Not what the doctor ordered: A retiring nurse looks at what's wrong with primary care

This column is an opinion by Diane Murray, a registered nurse in New Brunswick. For more information about CBC's Opinion section, please see the FAQ.

In a few months, I will retire as a nurse. Over 40 years I have seen many changes, amazing innovations and great improvements, but health care seems to be in a crisis now.

We are facing a great challenge because we may have arranged primary health care backwards.

Instead of organizing patients into groups and providing services needed for that group or community, doctors are asked to set up individual businesses, each with its own infrastructure.

It's a model that doesn't work properly — and we would never use it, for instance, in the school system.

Communities would never engage a teacher to set up their own classroom, and then have teachers decide how many students they can — and cannot — accommodate when they will teach, while also paying for their rooms, light and heat.

Unfortunately, that is how primary care is arranged for most New Brunswickers. The system has perpetually left many people without primary care because no doctor has picked them.

On Wednesday, the New Brunswick government is rolling out its plans for tackling health-care reform. As we learn these details, I want to lay out what I've learned from my career, and what I would love to see happen.

In 1981, when I graduated, nurses wore white dresses, shoes, nylons and caps. The first computers were purchased for hospitals, charitable foundations raised money to install the first CT scans, and patients stayed in hospital for a week after surgeries that are now day-op procedures. Nurses counted the drops to regulate an IV drip; now a computerized pump is used.

Some things, though, have not changed. 

The current nursing shortage is the third such crisis during my career. When I graduated, all Saint John School of Nursing grads were offered full-time positions at the soon-to-open Saint John Regional Hospital. Opportunities abounded. Some of my classmates ventured off to California or Texas, where they were offered huge signing bonuses. New Brunswick recruited nurses from the U.K.

Nursing shortages are the result of a complexity of problems, most significantly the high cost of educating nursing professionals. Provincial governments fund seats but not enough to consistently meet the demand. Hands-on experience in hospitals, community, long-term and home care is essential to nursing education, and supervision to ensure students provide safe care while learning is costly.

The reality is while there may be short periods of adequate nursing resources, the capacity to produce qualified nursing professionals will often not meet the need.

This problem is not limited to nursing. It is also found with laboratory technicians, diagnostic imaging and other health-care specialties.