PATT - Reflections on Nursing in Manitoba

NB: I originally drafted this blog January 20, 2026, but only today decided to edit and post it. Part of the delay was dealing with the PTSD of my Manitoba nursing experience and moving on from my identity as a registered nurse. Ironically, the following news item was posted on CBC...and I would submit that nursing retention in Manitoba runs much deeper than just patient-nurse ratios: More Than Half of Manitoba's Nursing Gains Lost to Departures.

Very soon after my last blog posting, where I shared my decision to let my Manitoba nursing license go, the professional college sent out a notice about the impending deadline for renewing registration. I should say it was less a notice and worded more like a stern warning. Essentially, if one does not meet the deadline they loose their status as registered nurse and must apply for re-instatement. And applying for re-instatement in Manitoba is, essentially, reapplying all over again - a very expensive process during which a person is treated as if they are a criminal if even if just one aspect of the renewal is missed. In comparison, I had a colleague in New Brunswick who accidentally forgot to do her whole renewal and, rather than being stripped of her registration and dignity, she was simply asked to please do it as soon as possible having only to pay a modest fine. No heavy-handed, top-down hegemonic smack down but, rather, the conveyance of understanding, a modest consequence, and demonstrated caring of professionals without threatening dignity and livelihood.

One of my observations of the nursing college in Manitoba was it being one of the most draconian, punitive regulatory bodies I have ever experienced. And, having been registered in eight different jurisdictions (six Canadian and two in the US), I can speak with some experience on this matter. When I first applied in 2019 or 2020 the college was still pretty much in the Dark Ages regarding use of technology - most things were done by snail mail and the application dashboard, such as it was, very rudimentary and difficult to navigate. In fact, things were so slow and compounded by the COVID pandemic that my employment to the University of Manitoba (UM) was in jeopardy. None of the other provincial and state regulatory bodies I dealt with were at this level.

From my humble perspective, the nursing college in Manitoba was the least customer service oriented and most unfriendly (quite frankly, nasty) of all the regulatory bodies I have been registered with. Their rationale for being so draconian and punitive is about “protecting the public” - well, all the other jurisdictions have the same responsibility but evidently do not feel the need to crap all over their constituents. My guess is that many of the people who operate in the college have never worked outside of Manitoba and in other jurisdictions, so have become systematically entrenched in an attitude of control and dominance. It seems to be another example of the horizontal and vertical violence so prevalent in nursing and such a contradiction to the notion of a “caring” profession.

It might also be reflective of the old colonial dominance culture in Manitoba where it almost feels like any wrong doing must be punished with harsh consequences to make an example of people - to me it seemed there was a pervasive mix of conservative cultural and religious values underlying society to control natural-born Manitobans and force newcomers to either conform or forever feel as an outsider. Fear, rather than enlightenment, was the tool frequently used and, at the time of my move to Manitoba in 2020, this was manifest in the conservative government of the day. A personal example was simply trying to get healthcare insurance in Manitoba - because my spouse was in Quebec and not immediately moving to Manitoba, I was told to maintain healthcare coverage in my "home province". I was moving from New Brunswick where I had worked (five years with NB health insurance) to Manitoba, so had no other home province. I was meant (would have been forced) to meet with lawyers representing Manitoba's health ministry to plead my case until the Liberal federal minister got involved. Manitoba happily took my taxes but was neither portable in healthcare coverage or very friendly. I know of two other people who went through this.

In any event, when I got that last notice from the nursing college in Manitoba in Fall 2026 it made my decision to relinquish my RN designation in Manitoba so much easier. Whereas I had kept formal non-practicing status in both British Columbia and Ontario to that point, I certainly did not feel inclined to do so in Manitoba. My decision for this was that I am unlikely ever to return to Manitoba, certainly never as a nurse. From my experience at the UM, which I will explore in more depth in an upcoming blog, and my observation of nursing in Manitoba the role of a registered nurse is quite restricted and not as full scope as I have experienced in other provinces. In fact, I would say with the exception of expanded practice in the more remote parts of the province, the latitude of RN practice in Manitoba is well behind that in British Columbia and Ontario (possibly even New Brunswick and Nova Scotia). I believe there are several reasons for this, perhaps the main one being the dominance of medicine over all healthcare professions, particularly nursing. I believe a second reason was the separation of regulatory functions of colleges across Canada from their earlier dual representation with professional advocacy as associations that left a void to champion the agency of nurses. And a third reason for the lack in scope of practice (possibly slippage in historical scope?) is likely the lack of ability of nurses to cohesively work together to advance the profession.

In relation to the dominance of medicine over nursing and other healthcare professions, this is so evident in the hierarchy of professions not just in Manitoba but nationally and around the world. To be clear, I truly appreciate the historical development of medicine as a profession, the body of knowledge it has, and the wide scope of practice it embodies. I also admire their collective discipline in advancing their profession into a strong and cohesive political force, something nursing could well learn from. And the fundamental requirement for physicians to have genuine clinical practice each year to maintain registration assures a connection to realities of a practice profession. In contrast, a nurse can use the title RN as a researcher, educator, or manager without even having actually practiced clinical nursing after graduation. And they can be hired to an academic teaching role without any (or any expectation of) clinical practice unlike a physician that has become the practice in many universities.

However, any profession secure in its own entity should not feel the need to control and dominate other professional groups. And, quite frankly, to meet the healthcare needs of a population when medicine cannot do it all (there will never be enough general practitioners to meet the needs of all Canadians) as the burden of healthcare is imploding the public system, it would stand to reason that sharing the workload through collaboration is necessary. But dominance of medicine to control nursing and nursing practice is effectively structured in and reinforced by systems in Manitoba. For instance, the minister of health for Manitoba, who represents themself as having a nursing background, has promoted the perspective that every Manitoban needs a doctor. I would respectfully say not every Manitoban needs a physician for care; they need the most appropriate healthcare provider and in a timely manner. If nurses were well-supported in their scope of practice, things like wound care, screening, immunizations, and treatment of common symptoms they could be the first (sometimes only) level of care needed. One only has to look to other countries, such as Brazil, where primary and community nurses work to (and past) this scope.

There are also nurse practitioners being educated in Manitoba at great tax payer expense but are not being effectively employed in crucial areas, such as family practice. A nurse practitioner’s full scope (assuming competence) can independently do up to 80% of general care if well supported - this ability has been demonstrated repeatedly in scientific literature, mainly in the US where NPs have been employed for decades, but also through data from Ontario. But the use of physician assistants, who must work under the direction of a physician, are more often being used as an intermediary in direct care. This leads to lack of continuity and fragmentation in care, further eroding the health of the population as things fall through the cracks. Another example where dominance over nursing is reinforced is at the UM where a free-standing Faculty of Nursing was rolled under the Rady Faculty of Health Sciences as a College, a faculty named for a physician and whose principal deans have been physicians.

The separation of regulatory bodies for nursing from the professional advocacy branch is almost universal across Canada. And it is understandable why this is necessary since the dual role of regulation and professional advocacy is an irreconcilable conflict of interest - one cannot regulate members and advocate for them at the same time. That separation has essentially left a void for championing the agency of nurses since professional nursing regulatory bodies have became solely dedicated to the regulation of nursing professionals and, in some cases, assumed almost autonomous control outside of government oversight. Some may think that nursing unions fill the gap of advocacy; however, a union’s primary mandate is to represent the employment interests of its constituents (i.e., wages, benefits, working conditions, etc.) and not, per se, advocacy for the profession. In any case, not every employed nurse is unionized.

In most provinces, the foundation for a professional advocacy body had to be rebuilt from scratch with no infrastructure support and no funding since, up to the separation from regulatory bodies, infrastructure was shared and the fees paid by nurses usually covered the advocacy branch. And, at the time, there was a somewhat unified voice through the Canada Nurses Association (CNA). But then came the very deliberate choice of some provincial advocacy bodies to operate separately from CNA and to, essentially, run competition for membership fees - nurses are faced with paying additional dues to more than one advocacy body in addition to annual registration fees. This fracturing of loyalties and finances has ultimately weakened the collective agency of nurses across Canada but also created political fiefdoms in some provincial jurisdictions and little support in other provinces and territories.

When in Manitoba, I had an ambivalent feeling about the Association of Registered Nurses of Manitoba (ARNM) as I did not feel it offered much in support for me and I did not see them politically active with the government in power. And, when a group of us approached ARNM for website space that had earlier been offered to represent a chapter of community health nurses, this was suddenly not possible for their very constituents. The only benefit I appreciated from ARNM was the group discount for liability insurance, but in the end it was cheaper to buy that insurance on my own rather than pay for a membership I did not feel had value.

Finally, with respect to the general lack of cohesion of nurses within Manitoba, there seemed little ability to collaborate and effectively move the profession, as a whole, forward. I will say this is not a phenomenon unique to Manitoba - it is pretty much a challenge across Canada as highlighted by the fragmentation I note in the previous paragraph. But if a provincial professional advocacy body has no room to incorporate and support its various nursing constituents, then what possibility is there for a coordinated and collective effort to advance nursing practice? As I have described in earlier postings, the collective nursing profession seems to be obsessed with playing the oppressed victim to medicine, oppressing each other with horizontal/vertical violence, and maintaining the perpetual schisms between the academic ivory tower (out of touch with, if ever part of, clinical practice) and frontline nursing, rather than unifying.

During my time in Manitoba from 2020 to end of 2025, I not only observed these dynamics but experienced some of it firsthand. I was one of those nurses who had to apply for re-instatement when one component of my annual renewal package did not make it in on time (proof of my liability insurance that I was able to get done before my registration expired to no avail). Until I went to work at the UM I had maintained clinical connections through clinical practice or placements with students in community, but I was not allowed to do that as a tenure-track professor at UM. I worked with professors in nursing at UM who had absolutely no clinical experience (one who proudly proclaimed it) and I came with almost 20 years full-time experience (mostly in community health) and this was not valued at all. In fact, I was actively blocked from teaching in my area of expertise and not assigned graduate students needing that expertise.

I would go so far as to predict that these dynamics are slowly causing the death of the registered nursing profession in Manitoba rather than raising it up. Perhaps it is all part of a political strategy by governments meant to oppress and muzzle registered nurses. Afterall, it is cheaper to hire licensed or registered practical nurses who, as it happens, are nearly educated up to the level of registered nurses from the old diploma programs. There are the laws that separate regulation from advocacy. Lack of portability of experience from one sector to another within a province. Institutional policies to limit a nurse’s ability to speak publicly…consequences tied to both employment status and retention of title.

But if physicians are able to collectively mobilize with enough power to protect its own (with a few exceptions), why is it nurses cannot do the same? I believe part of the fundamental problem the nursing profession has in getting its collective act together lies within its own inability to overcome its hegemony and horizontal/vertical violence within its own house. And, methinks, it is now far too late in the game for the profession to change. No, the issue of patient-nurse ratios is not the only, or main, reason people are leaving the profession - it has more to do with the cultures and work environments that nurses have cultivated over the decades that makes remaining in the profession unbearable.