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The role of nurses is evolving across Canada as the industry attempts to meet the challenges of an increasingly complex health care system. Many colleges, educational institutes and nursing organizations are rolling out specialized training programs to help nurses provide better care in such areas as oncology, neonatal, mental health, geriatric, perioperative and palliative care. This trend is "the new normal" in nursing, says Barb Mildon, president of the Canadian Nurses Association.

Angela Wolff, director of clinical education, professional practice and integration at Fraser Health Authority, said specialization for nurses is, in large part, a response to the fact that the population is living longer and many patients are struggling with a number of medical conditions. Plus, more care is being provided at home rather than in a hospital setting, and advances in health care are continuing at a rapid pace.

"I think there's just growing recognition that to be able to provide patient care, there is a lot of knowledge and expertise that's required," Wolff said. "Sometimes you just can't get it on the job."

The de Souza Institute is an example of the effort to provide nurses with specialization in the area of oncology. The institute offers a program, accessible to all nurses in Ontario, to teach new skills and knowledge that can be applied in the work force, said institute director Mary Jane Esplen.

One of the goals is to address important gaps in care identified by patients and their families, such as emotional support and better communication, Esplen said. Given the fast pace of change, it's important for nurses to learn new practices, emerging evidence and changes in techniques, Esplen said. It's "almost impossible to keep up" without specialty training, she said.

She noted the institute is working with Cancer Care Ontario, which now strongly encourages all nurses delivering chemotherapy to be certified by the de Souza Institute.

Wolff said that advances in nursing specialization may not be equal across the country and that opportunities may not be available in some provinces. That will become an area to address in the future as specialization increasingly becomes the norm for nurses, she said.

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