The Canadian Academy of Nursing: Why It Matters.

The Canadian Academy of Nursing (the Academy) was established in 2019 to provide a focal point for nursing leadership in Canada that had been missing among the 40+ specialty practice and interest groups affiliated with the Canadian Nurses Association (CNA). More than 41,000 regulated nurses work in formal administration or management leadership roles, and many of them have shared a worrying array of self-identified gaps in leadership skills and development. This article presents an overview of programs being launched within the Academy to help address these gaps and describes other public policy priorities being addressed by the CNA.

Vesicular glutamate transporter modulates sex differences in dopamine neuron vulnerability to age-related neurodegeneration.

Age is the greatest risk factor for Parkinson's disease (PD) which causes progressive loss of dopamine (DA) neurons, with males at greater risk than females. Intriguingly, some DA neurons are more resilient to degeneration than others. Increasing evidence suggests that vesicular glutamate transporter (VGLUT) expression in DA neurons plays a role in this selective vulnerability. We investigated the role of DA neuron VGLUT in sex- and age-related differences in DA neuron vulnerability using the genetically tractable Drosophila model. We found sex differences in age-related DA neurodegeneration and its associated locomotor behavior, where males exhibit significantly greater decreases in both DA neuron number and locomotion during aging compared with females. We discovered that dynamic changes in DA neuron VGLUT expression mediate these age- and sex-related differences, as a potential compensatory mechanism for diminished DA neurotransmission during aging. Importantly, female Drosophila possess higher levels of VGLUT expression in DA neurons compared with males, and this finding is conserved across flies, rodents, and humans. Moreover, we showed that diminishing VGLUT expression in DA neurons eliminates females' greater resilience to DA neuron loss across aging. This offers a new mechanism for sex differences in selective DA neuron vulnerability to age-related DA neurodegeneration. Finally, in mice, we showed that the ability of DA neurons to achieve optimal control over VGLUT expression is essential for DA neuron survival. These findings lay the groundwork for the manipulation of DA neuron VGLUT expression as a novel therapeutic strategy to boost DA neuron resilience to age- and PD-related neurodegeneration.

Shifting Sands: A View from the Centre in 2021.

After decades of growth and relative stability in professional nursing across the country, events of the past decade have generated unease across the profession as the very existence of some of our institutions is threatened. In this commentary, we describe factors leading to the erosion of historic membership models that were the backbone of professional nursing representation in Canada. We argue that clinging to old models of jurisdictional representation will not be fiscally sustainable in an all-voluntary membership model and suggest principles we believe could underpin a strong, united and pan-Canadian professional association representing all nurses in Canada.

A Century of Political Influence: The Evolution of the Canadian Nurses Association's Policy Advocacy Agenda.

The Canadian Nurses Association has a long-standing history of strengthening the nursing profession and the health system, supporting professional practice, and advocating for healthy public policy at the local, national, and global level. Historical writings have typically focused on the significant milestones achieved throughout the past century, and the various social, political, and economic contexts that have shaped the evolution of the association. While historical sources illustrate an organization with a strong track record of policy advocacy leadership and presence, there is little literature that has examined how the association's policy advocacy agenda has evolved overtime. Using Shamian's emerging "Bubble" Theory and Spheres of Policy Influence Model as an analytical framework, the authors use historical archives and documents to examine the internal and external drivers that have shaped the association's policy advocacy agenda over the past century and conclude that the Canadian Nurses Association has established itself as a credible leader in shaping not only nursing but also health-care and public policy at the local, national, and global level.

Medical Assistance in Dying: A Review of Canadian Regulatory Documents.

After years of heated debate about the issue, medical assistance in dying (MAiD) was legalized in Canada in 2016. Canada became the first jurisdiction where MAiD may be delivered by nurse practitioners as well as physicians. Experience has revealed significant public demand for the service, and Canadians expect nurses to advocate for safe, high-quality, ethical practice in this new area of care. Pesut et al. offer a superb analysis of the related Canadian nursing regulatory documents and the challenges in creating a harmonized approach that arise in a federation where the Criminal Code is a federal entity and the regulation of health care providers and delivery of care fall under provincial and territorial legislation. Organizations like the Canadian Nurses Association contribute to the development of good legislation by working with partners to present evidence to help legislators consider impacts on public health, health care, and providers. Nursing regulators across Canada responded quickly to the unfolding policy landscape as the federal legislation evolved and will face that task again: In February 2020, the federal government tabled legislation to relax conditions related to MAiD requests that will force regulators and professional associations back to public advocacy and legislative tables. The success of the cautious approach exercised by nursing bodies throughout this journey should continue to reassure Canadians that their high trust in the profession is well placed.

Gender equality policies, nursing professionalization, and the nursing workforce: A cross-sectional, time-series analysis of 22 countries, 2000-2015.

BACKGROUND: Nursing professionalization has substantial benefits for patients, health care systems, and the nursing workforce. Currently, however, there is limited understanding of the macro-level factors, such as policies and other country-level determinants, influencing both the professionalization process and the supply of nursing human resources. OBJECTIVES: Given the significance of gender to the development of nursing, a majority-female occupation, the purpose of this analysis was to investigate the relationship between gender regimes and gender equality policies, as macro-level determinants, and nursing professionalization indicators, in this case the regulated nurse and nurse graduate ratios. DESIGN: This cross-sectional, time-series analysis covered 16 years, from 2000 to 2015, and included 22 high-income countries, members of the Organisation for Economic Co-operation and Development. We divided countries into three clusters, using the gender policy model developed by Korpi, as proxy for gender regimes. The countries were grouped as follows: (a) Traditional family - Austria, Belgium, France, Germany, Greece, Italy, Netherlands, Portugal, and Spain; (b) Market-oriented - Australia, Canada, Ireland, Japan, New Zealand, South Korea, Switzerland, United Kingdom, and the United States; and (c) Earner-carer - Denmark, Finland, Norway, and Sweden. METHODS: We used fixed-effects linear regression models and ran Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction to examine the effect of gender equality policies on nursing professionalization indicators. Given the existence of missing observations, we devised and implemented a multiple imputation strategy, with the help of the Amelia II program. We gathered our data from open access secondary sources. RESULTS: Both the regulated nurse and nurse graduate ratios had averages that differed across gender regimes, being the highest in Earner-carer regimes and the lowest in Traditional family ones. In addition, we identified a number of indicators of gender equality policy in education, the labour market, and politics that are predictive of the regulated nurse and nurse graduate ratios. CONCLUSION: This study's findings could add to existing upstream advocacy efforts to strengthen nursing and the nursing workforce through healthy public policy. Given that the study consists of an international comparative analysis of nursing, it should be relevant to both national and global nursing communities.

The influence of welfare state factors on nursing professionalization and nursing human resources: A time-series cross-sectional analysis, 2000-2015.

AIM: The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators. DESIGN: We used a time-series, cross-sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian. METHODS: We used fixed-effects linear regression models and conducted Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March-December 2017 and subsequently updated from August-September 2018. RESULTS: Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes. CONCLUSION: Additional country-level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization. IMPACT: We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools.

Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce.

Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in-depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country-level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill-level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings.

The Canadian Nurses Association: Reflections on the NCLEX-RN through the Lens of Nursing History and Evolution.

Decades of work by professional associations, regulators and educators have produced an ethical, reliable, robustly educated and regulated nursing workforce that enjoys high levels of respect in Canada and around the world. The officers of the Canadian Nurses Association comment here on the organization's history and changing role in regulatory policy over the past decade during the introduction of the American NCLEX-RN examination as the assessment tool for entry-to-practice for Canadian registered nurses. Facing forward, to maintain a strong, trusted nursing workforce the association remains committed to meaningful collaboration among nursing's professional, regulatory, education and union sectors.

Role for VGLUT2 in selective vulnerability of midbrain dopamine neurons.

Parkinson's disease is characterized by the loss of dopamine (DA) neurons in the substantia nigra pars compacta (SNc). DA neurons in the ventral tegmental area are more resistant to this degeneration than those in the SNc, though the mechanisms for selective resistance or vulnerability remain poorly understood. A key to elucidating these processes may lie within the subset of DA neurons that corelease glutamate and express the vesicular glutamate transporter VGLUT2. Here, we addressed the potential relationship between VGLUT expression and DA neuronal vulnerability by overexpressing VGLUT in DA neurons of flies and mice. In Drosophila, VGLUT overexpression led to loss of select DA neuron populations. Similarly, expression of VGLUT2 specifically in murine SNc DA neurons led to neuronal loss and Parkinsonian behaviors. Other neuronal cell types showed no such sensitivity, suggesting that DA neurons are distinctively vulnerable to VGLUT2 expression. Additionally, most DA neurons expressed VGLUT2 during development, and coexpression of VGLUT2 with DA markers increased following injury in the adult. Finally, conditional deletion of VGLUT2 made DA neurons more susceptible to Parkinsonian neurotoxins. These data suggest that the balance of VGLUT2 expression is a crucial determinant of DA neuron survival. Ultimately, manipulation of this VGLUT2-dependent process may represent an avenue for therapeutic development.

Commentary: When You Know Better, Do Better.

As the world prepares to celebrate the remarkable life and contributions of Florence Nightingale on her 200th birthday in 2020, the Canadian Nurses Association (CNA) is putting the pieces in place to host an entire new pillar of programs and services focused on leadership for all regulated nurses across Canada. First among these is our relationship with the Dorothy Wylie Health Leaders Institute (DWHLI), which has built a partnership with CNA since 2015. As a great gift to CNA and nursing across Canada, to mark the Nightingale bicentennial we are thrilled that the DWHLI will come fully under CNA in 2020 as our premier residential leadership development program.

A very human being: Sister Marie Simone Roach, 1922-2016.

Sister (Sr.) Marie Simone Roach, of the Sisters of St. Martha of Antigonish, Nova Scotia, died at the Motherhouse on 2 July 2016 at the age of 93, leaving behind a rich legacy of theoretical and practical work in the areas of care, caring and nursing ethics. She was a humble soul whose deep and scholarly thinking thrust her onto the global nursing stage where she will forever be tied to a central concept in nursing, caring, through her Six Cs of Caring model. In Canada, she was the lead architect of the Canadian Nurses Association's first code of ethics, and her influence on revisions to it is still profound more than 35 years later. In this paper, four global scholars in nursing and ethics are invited to reflect on Sr. Simone's contribution to nursing and health-care, and we link her work to nursing and health-care going forward.

Canada's top 5 in 5.

In 2011, the Canadian Nurses Association made a decision to establish and fund a national commission focused on health system transformation, the National Expert Commission. In 2012, the commission presented an action plan, the lead recommendation of which was to ensure that Canada ranks among the top five nations on five key population health status and system performance indicators in the next five years. In this article, the authors outline the selection of the these indicators and the associated goals for improvement.

Better health, better care, better value: National Expert Commission, part 1.

Since about the midway point of the First Ministers' 10-year plan to strengthen healthcare, its impending expiry in 2014 has prompted the leading health professions to consider "what comes next," how to influence that decision and then, how best to position their messages in the politics of whatever might emerge. The Canadian Nurses Association (CNA), which has a century-long history of engagement in health policy, was no exception.

The health of our nation - the future of our health system: the national expert commission on the move.

The looming end of 2011 finds CNA's National Expert Commission wrapping up a jam-packed fall during which we had the privilege of speaking with nurses, members of the public and government leaders in all six of Canada's time zones, literally from Victoria to St. John's, and from the Far North to downtown Toronto.