PubMed · 8293369
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L M Mirvis. 1994-02-01. Lessons from Britain.. https://pubmed.ncbi.nlm.nih.gov/8293369/
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BACKGROUND: Health systems worldwide face persistent health workers challenges including nursing shortages, workforce strain, and inequities. In Canada, these challenges have prompted renewed national and provincial reforms to strengthen recruitment, retention, leadership, and sustainability. This paper compares nursing workforce policy directions across Canada, and international jurisdictions to inform policy and planning. METHODS: A cross-country comparative analysis of policies building on a comprehensive national funded review that included an umbrella review of 69 systematic reviews, a comparative policy review of nursing workforce strategies in five jurisdictions, and validation through national horizon-scanning and policy dialogues (n >100). Evidence was analyzed across system, organizational, and individual levels. RESULTS: At the system level, international jurisdictions demonstrate comprehensive, legislated approaches integrating data, governance, and multi-year funding have advanced key nursing strategies. In Canada, the advances show the importance of strategies to have national and provincial/territorial alignment emphasizing leadership, flexibility, and inclusion as key levers. Organizational and individual-level reforms such as mentorship, leadership development, and wellness initiatives are expanding but remain variably evaluated. Experts identified national workforce data strategies and policy integration with embedded evaluation as key enablers to inform scalability and sustainability of implemented strategies. CONCLUSIONS: Canada's nursing workforce reforms are advancing toward coordinated, equity-driven, and evidence-informed strategies. Continued investment in evaluation, leadership, and national integrated data systems along with integrating nursing workforce planning within broader intersectoral planning will consolidate these gains and position Canada as an international leader in sustainable nursing workforce policy.
Because acquired immunodeficiency syndrome (AIDS) is a shifting endpoint and sufficient follow-up data now allow modeling of survival time (i.e., time from human immunodeficiency virus (HIV) seroconversion to death), the authors evaluated non-parametric and parametric models of mortality with the use of data from 554 seropositive participants in the Vancouver Lymphadenopathy-AIDS Study. The authors then applied these models to quantify treatment benefits at the national level in Canada, using back-calculation and forward-projection based on death registries. The study revealed that the lognormal model better describes survival time than the Weibull model. Relative to observations prior to 1987, later observations (in the era of treatment) revealed a statistically significant change in disease progression: the median survival time increased from 10.1 to 12.0 years, but no further survival improvements were observed in the early 1990s. Concurrent with the increase in availability of treatment, the authors have observed pronounced treatment benefits at the national level: prior to 1995, approximately 1,500 deaths were prevented and 4,200 person-years of life were saved. Also, mortality rates were observed to level off in the mid-1990s due to the shape of the historical HIV infection curve and the accumulating availability of treatment in Canada.
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