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A nurse at Mount Sinai Hospital is seen in this file photo.Fred Lum/The Globe and Mail

The supply of nurses in Canada has declined for the first time in almost 20 years, according to a new report that has prompted two prominent national nursing organizations to warn that the country needs to do a better job of managing the health-care work force.

The latest snapshot of the nursing field from the Canadian Institute for Health Information (CIHI) found that more nurses left the profession than entered it in 2014 – a 0.3-per-cent decrease from the previous year in the number of people holding active nursing licences across the country.

The supply of registered nurses – by far the most common nursing category – fell 1 per cent.

At the same time, the number of nurses actually working in the field continued to climb last year, up 2.2 per cent from 2013, in keeping with the stable growth of the past 10 years.

"The sum of all the numbers is a tightening nursing labour market," Karima Velji, president of the Canadian Nurses Association (CNA), said in a statement. "Immediate action is needed to stave off the potentially long-lasting trend of a shrinking [registered nurse] work force and its consequences for population health."

The CNA is a professional organization that advocates for nurse-friendly public policy.

Andrea Porter-Chapman, CIHI's manager of health work force information, said it is too early to say whether the dip in supply marks the start of a nursing shortage in Canada or a one-year blip thanks to a regulatory change in Ontario. Either way, health policy-makers will need to watch the trends closely over the next couple of years, she said.

"This is the first shift in almost two decades where we've seen a decline in the supply," Ms. Porter-Chapman said. "But the positive side of this is that our work force continues to increase. ... I think [the supply issue] is something that our health-care system just needs to be aware of and monitor."

When it comes to nursing in Canada, the term "supply" refers to the number of people holding active licences with the provincial bodies that regulate the profession.

But not all licensed nurses work in nursing. Some hold on to their licences after landing other jobs, going back to school or unofficially retiring.

Last year, the College of Nurses of Ontario, the self-regulating body that oversees the profession in Canada's most populous province, put in place a new rule that effectively bars members from renewing their licences unless they have practised nursing in the province in the past three years. That contribued to an unusually high number of nurses formally exiting the profession in Ontario – 15,836 in one year.

Still, the CIHI report identified some underlying trends that suggest there is more at play.

Across the country, a total of 27,757 nurses let their licences lapse last year, while only 25,397 registered anew with one of the provincial or territorial regulators – a net loss of 2,360.

The supply of nurses dropped in six jurisdictions: Newfoundland and Labrador (down 0.7 per cent), Prince Edward Island (down 3.5 per cent), New Brunswick (down 0.9 per cent), Ontario (down 2.6 per cent), British Columbia (down 0.9 per cent) and the Northwest Territories and Nunavut, which together saw a decrease of 3.2 per cent.

Canada's nursing schools are simply not graduating as many students. "We've seen the growth in the number of [nursing] graduates slow down, so it's just under 1 per cent now," Ms. Porter-Chapman said. "This is after five years where the growth was between 6 and 12 per cent."

As well, the number of students admitted to entry-level nursing programs actually fell between 2009-2010 and 2010-2011, the most recent year for which CIHI was able to obtain national figures.

"Will the workplace feel it yet? Perhaps not. It might take a year or two to see these changes trickle into work settings," said Linda McGillis Hall, a professor in the faculty of nursing at the University of Toronto. "I think this report will actually bring this issue to the forefront again."

The Canadian Federation of Nurses Unions (CFNU), an umbrella organization that represents almost 200,000 nurses and nursing students from eight provincial unions, said the decline in supply may already be leading to increased overtime and absenteeism.

The CFNU's latest report found that nurses across the country worked more than 19 million hours of overtime in 2014, 20 per cent of it unpaid. Absenteeism was up too.

"The decrease in the nursing supply combined with an aging work force and fewer students admitted to [entry-level nursing] programs is a sign that our health-care work force is in transition," CFNU president Linda Silas said in an e-mailed statement. "To ensure patient safety and a sustainable health-care system, we need a national health human resources plan."