Thank you, Mr. Chair.

The Canadian Federation of Nurses Union, CFNU, is the largest nursing organization in Canada, representing over 250,000 frontline nurses and nursing students in every sector of health care.

Everyone in Canada knows that our health care system is very challenged. We would say it's in crisis.

The most serious challenge is the nursing shortage. According to a recent report from StatCan, there are 42,000 nursing vacancies. We have fewer than 500,000 nurses in this country. Beyond this, the working conditions of nurses are horrendous.

In our original submission, we discussed the government moving forward with the pharmacare program. Due to the time constraint and the role of this committee to advise the minister, we're going to focus on the nursing shortage.

Our first recommendation is to create a patient bill of rights. Because the condition of work is the condition of care, the bill should have three components.

First is a nurse-patient ratio, which refers to the number of patients assigned to a nurse. These ratios are an international practice and have demonstrated benefits in reducing the nursing workload, especially in the acute care sector. In California and Australia, we see a nurse-patient ratio with higher job satisfaction and better outcomes for patients. British Columbia and Nova Scotia have committed to this. Now we need to move it forward.

Second is to limit consecutive working hours for nurses. Currently, there's no regulation limiting how many hours nurses can work in a week. Fatigue is a well-known safety risk. Other industries with critical safety concerns have established regulations for work hours. For example, rail operators are restricted to 12 hours. Nurses can work double shifts up to 24 hours and nobody questions it.

Third is enforcing long-term care standards. The Government of Canada established long-term care standards. One example is to guarantee our seniors 4.5 hours of direct care. That brings seniors safety, but the standards need to be enforceable.

Our second recommendation is to call for a $1-billion fund to enact a nursing retention tool kit. This fund would enable provinces, territories, municipalities and local health authorities to work on nurse and health care worker retention through the tool kit recommendation. There are other actions this government can take to help students and young nurses, such as developing paid preceptorship and mentorship programs, as already exist in Australia.

We need to work toward phasing out the use of private, for-profit staffing agencies, which are sapping billions of dollars from our public sector. They are completely unregulated. Research shows that these agencies create staff turnover, deterioration of quality of care, and inequities in working conditions and salaries, and they destabilize our health care teams.

We also propose tax incentives for nurses, such as a $5,000 Canadian nurse tax credit modelled after the volunteer firefighter tax credit, which would help retain nurses.

Finally, Canada needs a health human resource strategy that will reduce the risk of future shortages in health care. I've been doing this job for 21 years and this is the third time I've appeared at different government committees talking about different waves of nursing shortages. We need to do better.

Nurses are asking you to fund Health Canada so we can include a patient bill of rights and retention and recruitment efforts in your recommendation to the Minister of Finance.

Thank you.