THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, October 28, 2024
The Standing Senate Committee on Official Languages met with videoconference this day at 5 p.m. [ET] to study matters relating to minority-language health services; and in camera, to consider a draft agenda (future business).
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: I am René Cormier, senator from New Brunswick, and I’m chair of the Standing Senate Committee on Official Languages.
Before we begin, I would like to ask all senators and other in‑person participants to consult the cards on the table for guidelines to prevent audio feedback incidents. Please make sure to keep your earpiece away from microphones at all times. When you are not using your earpiece, place it face down on the sticker placed on the table for this purpose.
Thank you for your cooperation.
I would now invite committee members participating in today’s meeting to introduce themselves, starting on my right.
Senator Mégie: Marie-Françoise Mégie from Quebec.
Senator Aucoin: Réjean Aucoin from Nova Scotia.
Senator Clement: Bernadette Clement from Ontario.
Senator Moncion: Lucie Moncion from Ontario.
The Chair: Thank you very much, colleagues. Welcome to the meeting.
[English]
I wish to welcome all viewers across the country who may be watching. I would like to point out that I’m taking part in this meeting from within the unceded traditional territory of the Algonquin Anishinaabe nation.
Tonight we continue our study on minority-language health services by welcoming organizations able to address the theme of health professionals, which is one of the seven themes of our study.
[Translation]
For our witness panel, we welcome in person Ivy Lynn Bourgeault, Director of the Canadian Health Workforce Network, Research Chair in Gender, Diversity and the Professions, and Professor at University of Ottawa.
We also welcome, from the Canadian Nurses Association, Kimberly LeBlanc, President, and Alexandre Bourassa, Lead of Public Affairs.
By video conference, we welcome Véronique Landry, president of the Groupe d’infirmières et infirmiers francophones du Nouveau-Brunswick. Welcome, Ms. Landry.
Thank you accepting the committee’s invitation. We will now hear your opening remarks. They will be followed by questions from the senators.
Ms. Bourgeault, the floor is yours.
[English]
Ivy Lynn Bourgeault, Research Chair in Gender, Diversity and the Professions and Professor, University of Ottawa, Canadian Health Workforce Network: Thank you for the invitation to speak to the Senate Standing Committee on Official Languages as part of its study of minority-language health services.
As you mentioned, my name is Ivy Lynn Bourgeault. I am a professor and research chair at the University of Ottawa and lead the Canadian Health Workforce Network, a pan-Canadian knowledge exchange network of researchers, decision makers and other knowledge users dedicated to bringing the best evidence to health workforce policy and decision making.
Let me begin by stating that ensuring the delivery of health services in one’s language, especially those enshrined in the Official Languages Act, is a critically important issue.
In the Canadian Academy of Health Sciences report Canada’s Health Workforce that I was privileged to co-chair, we wrote:
In many regions of Canada, there is a mismatch between the distribution of French speaking health care practitioners and French-speaking patients. For instance, French speaking pharmacists in Ontario were found to be most concentrated in the regions with the smallest French speaking populations. A study of Francophone physicians in Ontario found a similar mismatch. Most physicians are concentrated in southern and urban areas, leaving the north of the province with many Francophone patients and few Francophone practitioners. When health care practitioners do not speak the same language as their patients, it can be challenging for both parties, and has been shown to increase workload.
Participants with whom we engaged in the preparation of this report highlighted the need to approach language as a question of safety and quality of care. Indeed, our review of the literature concurred that language-concordant care improved patient satisfaction and understanding of diagnosis and objective measures of care.
It is why we recommended in that report the following pathway of action: to enable health care practitioners to provide culturally and linguistically safe care through curricula, training programs, tools and other resources that are reinforced by policy and procedural changes.
Researchers earlier have suggested that health care organizations should also evaluate clinicians’ non-English language proficiency and set policies about the use of language skills in clinical care. This speaks to the need to have data in that regard.
This brings me to the foundational work the Société Santé en français has undertaken, including in collaboration with our Canadian Health Workforce Network.
First, we scanned the availability of publicly accessible linguistic data in provincial health professional regulatory authority databases, distinguishing between data on identity, capacity and availability of services. We found that data of this kind were generally not publicly available and definitely not with this level of detail.
Next, we surveyed seven professional regulatory authorities across 10 provinces regarding the data that they collected, regardless of whether or not they made that available to the public. We found that roughly two thirds do collect these data but less than one third make those data available to the public. There were important inconsistencies by profession and province that I can speak to in the question-and-answer period.
Notable is the province of Ontario, where the collection of linguistic data on all regulated health professions has been legislated since 2008 through an amendment to their Regulated Health Professions Act. To my knowledge, it is only here where we can systematically assess language concordance of practitioners and patients.
An analysis colleagues at the Canadian Health Workforce Network undertook, again in partnership with Société Santé en français, found that according to 2021 data in the Ontario Health Professions Database, English was the dominant language among all professions, where between 55 and 80% of health care workers practice in English only. Registered practical nurses were noted to be the least likely to be able to practise in French at 5%, where midwives were the most likely at 16%. Workers over 35 years of age were more likely to speak French and/or another language, which speaks to that younger population of health workers. If they are not able to speak French, the challenging situation we have will only be more challenging.
In a follow-up survey we undertook of different registrars, a majority, 74%, see value in collecting linguistic data, and some reported that these data are helpful for health workforce planning, enabling the linkage of patients to linguistically appropriate health care providers.
A notable promising approach that was created in Ontario is the Geoportal of Minority Health created by colleagues at the University of Ottawa, led by Dr. Louise Bouchard. With funding from the Ontario Ministry of Health from 2013-14 — 10 years ago — Dr. Bouchard’s team created a series of detailed multi‑layered maps that included socio-demographic data from national surveys about French-language minority populations. The overlay on top is the availability of health professionals to provide services in French from the Ontario Health Professions Database, and overlaid on top of that are clinics and organizations. This was an incredibly useful resource. It is terribly unfortunate this work was not funded to be continued nor updated. It was an enormously helpful tool for local planners.
An additional promising development is the inclusion of linguistic data elements in the voluntary health workforce minimum data standards guidance developed by the Canadian Institute for Health Information in 2022. I note that it’s voluntary, but they are working more actively to include this.
I will conclude by strongly recommending that your committee encourages, in the case of this particular theme, all health practitioner organizations — especially regulatory authorities, but including professional associations — to adopt a systematic and standardized approach to collect and make linguistic data on health practitioners available to the public; and that planning efforts to align with data on the linguistic capabilities of the population build on the approach taken by the geoportal project.
Thank you again for this opportunity and I would be pleased to address any of these or other points from the committee going forward.
[Translation]
The Chair: Thank you very much, Ms. Bourgeault, for that statement, which had a lot of substance and raised a lot of questions for us.
I will now give the floor to Kimberly LeBlanc. You have the floor, Dr. LeBlanc.
[English]
Kimberly LeBlanc, President, Canadian Nurses Association: Senators, good evening. As the chair said, my name is Kimberly LeBlanc, and I am honoured to serve as the President of the Canadian Nurses Association.
I would like to begin by expressing my sincere gratitude for the opportunity to appear today to share the perspectives of Canada’s almost 500,000 nurses on the important topic of minority-languages and health services.
It is a privilege to be here, and I am deeply honoured to speak on behalf of the dedicated and compassionate professionals who form the backbone of our health care across this country. Today’s discussion touches on a vital issue that affects the health and well-being of many Canadians, and it is crucial that we address both the challenges and opportunities in delivering accessible, equitable care.
Before I begin, I would like to state that I have the honour and privilege of working here in Ottawa, on the unceded territory of the Algonquin nations and Anishinaabe peoples.
At the CNA, our mission is clear. We are committed to advancing the nursing profession and improving the health and well-being of all people in Canada. We strive to be the national voice of nursing, championing the role of nurses in shaping a responsive, innovative and sustainable health care system. Our goal is to ensure that every Canadian, regardless of their background, has access to the highest standard of care.
Our organization represents a broad and diverse group of health professionals, including registered nurses, nurse practitioners, licensed and registered practical nurses, registered psychiatric nurses, nursing students and retired nurses from across all 13 provinces and territories. With nearly half a million nurses across Canada, we are a powerful and essential force in delivering care to patients, families and communities in every corner of the country. Nurses are vital in ensuring access to quality health care for minority-language communities, both as front-line workers and as advocates for equitable health services.
I look forward to discussing with you some of the issues that we face and some of the key points that we want to bring across. I can speak to you about this from the heart. While I have an academic practice, I also maintain a busy clinical practice. This morning, I spent all day seeing patients in long-term care. For me, one of the most important things is making it part of the inclusion of language clauses in the federal health transfers to ensure that we have a pathway to equitable health care for all. It’s really dependent on where you live in this country as to whether or not you will have equitable health care, particularly around languages.
For instance, in the Ottawa area, if you are a francophone, there are options for you to live in a francophone long-term care facility, and if you are in community or acute care, receiving equitable health care in French. However, if you have another minority language, that may not be a reality for you.
When I speak to nurses across the country from coast to coast to coast, they talk about some of the challenges when they have patients who speak other languages. In certain areas where we do have pockets of francophone patients, they do not have equitable access to care in French, so we need to make sure that we have ways for effective communication. Some of these options include the use of AI. We have to look at integrating artificial intelligence in an ethical and timely manner into our care.
It’s one of those timely things. Just this morning, I had a Polish-speaking patient and used Google Translate to be able to communicate with this patient because we had no translator. So we have to look at ways to provide this care.
We know that nurses play a key role in disease prevention and health promotion, but we need to be able to reach our patients in their language of choice to be able to really impact our patients and to move forward.
I think we’d be remiss if we also don’t mention our Indigenous communities. While this is a multi-pronged and big issue because there are so many different languages, we need to be cognizant when providing care that we not only look at language in that population but also culture. For many of our residential school survivors, when these individuals are placed in long-term care, it can be triggering and traumatic for them. If we can’t provide their language of choice, that’s just compounding the issues.
We know that there’s a shortage of health care professionals, predominantly nurses, across the country. In many cases, minority language also becomes an issue. But we also have an opportunity here where we have nurses coming from many different backgrounds, and we have many different languages being spoken that we can capitalize upon.
We have to look at post-secondary education for nurses that would involve language training as well. Depending on where you live and work, we need to have the opportunities for nurses to — for instance, if you’re working in an English area that has a big pocket of francophones, we need to look at language training for those nurses so that we can provide care to our patients in a timely fashion in the language of their choice.
We have to be cognizant that as our patients age and with many who get dementia, they may have been bilingual at one point, but as dementia increases, they could often lose their second and third languages. Not hearing about your care in your preferred language can also compound your dementia, so we need to be cognizant, when looking at that population, that we make sure we’re giving them care in the language they can understand.
One thing that’s sensitive that we have to work around is that different people have different accents when they speak. For instance, when I speak French, I have a heavy anglophone accent, and many of my francophone patients don’t understand me, so I’ll use AI to help so they can understand my accent. I think one of the things we need to look at is embracing technology in an ethical manner to help provide this care.
We also have the option of using telemedicine to be able to better provide care. We’re not utilizing this great resource in Canada to the extent that we can so that we can leave patients in their own communities, but at the same time, provide care in their language of choice.
As Ms. Bourgeault has said, we need to have more research in this area. We need to have evidence and evidence-informed solutions. There’s currently a huge gap in the research. We have limited data on language access in health care settings. There’s inadequate research on health outcomes. There’s a lack of research on telemedicine and language. There are insufficient studies on Indigenous and multicultural communities.
Thank you for allowing me the opportunity to share these perspectives of Canada’s nurses on the important issue of minority-language health services. As I conclude, I want to affirm the CNA’s commitment to advancing equitable access to health care for all Canadians, regardless of the languages they speak.
Thank you for your time, and I welcome any questions.
[Translation]
The Chair: Thank you, Dr. LeBlanc.
Ms. Landry, you have the floor. You have five minutes for your opening remarks.
Véronique Landry, President, Groupe d’infirmières et infirmiers francophones du Nouveau-Brunswick: Good evening, senators.
Today, I wish to draw your attention to a crucial subject for our health care system, namely, access to care for minority-language communities, particularly in the context of francophone nurses in New Brunswick.
I represent the Groupe d’infirmières et infirmiers francophones du Nouveau-Brunswick, or GIIFNB, a non-profit organization set up in 2020 to address the inequities experienced by francophone candidates during the entry-to-practice examination. Our mission is to promote the development of francophone nurses, while defending their professional interests and those of the public.
We are committed to ensuring our members’ linguistic rights are upheld when they practise their profession. We also support candidates who wish to enter the profession, thereby ensuring optimal nursing practice.
Since the arrival in 2015 of the NCLEX examination, we have observed an alarming drop in the pass rate for francophone candidates. The statistics are revealing: Prior to the entrance examination, the 2014 pass rate for francophone students at Université de Moncton was 93%. In 2015, when the examination was first administered, the rate dropped to 32% for students who had taken the same program. These results were published in a study by Guerrette et al. in 2019. As a result, an increasing number of francophone candidates are choosing to take the exam in English. This situation is worrying for our institutions and for francophone communities.
A 2020 study by Lalonde et al. on the potential effects of the NCLEX exam found that 66.7% of students chose to take the exam in English, whereas only 19.6% opted for French and 13.7% were unsure. Moreover, only 49% of students stated they intend to work in a French-language health care setting after graduation. This shortfall stems from the significant disadvantage experienced by francophone nursing candidates, who have few preparatory resources for the entrance exam, as described in Lalonde’s 2021 review of preparatory resources in French.
The results are even more worrying for foreign-trained nurses, whose pass rate is lower than that of francophone candidates. That raises concerns, as we have more and more nurses trained abroad who want to practise in Canada, but face major barriers to entering the profession.
This debate has far-reaching ramifications, as it has the potential to directly affect the care offered to New Brunswick citizens. The labour shortage is real and greatly impacts access to health care, depriving the population of services they’re entitled to.
It is imperative to address these issues. Here are a few possible recommendations.
First, increased support and training for francophone nurses. To achieve this, it is imperative to provide sufficient and sustainable funding for francophone programs in minority settings, which would prevent a reliance on one-time special amounts. Long-term funding is therefore a must.
Second, promoting recruitment and retention. It is crucial to develop attractive initiatives to encourage young people to choose nursing in French. This includes targeted study bursaries and increased financial support for targeted post-secondary institutions in minority settings. By investing in the training of future health care professionals, not only can we meet the current needs of the health system, but we can also ensure lasting access to care in French for generations to come.
Finally, a Canadian entrance exam to the nursing profession should be established. Although regulation of care is a provincial jurisdiction, it is essential to advocate for the introduction of a Canadian exam. This measure would guarantee equitable access to the profession for all candidates, no matter their background. The regulators’ lack of transparency regarding candidate performance is worrisome, though, since we no longer have data as of 2020 on the exam language or the pass rate. It is therefore urgent to fund research into the impact of the NCLEX exam and to support the development of preparatory resources in the meantime. Lastly, it is crucial to pay particular attention to the results of francophone nurses trained abroad, whose performance is often even worse. This would allow the necessary support measures to be tailored to this clientele.
In conclusion, the Canadian health system must evolve to better meet the needs of all communities, including linguistic minority communities. New Brunswick’s francophone nurses are essential to this mission. Let’s invest in their future to guarantee that every Canadian, regardless of language, has access to quality care.
Thank you for your attention.
The Chair: Thank you very much, Ms. Landry, for your opening remarks. We are ready to go to questions.
Senator Moncion: My first question is for Ms. Bourgeault.
[English]
Thank you for attending today. It is always appreciated to have witnesses to discuss this item. Any items that we study are usually interesting.
With the data collected, you mentioned that Ontario is doing a better job, if I understood you correctly, if you compare Ontario with the rest of the provinces. Even in Ontario, the collection of data is not that great. Am I mistaken?
Ms. Bourgeault: Thank you for the question. In terms of a leading practice in Canada, yes, Ontario has been collecting data on the ability to provide services in French. That is a very important way to ask the question and not just get at identity or language of training. That ability to provide services is the crux of the issue. You want to make sure you’re collecting those data.
Since 2008, they have been collecting those data for all regulated health professions. There are over 20 regulated health professions for which they have those data, and that’s collected in the Health Professions Database.
With all the Canadian studies that I cited to you, you probably noticed they were disproportionately in Ontario. Why? Because those data are available in Ontario. Why do we not know of this circumstance in Alberta where my francophone parents grew up, or in Saskatchewan? We don’t know what those circumstances are.
I think that it is about spreading and scaling the collection at registration — by the regulatory authorities — of the ability to provide services in French. At the same time, you can also ask their ability to provide any type of language. If you’re asking them French, you can ask them other things, and that’s typically what they do. Then you have a data point to be able to say here is what the population needs, and here is where the health workers that have those capabilities are. If there’s a mismatch then we know what the problem is, and then we can implement evidence-informed decisions. If we don’t know that information, we can’t develop evidence-informed interventions. I think collecting those data are really important.
Those data could also be collected by other organizations, such as schools of nursing, schools of physiotherapy, et cetera, because we want to know that the students getting into programs have roughly the range of French-language services or other language capabilities as the population and how they fare through the program. Are those who enter the same proportion as come out of the program, and then where do they end up?
Data are very important upon registration, upon entry into education programs. You can get pointy-headed scientists like us studying this and being able to show where the problems lie so that training programs and others can implement interventions that address where the problems are.
I hope that helps.
Senator Moncion: Thank you. My second question is for Dr. LeBlanc. You talked about telemedicine. You said that it wasn’t sufficiently used. How is telemedicine used?
Ms. LeBlanc: It depends on where you live in the country right now, and there are many different platforms. In some areas, they’re using it quite well, but they’re using it more to provide specialty care, not so much for language access.
We try to use it to keep people in their own communities, to prevent them from having to come to larger centres, or for patients who can’t leave their homes, to be able to have that link with the physician.
We have the opportunity to use it to actually get the proper language care into homes or long-term care homes or acute care. If you have somebody whose language is a minority language, we have this opportunity to use it to be able to link a medical interpreter with them.
Senator Moncion: Is it used more by nurses than by practitioners?
Ms. LeBlanc: It’s normally used in combination and collaboration with physicians, nurse practitioners and registered nurses or practical nurses.
One way it’s often used is that you may have a nursing station where you have a nurse with a patient with a particular problem, and then what will happen is you will have a specialist or a physician or nurse practitioner who is on the telemedicine end, and you come together to discuss a problem with the patient.
Where we’re run in sometimes is that we have someone who doesn’t speak English or French well, or it could be a unilingual francophone with all-English staff. The patient is sitting there but they don’t have all the care they need in terms of having that interpreter. I think we could expand it.
They normally do always try to have people of the same language on these calls, but where you could expand it is if you are a nurse taking care of a patient who is unilingual francophone or any other language, and if you don’t speak it, you could have that opportunity to be able to set up telemedicine either nurse to nurse or nurse to interpreter so that they can do that interpretation with the patient and their family.
Senator Moncion: Is that different from telehealth, when people call in?
Ms. LeBlanc: Telehealth is when someone is calling in for health or advice, or it could be the patient directly with a physician. Telemedicine is more when you have a collaborative team of health care professionals working with the individual and the plan is to keep that individual in their own home.
Senator Moncion: Thank you.
[Translation]
Ms. Landry, my question is about the tests. You said that, prior to 2015, the pass rate was higher than 90%, and that since 2015, it has been lower than 35%. What happened to the entrance exam before and after 2015?
Ms. Landry: We used to have a Canadian exam. The regulatory bodies decided to adopt an American exam, the NCLEX. There were errors in translation, language and context.
Currently, the rates are a little better, because our universities have adjusted to the American exam, although we’re in a Canadian context. In fact, it’s difficult to get access to the real data, because the latest data goes back to 2019, when we were able to learn that the proportion of francophone candidates from our teaching establishment that took the exam in English was 50%. We no longer have access to this data. It’s difficult to obtain data on the number of candidates who take the exam in English and the number of francophones who take it in French.
Senator Moncion: I’m going to wait until the second round, as I’ll have more questions about this exam.
The Chair: Actually, I have a follow-up question. If I understood correctly based on my research, can candidates choose between the two exams? There’s the American exam, the NCLEX, but can they also sit the Quebec exam? Can they sit either? Your suggestion is to create a Canadian exam.
I’d like to start by understanding what the content of this Canadian exam would be; what would differentiate it from the Quebec exam? I’m trying to understand the various options. Would a Canadian exam provide more options for francophones, who would have an exam that’s right for them.
Ms. Landry: An exam was designed by the Canadian Association of Schools of Nursing, which brings together all educational institutions. This exam was developed in both languages, so it includes questions written in French and translated into English, questions written in both languages and translated, and validation. Unfortunately, no one adopted it. This exam is now obsolete.
At the moment some students decide to sit the exam in Quebec, but it’s important to note that the Quebec exam requires a college diploma, with a technical baccalaureate degree, whereas in Canada, entry to the profession requires a bachelor’s degree.
The Canadian exam requires a bachelor’s degree. That would be the major difference.
The Chair: Why wasn’t it selected? What could explain this? It seems to be part of the solution?
Ms. Landry: Yes, the professional associations decide whether to adopt it or not. The vast majority of provinces opted for the NCLEX. The support of a number of groups was required to keep the exam, but no one adopted it.
The Chair: Thank you very much for that clarification.
Senator Mégie: I’ll continue in the same vein with Ms. Landry. Does Quebec now have its own French-language nursing exam?
Ms. Landry: Yes, it has its own exam; Quebec considered switching to NCLEX, but had second thoughts and decided to keep its own exam, given the challenges it had with COVID-19, I believe. Some of our New Brunswick students currently sit the Quebec exam. They’re very successful at it. That’s an option right now, and the exam is recognized by the New Brunswick regulatory body. However, there are some administrative challenges, and it’s not as simple as just sitting the NCLEX exam. I have one concern about the NCLEX exam, and that is that nurses from abroad who want to practise in Canada score even lower on it than our francophone students do. We may be looking for people abroad, but perhaps they’ll never be able to practise in this context.
Senator Mégie: In other meetings we’ve held, we realized there was another issue that hadn’t been addressed.
I don’t know if people are starting to think about it. Nurses from abroad often come here to work in French-speaking environments, but when they get here, all the documentation they get is in English, not to mention the actual exam. Isn’t this also an issue? Have you heard of this? Is there any desire to rectify the situation, or is it just going to stay on the back burner?
Ms. Landry: Of course, there are challenges, and all NCLEX exam preparation documents are written in English.
People who have trouble understanding English won’t be able to adequately prepare for the exam. They’ll need guidance and support.
Senator Mégie: How well do English-speaking Canadians deal with the NCLEX exam? There are cultural differences between Americans and Canadians. Isn’t that also an issue? How is that going? Do they just take it, and all’s well because it’s in English?
Ms. Landry: There was an adjustment period over the first few years. Anglophones do better than francophones. All post‑secondary institutions have adjusted to this exam. We’ve even created a course to help our students prepare so they can do well.
Senator Moncion: Ms. LeBlanc, could you provide some answers on this?
[English]
Ms. LeBlanc: Ms. Landry is correct. What we saw across Canada is English nurses really struggled for the first few years. Then the universities adjusted to how they were teaching the material, so English students are now doing better on the exam. Our francophone colleagues continue to struggle.
It’s also multi-factorial because when you read scholarly articles in health care, most are written in English. Francophone students have the added challenge where many of them have to translate the reading materials into French so they can even learn the material.
All the prep work for the NCLEX is in English, so these students have a definite disadvantage. It’s not as easy as saying, “We’ll just go to Quebec and write the French exam there” because that exam is geared toward nurses who are more technical and at the college level. In the rest of Canada, the RNs are all at the bachelor level, so what they learn and how they learn it is in a different context.
Most French nurses from outside of Quebec do very well on the OIIQ exam, but then they have the added challenge — they pay for this exam in Quebec, and correct me if I’m wrong, Ms. Landry, but I believe is more expensive than the NCLEX. Then they have the added expense of transferring that exam to get their licence back in whatever province they want to work in. They have just paid for a licence in Quebec, and because we do not have a national licensure for nurses, they have to then pay in another province.
For instance, my licence is from Quebec. I did the OIIQ exam. When I moved to Ontario, I had to pay to then get my Ontario licence. I didn’t have to redo the exam, but I had to pay double for my registration.
These young nurses who are just beginning, many of whom have university loans and have had a lot of expenses, if they choose to write the Quebec exam, but want to work in northern New Brunswick, they have to transfer their licence back to New Brunswick. This puts an added financial burden on them to move forward.
We know that our French nursing colleagues are struggling with the National Council Licensure Examination, or NCLEX. There is a lot of politics behind why the colleges decided to go with the NCLEX exam. It’s probably beyond this committee, but there’s a lot going on behind the scenes, and many of us feel that we should have our Canadian exam back. But that goes to the regulatory colleges, about which, unfortunately, academics don’t have a say.
Ms. Bourgeault: I wanted to provide some important context for this specific discussion. There was a Canadian exam. It was the Canadian Registered Nurses Exam, or CRNE. That was developed in Canada for Canadian nurses in a Canadian context, because the U.S. context — as we know — is very different, and it isn’t just that a nurse is a nurse is a nurse. There was a decision not to continue the Canadian Registered Nurses Exam because it was expensive to keep it updated, to keep it secure and to make it available. So there was a decision to opt for the NCLEX exam.
I think that that was a decision that didn’t take fully into consideration the impact on French language minority situations, so I don’t think there was accountability for the equity considerations.
I think that this is one profession —there are other professions for which some applicants have to take a U.S. exam because there isn’t an exam in Canada. I can’t name them explicitly, but we need to consider that there is a whole range of health workers that we need to consider in terms of access to French language services. Nursing is very important, and medicine is very important, but all of the other professions are important as well. I wanted to give a bit of background context for some decisions that are made without equity considerations.
The Chair: Thank you for that answer.
[Translation]
Senator Aucoin: Ms. LeBlanc, I need a short answer. The exam was adopted 30 years ago. What has the Canadian Nurses Association been doing for the past 30 years?
I don’t want to compare. I’m a lawyer by trade. All the law societies in Canada have come together. Now we have a code of ethics. It hasn’t been easy.
Are steps being taken to try to address some of these problems, so that francophones can have equal access to tests that are at the same level, but tailored to them?
[English]
Ms. LeBlanc: Thank you for that question. We are certainly working very hard to make sure that we have equitable access to all the nurses in Canada. We have codes of ethics that are developed in English and French simultaneously, which we have put out. We are also putting pressure on the regulatory bodies to revisit the idea of having a Canadian exam, and if you’re not going to do the Canadian exam then we’re putting pressure on them to make sure that they make the current exam — the NCLEX exam — equitable for our French-Canadian nurses.
It is to ensure that they have the study guide in French and the exam has been validated in French as well to try to overcome some of those inequities. But we are trying to advocate that the exam should come back to Canada.
[Translation]
Senator Aucoin: Thank you.
My second question is for Ms. Bourgeault. Someone mentioned scholarships. We represent the federal government. What can the federal government do to improve data collection?
Ms. Landry, can the federal government do anything about testing? Could it also help develop data collection and mandate it? Ms. LeBlanc mentioned health transfers. A language clause already exists. Should we improve it, make it stricter and require more data collection on an annual basis, as with Bill C-35 and the daycare system? Does the same clause exist in the health care sector?
[English]
Ms. Bourgeault: Thank you for that question. I am not familiar with all the data required around accountability for languages. It’s important to think of a pipeline of health workers into the professions. There is who applies to the program, who gets in and who graduates from the program, because we lose people in the program. Sometimes they change their mind. They say, “This wasn’t for me. This was not what I thought it was going to be.” In some cases, it can be a very distressing education program. It’s important to know who comes in, who comes out, then who gets registered and who does well on the exam.
We need to look at data on these important junctures along the pipeline and for there to be some accountability for equity for different language applicants. That’s very important.
There are a number of tools that the federal government has at their disposal to assist in that. Some of it’s data collection. Some of it is through pan-Canadian health organizations like the Canadian Institute of Health Information. They have a data element in their health professions database or their health workforce minimum data standard guidance. Strong encouragement for that to be included in data collection across education training programs as well as registration would be very important.
Through the federal government, also in partnership with the Canadian Institute of Health Information, it is developing some dedicated research programs that in partnership with the development of data there are funds for health workers to address important policy questions. That’s another tool that’s available.
The federal government has also instituted loan forgiveness programs, Canadian student loan programs for students that will, upon graduation, locate in rural areas. There could be a dedicated stream for francophone students, so that when they apply, they know that there will be loan forgiveness. They are more likely to apply for a program and take out a loan if there will be forgiveness. If that do that disproportionately, a win-win situation is for francophones from rural areas. They would know that, because to tell students at the end of the program that there are these loan forgiveness programs, they will say, “I wish I would have known that earlier. I would have applied.” For some students, if you’re coming from low-income backgrounds, rural areas, it becomes very difficult for you to even fathom that you’re going to have a $50,000 or $100,000 loan. Those are tools that are available for the federal government to utilize for these specific directed programs. Those would be some examples that I would give.
[Translation]
Senator Aucoin: Do the other witnesses wish to respond?
[English]
Ms. LeBlanc: I agree. We have the opportunity to look at the loan forgiveness program and some of the nurses working out in rural areas. There are students from those areas who would go back to those communities and work in French language. For many students, access to education is a big problem. Certainly, now with distance education for many university programs, that opens things up. But if you’re a nurse, you can’t do nursing by distance. You have to be there. It’s a hands-on profession.
Nurses in these rural communities have to travel to centres where there are nursing programs to be there face to face. Any way that the government can assist request that education is going to remove some of the barriers that are there for these nurses.
[Translation]
The Chair: Thank you.
[English]
Senator Clement: Thank you for being here, and thank you for your careers. They’re very important. I have a question for each of you I’ll ask them and then get out of the way. For Ms. Bourgeault, you were talking about that mismatch- and Senator Aucoin was speaking about that too — between people with skills, working in communities where there may not be a large number of francophones.
It reminds me that municipalities play an increasing role, and it can be controversial that it’s falling on the shoulders of municipalities to attract the right mix of health care professionals to their communities.
Could you comment on the role of municipalities and whether that’s a thing or it should be a thing? Also, if you could lean into the geoportal project that Dr. Bouchard had and why we haven’t gone back to that or updated that.
Dr. LeBlanc, your talking of cultural competence had me going to your website to look at your policies, which look fantastic in terms of not just cultural competence but cultural humility, challenging our own perceptions. I wonder what you do to translate that policy into your membership that is taking that up.
You also talked about your own clinical practice use of AI. Where you work, do you have policies around the use of AI? How do you determine when it is appropriate to use AI or Google Translate or that? That would be great.
Also, if you could answer the question about where we’re struggling to retain nurses more — is it public health, hospitals?
[Translation]
Ms. Landry, I’d like to know something. I imagine that in New Brunswick, as in Ontario, there are many francophone newcomers who already have experience and want to join the workforce. Are newcomers that want to join the Canadian health care system facing barriers other than linguistic ones?
[English]
We will start with Ms. Bourgeault.
Ms. Bourgeault: I’ll start first in regard to municipal governments. Yes, they have an important role. All three levels of government have an important role to play in health care, from municipal, provincial and territorial to the federal government. It’s all about collaboration and working in alignment.
I would see certain municipalities as partnering, for example, with educational institutions to develop pipelines for francophone students into programs, and programs, for example, at Laurentian, at the University of Ottawa, other universities for programs. Those are for programs that we have at universities for health professionals. Some programs are at available at a college level. And for municipalities to again work collaboratively and to develop leading practices, how do we better utilize telemedicine infrastructure? How do we learn from different communities about how they’ve done this well? How do we scale up promising practices in certain communities?
An excellent example for the senators to consider is the midwifery education program in Ontario. They had a dedicated training program in Laurentian for French-language students. That, unfortunately, has folded. I know that the University of Ottawa has offered to host that program. I think that will be really important.
The data that I gave to you about midwives having the highest capacity to provide services is directly proportionate to that program. I suspect those data might become poorer over time because of the closure of the program at Laurentian, but what really happened was utilizing all of the technology for midwives to train in local communities with those community partners that they would ultimately practise with, the nurses and physicians in those communities, so that there was an easier transition and for them to be able to continue to use their French-language capabilities. Midwifery would be an excellent program to look at.
I know there is one midwifery education program in Quebec, at Trois-Rivières. Some students from Ontario can go there, but it is similar in the circumstances in terms of coming back.
Municipal governments can absolutely form partnerships with different organizations, educational institutions, to create those supportive pipelines for francophone students.
The second part of your question is the geoportal. Yes. Canada is a country of pilot studies. This was a pilot. It was an exceptional pilot. I was not a part of it. This was a colleague who was at the University of Ottawa. Dr. Bouchard has retired, but the infrastructure for that program is available for us to build on. It was very publicly accessible in terms of how to go about doing it. You would just need to have some funds to bring that together.
That type of approach would be very important to refresh in Ontario as an exemplar of how other provinces — like New Brunswick, like Alberta, like British Columbia — could build upon that. What I really appreciated from the geoportal was that it was purpose-built for French-language minorities, but it also was an excellent resource for health workforce planning writ large. We’ve taken that approach, and we’ve worked in partnership with the City of Toronto — another municipality — to look at interprofessional primary care workforce planning which includes a consideration of ability to provide services in French language. It is part of it, but it’s not the main part.
So again, I think it was a really exceptional program that really needs to be refreshed. Thank you for asking.
Ms. LeBlanc: Thank you for your question. I’ll start with the retention question.
We need nurses across the board. We know that, particularly in long-term care, we are struggling to retain nurses, but we do see a shortage of nurses across the board and retention is the key.
We are graduating more nurses than ever. We are attracting many nurses from other countries, but we’re having trouble retaining them. I can’t remember the statistics off the top of my head, but the CNFU report was dismal when they looked at the retention of nurses. Nurses are leaving in droves, specifically our younger nurses, five years and less of experience. They’re becoming disillusioned. It’s not just about money; it’s the working environments.
We have this great retention tool kit that just came out by the Chief Nursing Officer of Canada, Dr. Leigh Chapman, and it’s almost as if it has been forgotten already. We need to look at that retention tool kit and find ways that we can retain our nurses, particularly in long-term care where we’re still seeing that high level of agency nurses being used.
To look at your next question around the use of artificial intelligence, in the workforce right now, it’s almost facility by facility. There are no direct policies in place. You’re almost making it up as you go along.
Now, technology is moving at a very fast rate. For instance, I consult in many different long-term care facilities, and each facility, I have to go in and ask what their policy is around me using artificial intelligence such as Google Translate for this, and many of them don’t have a policy in place.
This is something that the federal government can really help us with by putting out some guidelines for the use of AI in the health care sector. It could then be adapted in.
Your other question around the CNA and our cultural humility, we’re doing many things to try and provide resources to our members. One of the things we have are advisory councils. We have a francophone advisory council. This is so critical for us. Everything we do is informed, and we have the advice from our francophone council. But we try to put this across the board. We also have an anti-racism council. In a few weeks, we’re going to have an anti-racism summit that we’re putting on, and part of that is language racism. So we’re looking at things from across the board. We have an Indigenous council as well.
At the Canadian Nurses Association, the main focus is about promoting the nursing profession, but also protecting our patients and ensuring our nurses have the tools they need to provide equitable care.
[Translation]
Ms. Landry: Thank you for your question. I’ll answer it briefly.
Certainly, there are challenges for foreign-trained nurses entering the Canadian context.
I’m currently working with a colleague, Latifa Saidi, on a study to identify what the challenges and barriers are. There are certainly administrative and contextual barriers, and the care may also differ. I think there are initiatives already in place, such as a mentoring program to support them, but we need to further these initiatives to better help nurses with their integration, because we need them. If we’re going to seek them out, we need to make sure they get the support they need to stay within our network.
Senator Clement: Thank you.
The Chair: As you know, colleagues, we’ll be going in camera soon, but first we’ll hear from Senator Moncion, followed by Senator Mégie. I’m going to ask the senators to be brief in their questions and the participants brief in their answers. We’ll conclude the meeting and then quickly suspend while we prepare for our in-camera session.
[English]
Senator Moncion: I would like to go back to the NCLEX exam. I just want to know if it is a standardized exam that is being used and is recognized in Canada as the standard that we’re using. Outside of Canada and the U.S., if it is standardized and it is recognized, is it recognized elsewhere in the world?
Ms. LeBlanc: The NCLEX exam was developed in the United States for American nurses. It has since been used in several different countries. I’m not sure of all of them. I believe some of the Middle Eastern countries are using it as well, but I’m not 100% sure.
In Canada, there are many political reasons behind it, but the regulatory bodies moved to the NCLEX exam. It is a standardized exam. It’s a core competency and standards-based exam. It has gone through extensive outcome metrics testing. The question always remains: Have they adapted it enough for the Canadian context, particularly from a francophone perspective? That is a question that we are constantly asking, but it has gone through rigorous testing for content validity and standards.
Senator Moncion: Thank you.
[Translation]
Senator Mégie: This is a question for Ms. LeBlanc or Ms. Bourgeault.
Did the pilot project you mentioned as being tailor-made for French-speaking minorities require the use of interpreters? If it’s AI-based and people are online, do you need interpreters, or is the pilot project so tailor-made that there’s no need for them?
[English]
Ms. Bourgeault: That’s a very good question. I think the point of the project was to show where French-language services, in terms of health workers, were available for francophone minority communities. Ultimately, you would choose sort of a multi-pronged approach to address the gap in the availability of services.
The first would be to increase the proportion of health care professionals who could provide services in French in those communities. Second, you could have interpreters or you could use different forms of AI in a very systematic way. The third would be partnering up communities that have a francophone population but not francophone health care providers through telemedicine in a much more systematic way than the ad hoc way that currently we have.
The geoportal would make clear where those gaps are so you could have evidence-informed interventions that quite systematically address those in a multi-pronged way with those three approaches.
The Chair: Considering all the issues that were raised tonight — this is perhaps for Dr. LeBlanc — do you think that changes should be made to the training of nurses with regard to the use of new technologies; the availability of linguistically or culturally adapted services; and equity, diversity and inclusion issues?
Ms. LeBlanc: I’m pleased to say that across the country, most universities are already addressing that and have integrated those concepts within their core curriculum. I can’t speak for every university, but I know many of them have.
Here in Ottawa, we have a new program that’s about to start at Carleton University. The whole platform is exactly what you just said; it is looking at those aspects.
I think that over the next few years, we will be seeing changes, but it takes time. Those nurses have to graduate and get out into practice, but most of the universities are embracing all of those concepts.
The Chair: Thank you very much. Thank you for your contributions to this study and for your contributions to the health system. We’re so proud to have incredible nurses in Canada who deserve our recognition and our appreciation. Thank you so much for this.
[Translation]
Ms. Landry, Ms. Bourgeault, Ms. LeBlanc, Mr. Bourassa, thank you for joining us this evening.
We’ll now suspend the meeting, so we can thank our witnesses and go in camera.
(The committee continued in camera.)