The Evolution of the Nursing Supply in Canada
Economic Note examining the growing proportion of young nurses leaving the workforce over the past decade across Canada, and proposing some potential solutions
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This Economic Note was prepared by Emmanuelle B. Faubert, Economist at the MEI, in collaboration with Olivia Martiskainen, Research Intern at the MEI. The MEI’s Health Policy Series aims to examine the extent to which freedom of choice and entrepreneurship lead to improvements in the quality and efficiency of health care services for all patients.
Nurses form the backbone of the Canadian healthcare system, working in hospitals, primary care centres, and long-term care settings. They are the largest group of regulated health professionals in Canada, with over 450,000 members.(1) As Canada’s population grows and ages, the demand for health care is increasing, putting additional pressure on nurses. Indeed, there is a widespread shortage of nurses across Canada. Over the past 10 years, the number of nursing job vacancies, and the proportion of these that are for full-time positions, have risen.(2)
The MEI studied the supply of nurses in 2023 and 2024. This year, we deepen our analysis by looking at the most recent data from the Canadian Institute for Health Information (CIHI). Has progress been made on recruiting and retaining young nurses? What lessons can be learned from different provincial initiatives to keep these valuable health professionals working?
A Worsening Situation
CIHI collects data on applications for registration to practise from the provincial and territorial professional regulatory bodies for nurses.(3) Using this data, they are able to track the total number of nurses, employed and unemployed, that are registered to practise.(4)
The metric studied in this publication is the ratio of yearly outflows to inflows of nurses under 35 years of age.(5) An increase in this number from one year to another means that relatively more nurses are leaving the workforce, compared to the number entering it. Conversely, a reduction in this number means that proportionately fewer young nurses are exiting the workforce.
In 2023, according to the latest data released this past July, for every 100 nurses under the age of 35 who entered the workforce by registering to practise, 40 left(6) (see Figure 1). To put this number in context, in 2014, for every 100 nurses in the same age group who joined the Canadian nursing workforce, only 36 left.(7) A growing proportion of young nurses leaving indicates a worsening retention situation across Canada.
Meanwhile, the average age of nurses registered to practise in Canada is decreasing. In 2014, 27.7% of them were under 35.(8) By 2023, that proportion had grown to almost 31%.(9) A greater proportion of Canadian nurses are thus now in an age group with a larger turnover rate compared to the general nursing population.(10)
The number of Canadian nursing job vacancies has also grown considerably in recent years, from 13,178 in 2018 to 41,716 in 2023.(11) In a free market, such a shortage of workers would tend to create an advantageous situation for employees, with employers competing to attract workers, leading to higher pay and improved working conditions. This, in turn, would generally help alleviate the issue of retention and attract more people into the nursing profession.
Over the past 10 years, the number of nursing job vacancies, and the proportion of these that are for full-time positions, have risen.
In the current context, however, in which most nurses are employed in the public sector, heavily micro-managed by the government, these market mechanisms do not function properly. We therefore see a situation where, despite shortages sending a strong signal, the market is not allowed to self-correct, and the situation does not improve. Indeed, in most provinces, it is deteriorating.
The Best and the Worst
In 2023, the province with the lowest ratio of young nurses leaving to those entering the workforce was British Columbia (see Table 1). This province is also the most improved over 10 years, with a 50% reduction in its young nurse outflow/inflow ratio.(12) This is due primarily to sustained increases in inflow numbers across all types of nurses, particularly nurse practitioners and licenced practical nurses. There have also been slight decreases in outflow numbers for registered nurses, registered psychiatric nurses, and practitioners.
Beginning in 2022, the BC College of Nurses and Midwives launched the triple-track assessment process for internationally educated nurses, which allows them to submit a single application for three nursing designations: registered nurse, licenced practical nurse, and healthcare assistant.(13) This reduces costs and delays of applying for one nursing designation, and if rejected, having to start all over to apply for another designation. The provincial government has also launched a service called BC Health Careers, which provides recruitment services and information to international healthcare professionals, including personalized support to navigate the licensing, job search, and relocation process.(14)
According to CIHI data, in 2023, about 93% of nurses trained in British Columbia were registered to practise in British Columbia, so the province is reaping the benefits from its investments in education.(15) The province is also successfully recruiting and retaining nurses from across the country. In 2023, while 3,108 BC nurses had registered out of province, 9,249 nurses who graduated from another Canadian jurisdiction were registered to practise in British Columbia.
In 2023, for every 100 nurses under the age of 35 who entered the workforce by registering to practise, 40 left.
Quebec is the only other province that shows an improvement in the outflow/inflow ratio since 2014. In 2023, for every 100 nurses under the age of 35 who joined the nursing workforce, 37 left.(16) This is a slight decrease from the 40 exits per 100 entrants observed in 2014.(17) Some of this may be due to the Quebec government’s efforts to attract internationally educated nurses. It has a mutual recognition arrangement with France to make the licensing process quicker for nurses who have been educated and registered in France, and have worked there.(18)
However, there is room for improvement. For nurses from countries other than France, coming to Quebec is a complex process in which they are solely responsible for finding a hospital to hire them for their professional integration program.(19) In addition, a November 2024 report revealed that Quebec’s foreign nurse recruitment program faced some major issues, notably that nurse candidates were not properly informed about the duration and costs of the training program, and were under severe stress.(20)
The province with the highest ratio of young nurses leaving to those entering the workforce in 2023 was Newfoundland and Labrador. It also saw the second highest increase in this ratio over the previous 10 years, behind only Manitoba. In both provinces, virtually all of this increase is due to large spikes in outflows in 2023. (See the Annex for details.)
A contributing factor in Newfoundland and Labrador may be the expiration of many short-term contracts with out-of-province travel nurses who arrived during the COVID-19 pandemic. For instance, in 2022, in two regions of the province, Canadian Health Labs was providing at least 74 registered nurses.(21) These contracts were for a period of one year, thus likely contributing to the increased outflows seen in 2023.
Causes and Potential Solutions
Why are nurses leaving the profession? The 2025 edition of the Canadian Federation of Nurses Unions annual survey(22) can help us shed some light on the likely causes:
- Overtime work: over a third of respondents had worked involuntary overtime in the past six months.
- Problematic working conditions: 59% of respondents had experienced some type of violence or abuse related to their job in the past year.
- High stress: around 25% of nurses are actually showing signs serious enough to be considered anxiety, depression, or burnout by medical standards.
As a result, 20% percent of all working nurses were considering leaving their current job, and another 10% were actually even considering leaving the profession altogether. These numbers are consistent with data from CIHI, which shows that 6.4% of the 2023 nursing workforce actually declined to re-register to practise in 2024.(23)
One potential solution to these problems is to allow nurses more flexibility, letting them work for travel nurse agencies, private clinics, or telehealth companies. This would allow them to better control their hours and maintain a work-life balance. Provinces should take inspiration from British Columbia’s job swapping pools, which allow nurses to trade shifts without needing approval from administrators.
In the current context, in which most nurses are employed in the public sector, heavily micro-managed by the government, the market is not allowed to self-correct, and the situation does not improve.
Union contracts should be renegotiated to reward skills and competence over seniority. Hospitals should implement transition assistance programs, such as the one at the Centre Hospitalier de l’Université de Montréal (CHUM), to help nurses better integrate into new workplaces.(24) There is also the possibility of leveraging artificial intelligence to reduce nurses’ workloads by automating administrative tasks.
The number of Canadian nurses under the age of 35 who leave the workforce every year is increasing relative to the number joining it. While certain provinces have shown some improvement, especially in recent years, in most cases, the negative trend of the past decade continues. Nurses are still suffering under harsh working conditions that make them leave in large numbers, undermining the quality of health care in Canada. As the demand for health care increases, the loss of higher numbers of trained nurses every year is simply unsustainable.
References
- Data from 2023. Canadian Institute for Health Information, Access Data and Reports, Reports and Releases, Balancing the needs of Canadians and our health workforce, consulted August 14, 2025.
- Statistics Canada, Table 14-10-0443-01: Job vacancies, proportion of job vacancies and average offered hourly wage by occupation and selected characteristics, quarterly, unadjusted for seasonality, 2025.
- Canadian Institute for Health Information, Nursing in Canada, 2024 – Methodology Notes, 2025, p. 7.
- CIHI excludes secondary registrations from their count, unless one of the jurisdictions of registration is a territory. The number of registrations to practise is the number that CIHI reports as the supply of nurses.
- Based on CIHI’s reported data, including only nurses under 35 years of age, using the following calculation: outflow year x / inflow year x. Outflow 2023 is the number of regulated nurses that were registered in 2023 and did not register in 2024. Inflow 2023 is the number of regulated nurses that were not registered in 2022 and did register in 2023.
- Author’s calculations. Canadian Institute of Health Information, Topics, Health workforce, Data tables, Nursing in Canada, 2024 – Data Tables, consulted July 24, 2025.
- Author’s calculations. Canadian Institute of Health Information, Topics, Health workforce, Data tables, Nursing in Canada, 2023 – Data Tables, consulted July 21, 2025.
- Author’s calculations. Idem.
- Author’s calculations. Canadian Institute of Health Information, op. cit., endnote 6.
- Idem. Author’s calculations. While Canadian nurses showed a global turnover rate (outflows as a percent of supply) of 6.4% in 2023, the turnover rate was 7.1% in nurses under 35.
- Author’s calculations. Statistics Canada, op. cit., endnote 2.
- Author’s calculation.
- British Columbia College of Nurses & Midwives, About the College, Announcements, “New strategies streamline path to registration for internationally educated nurses in B.C.,” April 19, 2022.
- BCHealthCareers, Find your pathway, consulted August 7, 2025.
- Canadian Institute of Health Information, op. cit., endnote 6.
- Author’s calculations. Idem.
- Author’s calculations. Canadian Institute of Health Information, op. cit., endnote 7.
- Ordre des infirmières et infirmiers du Québec, Becoming a Nurse in Quebec, Practising in Québec, Infirmier ou infirmière de la France, consulted August 11, 2025.
- Ordre des infirmières et infirmiers du Québec, Becoming a Nurse in Quebec, Practising in Québec, Nurses who earned their degrees outside Canada, consulted August 11, 2025.
- Maura Forrest, “Foreign nurses recruitment program in Quebec plagued by major flaws, internal report reveals,” CBC News, March 25, 2025.
- Author’s calculation. Canadian Institute of Health Information, op. cit., endnote 6; Government of Newfoundland and Labrador, Justice and the Law, General, Access to Information (ATIPP), Completed Access Requests, Request Number HCS/149/2023, consulted July 28, 2025.
- Viewpoints Research, CFNU National Nurses Survey, Canadian Federation of Nurses Unions, March 2025, pp. 10, 19, 24, and 35.
- Among nurses considering leaving, only a portion tend to actually leave. Author’s calculations. Canadian Institute of Health Information, op. cit., endnote 6.
- Jennifer Pierre and Sophie Alaurent, “How a hospital in Montreal supported new nurses and recruits during the critical summer months,” Canadian Nurse, July 7, 2025.