The intensifying climate crisis poses significant challenges to healthcare systems, including extreme weather events, rising temperatures and evolving disease patterns. In response, healthcare leaders must both adapt care delivery and pursue system-wide decarbonization. Nursing roles are expanding to include advocacy for planetary health, with educational programs working to equip nurses for climate-responsive practice. This commentary presents examples of nursing leadership in climate resilience and calls on healthcare organizations to leverage the profession's capacity to lead efforts integrating planetary health into sustainable, climate-resilient patient care.
Nursing workforce data development, standardization and liberation enable enhanced evidence-informed planning, staffing decision making and quality improvement initiatives. This commentary discusses how the nursing profession can work collaboratively to create an agile, responsive nursing workforce to meet patient needs and respond to broader health system goals through the optimal use of data, and describes data initiatives in progress that can assist nursing leaders to understand how to prepare the nursing workforce for a changing world. The data generated at registration by nursing regulators is a particularly strategic opportunity to leverage efforts to standardize and optimize data for such needed planning.
Nursing regulators must uphold their mandate to protect the public amid increasing scrutiny and shifting expectations. As understandings of the public interest evolve, so too must regulatory policy and practice. In this commentary, we explore the role of nursing regulation in addressing system-level challenges, including workforce dynamics, racism, misinformation and planetary health. Stronger investment by governments and nursing leadership in regulatory research, as well as support for partnerships between regulators and researchers, can help build an evidence base demonstrating the unique role of regulation in not only supporting a safe, competent workforce but also advancing equity and sustainability in health systems.
Nursing's moral imperative toward anti-racism has been vital in opening spaces of critical dialogue within the discipline and profession. Yet, solely focusing on a moral mandate is limiting by risking professional precarity and moral distress. A renewed reflection is required to address the material and structural conditions that impede sustained anti-racism action. Nursing leaders are well-positioned to undertake anti-racist worldmaking through their commitments for a political imperative.
The contemporary debate on equity, diversity and inclusion (EDI) in nursing practice has been affected by numerous intersecting forces. In this commentary, we draw on insights from Bukola Salami's 15-year research program, which offers critical perspectives on how racism, migration status, labour precarity, social inequities and institutional structures influence the health and well-being of Black and immigrant populations across the life course. For researchers, practitioners and legislators dedicated to promoting EDI inside health systems and associated social institutions, her corpus of work offers useful evidence. Significant implications for clinical nursing practice, leadership and research are also outlined.
We are living in increasingly complex and uncertain times that demand both resilience and agility. A reality that is made ever more challenging in healthcare environments that face long-standing pressures to do more with less by a healthcare workforce that often is exposed to great personal and professional strain. Adopting and actioning principles of trauma-informed organizational culture and leadership can provide a pragmatic and responsive framework that can bolster health worker well-being and system agility in the face of adversity.
It's no surprise to anyone to have us say that we are living in challenging times. Though some may have thought that a postpandemic world would see the recovery and stabilization of economies, healthcare systems and workforces, at times it feels somewhat similar to a never-ending era of calamity. We continue to live in a time of polycrisis - from economic instability exacerbated by ongoing global trade wars, struggling health workforces impacting the accessibility and availability of healthcare services, to worsening planetary health exacerbating food and water insecurity, physical and mental health issues, health inequities and forced migration and displacement. We are severely off track to meet the United Nations' Sustainable Development Goals (SDGs) by 2030 (UN 2015). Nurses and nurse practitioners are leaving the profession at record numbers, with many leaving just within the first few years of being licensed (Faubert 2025). Working conditions remain a challenge across provincial and territorial health systems (CFNU 2025). Yet, while the future may look bleak, these wicked problems are not impossible to fix. Indeed, this is our new normal - a constantly changing world that, now more than ever, needs our resolve to create a healthier future for all.
The COVID-19 pandemic intensified Canada's nursing shortages, increasing reliance on internationally educated nurses (IENs) as a solution for these vacancies. IEN integration strategies vary across Canadian provinces and territories, driven by contextual needs and available resources. This discussion paper provides a high-level overview of IEN integration in Canada, offering practical recommendations for nursing leaders to develop an ethical, equitable and sustainable nursing workforce. We outline the benefits of investing in improvements to IEN integration and the value it plays in achieving the United Nations' Sustainable Development Goals. This requires equity-focused reforms at macro-, meso- and micro-levels to fully utilize IEN expertise and experiences.
Artificial intelligence (AI) offers many opportunities for nursing to improve health outcomes and contribute to meeting the Sustainable Development Goals nationally and globally. However, it also presents challenges to meeting these goals and keeping pace with innovation, which nurses must anticipate and mitigate. Canadian nurse leaders are well-positioned to guide transformative change in the nursing workforce, ensuring that nurses have the competencies and resources needed to thrive in AI-supported care environments. This not only allows nurses to better adapt to AI but also leverages new skills to take on more significant roles in improving healthcare on a wider scale.
The world is off-track to meet most of the health-related Sustainable Development Goal (SDG) targets by 2030, including SDG 3.8, universal health coverage (UHC). A sustainable nursing workforce is needed to advance UHC. This paper discusses key issues surrounding the global nursing shortage and offers solutions for the Canadian context to build a sustainable nursing workforce and strengthen health systems to improve access to care for all. Primary healthcare, investment in nursing and enhanced nursing leadership capacity are just a few of the proposed policy levers discussed.
The role and influence of nursing associations (NAs) are evolving, making their collective power more vital than ever. This reflective piece traces my professional journey from direct care to executive leadership, showing how active engagement in NAs shaped my career and deepened my understanding of their pivotal impact on the nursing profession and health policy across Canada. Readers are invited to consider a nursing leadership challenge and reflect on their own involvement with provincial/territorial NAs and the Canadian Nurses Association. Amid current system pressures, united and active participation in NAs is essential to strengthen nursing's voice and drive meaningful, lasting change.
Building capacity within programs to conduct evaluation allows leaders to increase the potential of harnessing systematic assessment to improve program impact. At Sunnybrook Health Sciences Centre, Canada, nursing leaders leveraged evaluation capacity building (ECB) as a tool to improve the Transition Mentorship Program, an initiative using mentorship to support practice transitions and foster improved retention, a challenge in the nursing workforce, especially among newly registered nurses. In collaboration with evaluators at the University of Waterloo, Sunnybrook implemented an ECB intervention to bolster the program's evaluation capacity, bridge silos across clinical settings and embed standardized, evidence-informed processes. This case study describes this intervention while discussing lessons learned and recommendations for nurse leaders.
Background:Tailored and responsive programs are essential for integrating and retaining internationally educated nurses (IENs). The Supervised Practice Experience Partnership (SPEP) program in Ontario supports IENs in their transition. The University Health Network in Ontario developed a customized SPEP program to facilitate a two-way integration into practice, engaging IENs and practice leaders. Method:The advanced practice nurse educator (APNE) team leveraged continuous evaluation approaches to develop and refine the program, using a combination of surveys and focus groups with IENs and leaders (e.g., managers, APNEs and preceptors). Core components of the evidence-informed and adapted SPEP program include onboarding workshops, structured learning pathways, IEN and preceptor handbooks and a community of practice that incorporates peer support from successfully transitioned IENs. Findings:Evaluation results show improvements in IENs' critical thinking, communication, clinical reasoning and judgement. However, limited clinical experience among many IENs led to curricular adjustments emphasizing nursing fundamentals through case-based learning aligned with organizational values. Ongoing support from dedicated SPEP APNEs, particularly with prior experience as IENs, has been key to successful implementation. Conclusion:This data-informed, adaptive approach has enhanced IEN integration into the workforce and offers a practical model for nursing leaders and educators designing transition programs in dynamic healthcare settings.
Exacerbated by the COVID pandemic, shortfalls in the current and predicted nursing workforce have propelled provincial and territorial governments to find solutions to provide the nursing care needed by a population that is increasing in size, age and complexity. Internationally educated nurses (IENs) are not new to Canada - they have been part of nursing's history for centuries (Indar et al. 2025). When faced by the shortages in the nursing workforce following the pandemic, all provinces and territories accelerated recruitment of IENs. In fact, this year the College of Nurses of Ontario (2025) reported that, for the first time, the number of new internationally educated registered nurses (RNs) exceeded the number of new Canadian-educated RN registrants.
Internationally educated nurses (IENs) are a growing segment of our Canadian health workforce. Nursing leaders are seeking examples of effective IEN integration programs to shape organizational policies and strategies to support IENs in their local context. In this special issue, we share national and international examples of successful IEN integration, authored by the nurses leading these programs. In the first issue, we profile examples of IEN integration in rural Manitoba and in an urban centre in Ontario. Both examples offer insights suitable for varied geographical and cultural contexts, with commonalities regarding the need for thoughtful and collaborative approaches to IEN program planning, implementation and evaluation.
In the post-pandemic healthcare context, the destabilization of the nursing workforce prompted organizations to recognize the need for additional support in clinical settings to facilitate successful nurse integration and retention. To better understand how mentorship can be optimally structured and operationalized to support transition to practise, Sunnybrook Health Sciences Centre, The Ottawa Hospital and Unity Health Toronto collaborated to explore multi-site experiences with a provincial mentorship program. This case study will describe and compare three organizations' implementation and evaluation of the government-funded Clinical Scholar Program, while highlighting considerations for nurse leaders and program recommendations.
Objective:To identify and describe the advanced practice nurse (APN) workforce and models of care (MOC) in emergency departments (EDs) across Ontario, Canada. Background:EDs face pressures related to patient acuity, wait times and resources. Research is needed to support ED APN MOC. Method:a cross-sectional survey was distributed to ED APNs. Results:Total respondents: n = 52 (44.4% response rate). Frequently reported MOC were fast-track and general emergency, with fewer triage, geriatric and mental health MOC reported. Conclusion:Future efforts should focus on ED APN MOC improving equity and access. Results can inform health human resource planning to meet priority patient needs.
Rural communities across Canada are experiencing a shortage of registered nurses (RNs). Internationally educated nurses (IENs) make up an important component of the nursing workforce; however, the recruitment and retention of IENs in rural areas can be challenging. This article will discuss a collaborative rural IEN RN pilot that centred on a partnership between Manitoba Health, two regional health authorities, the College of Registered Nurses of Manitoba and Red River College Polytechnic. The purpose of the pilot was to recruit IENs who were living in Canada, seeking licensure as RNs and were interested in living and working in rural Manitoba.
Newly graduated nurse practitioners (NPs) often face challenges transitioning into practice due to increased responsibility, limited support and unclear role expectations. This quality improvement study examined the implementation of a mentorship program for new NPs in Nova Scotia, supported by the Nursing Innovation Fund and developed in collaboration with Nova Scotia Health, the IWK Health Center, and the Department of Health and Wellness. Ten NPs engaged in virtual or hybrid mentoring relationships. Findings highlighted six months as a critical period for role identity, with ongoing workload and support challenges noted at 12 months. Results suggest mentorship must be flexible and tailored to evolving needs.
Healthcare largely remains fragmented between physical and mental health services, resulting in poorer outcomes and inefficiencies. An aging population and increasing comorbidities among patients highlight the urgent need for integration. Barriers such as historical separation of physical and mental health services, workforce limitations and stigma persist, yet societal attitudes are shifting to be more aware and accepting of mental health conditions. Nurse leaders, with their holistic, patient-centred approach, are uniquely positioned to lead this transformation. This commentary will explore the critical role of nurse leaders in advancing the integration of physical and mental healthcare.
