Nurses represent the largest group of the health care professionals across Canada, and the world yet remain underrepresented at policy tables both provincially and federally. Nurses are highly educated professionals who work in all sectors, across every domain of practice with all populations and are integral to maintaining and promoting population health and wellness. Under previous governments, Canada had a Chief Nursing Officer (CNO) and while this position was eliminated during the Harper government yearsi, the revival of this key role is growing increasingly imperative. Under previous national CNOs, nursing education positions in hospitals were restored, the federal government focused funding on provincial nursing working conditions and Ministry Chiefs of Staff had access to complete databases of nursing information that could better inform their health care related findings.ii In 2019, Prime Minister Justin Trudeau indicated that he would be open to considering restoring this role. The reinstatement of such a position would recognize the role nurses play in achieving the United Nations Sustainable Development Goals (SDGs), to which Canada is a signatory, and would bring Canada to the same level as other countries that have focused these goals in the hands of senior nurses at the federal government level. Without clear nursing policy leadership, Canada has created a knowledge gap that at present remains unfulfilled.iii
In 2015, Canada along with 191 other nations attended the Agenda for Sustainable Development at then United Nations General Assembly. The purpose of this initiative was to rally global partners to end poverty, protect the planet and bring about peace and prosperity.iv Seventeen sustainable development goals (SDGs) were conceived and of those 17 goals, one was focused on good health and well-being calling for specific outputs such as reducing preventable newborn and maternity mortality rates, eliminating various epidemics and diseases, strengthening the prevention and treatment of substance use, and ensuring effective access to sexual health care services, among others.v vi Nurses are integral toward effectively combating each of these deliverables and a national CNO would better solidify the mandate around achieving them.
In addition, the World Health Organization (WHO) has been calling for countries to establish a national CNO position. In late 2017, WHO Director General Tedros Adhanom Ghebreyesus named Elizabeth Iro as the first CNO for the organization.vii In this role, Ms. Iro presents a nursing focus in key policy decisions. This role was created specifically in deference to the recognition of the necessity of including the nursing voice in achieving the lofty health goals resulting from the United Nations SDGs. Moreover, as a result of the International Council of Nursing (ICN) meeting in Singapore in 2019, Canadian Nursing Association (CNA) then president Claire Betker along with Dr. Sonya Grypma from the Canadian Association for Schools of Nursing and Lisa Little, ICN member, addressed a letter to Prime Minister Justin Trudeau calling for the reinstatement of a national CNO by the spring of 2020, at the urging of Dr. Ghebreyesus. Not only would the national CNO be a recognizable representative for nursing in Canada on the global front in achieving the goals of the SDGs, but this person would also be responsible for contributing to the WHO’s State of the World Nursing Report.viii
The State of the World’s Nursing Executive Summary specifically calls for the role of a senior nurse leader in government.ix The report, released in April 2020 by the WHO in collaboration with ICN and the Nursing Now Campaign, recommends the establishment and support of the CNO role in order to strengthen the national nursing workforce. The CNO would maintain a workforce database with information that could be used strategically at both the national and international levels to create programs to further develop young nurses into positions of leadership. This work done at the Canadian level could then be translated to the global stage to assist other jurisdictions as they seek to develop and expand nursing institutional foundations.
In the absence of a Chief Nursing Officer, nursing in our country is forced to be ‘reactive’ to events that impact health and wellness. This has been startling clear during the COVID-19 pandemic as information is changing rapidly as we learn more about COVID-19. While we have strong, capable and dedicated leadership from Canada’s Medical Health Officer, there is not a focus on the nursing aspects of response to the pandemic. These would include day to day care of COVID-19 patients, public health work related to contact tracing, public compliance with respect to health protocols and understanding of and compliance of vaccinations which will become particularly necessary during influenza season. In these cases, a national CNO could collaborate with provincial and territorial level CNOs and ensure that provincial and territorial actions were aligned and progressing adequately in accordance with federal and provincial mandates.
This Year of the Nurse and the Midwife presents a timely opportunity for the federal government to renew its commitment to creating this national CNO position. Outside of a global pandemic the national CNO role is critical but in the context of a global pandemic that is showing no signs of slowing, the reestablishment of a national CNO position would make it clear to nurses across the country that nursing leadership is critical.
i Pinkerton. Restore position of Canada’s top nurse, nursing group urges Trudeau, 2020.
https://ipolitics.ca/2020/08/28/restore-position-of-canadas-top-nurse-nursing-group-urges-trudeau/. Accessed September 2020.
ii Ibid.
iii Grympa. Why Canada Needs a Chief Nursing Officer- Now. https://nnpbc.com/why-canada-needs-a-chief-nursing-officer-now/#_ftnref2
iv Government of Canada. Canada takes action on the 2030 Agenda for sustainable development, 2019. https://www.canada.ca/en/employment-social-development/programs/agenda-2030.html. Accessed September 2020.
v Government of Canada. https://www.canada.ca/en/employment-social-development/programs/agenda-2030/health-well-being.html. Accessed July 2026.
vi United Nations. United Nations Sustainable Development Goals. https://www.un.org/sustainabledevelopment/health/. Accessed September 2020.
vii World Health Organization. WHO Director-General Dr Tedros appoints Cook Islands’ Elizabeth Iro as WHO’s Chief Nursing Officer, 2017.
https://www.who.int/news/item/12-10-2017-who-director-general-dr-tedros-appoints-cook-islands-elizabeth-iro-as-who-s-chief-nursing-officer. Accessed
July 2026.
viii Grympa. Why Canada needs a Chief Nursing Officer – Now. https://portal.nnpbc.com/why-canada-needs-a-chief-nursing-officer-now/. Accessed September 2020.
ix World Health Organization. State of the World’s Nursing Executive Summary, 2020.
https://apps.who.int/iris/bitstream/handle/10665/331673/9789240003293-eng.pdf?sequence=1&isAllowed=y. Accessed September 2020.