attention to the appropriate compensation of nurses and provision of quality health care work environments. Lessons acquired throughout Canadian history encourage the vigilance of nurse leaders as they build the future for nursing and health care in Canada.

    After completing this chapter, you should be able to:

    1. Identify historical events related to Canadian health care and the role that early nurse leaders played in those events.
    2. Identify how health care responsibilities have been divided among federal, provincial, and territorial governments.
    3. Describe how demographic forces and social forces impact nurse leadership within the Canadian health care system.


    1. What are the responsibilities of the federal government under the Canada Health Act? Discuss the impact of dividing the responsibilities for health care between the provincial, territorial, and federal governments.
    2. Discuss how social forces have had a significant impact upon the roles of nurses in Canadian health care. Provide at least three examples of social forces.
    3. What changes would you recommend to the Canada Health Act?


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