Nurses are ready to advance reconciliation. Systems need to support them

Ninety-one per cent of nurses who responded to a Canadian Nurses Association survey say they are familiar with reconciliation. They want to deliver culturally safer care for First Nations, Inuit, and Métis Peoples, and they know why it matters. The harder question is whether the systems around them are equipped to support them in doing it well.

That gap between commitment and capacity is what the Canadian Nurses Association (CNA) set out to address with the release of The 4 Streams of Reconciliation: CNA's Action-Oriented Framework—a practical guide co-developed with Indigenous nursing leadership. It’s not a statement of intent, but a structure for measurable change. As part of the framework, we are calling on the federal government to invest in the infrastructure nurses need to deliver culturally safer care.

Doing that work honestly requires naming something directly. As part of the colonial health system, nursing has a history inseparable from the oppression of First Nations, Inuit, and Métis Peoples. Nurses worked in residential schools, Indian hospitals, and other institutions where neglect and abuse occurred. The profession upheld policies of assimilation, excluded Indigenous healing practices and knowledge systems, and in many cases, continues to contribute to the entrenchment of anti-Indigenous racism and deep mistrust of health systems. This reality is not a backdrop to this framework. It is the reason this framework is necessary.

Accountability begins with truth.

The data from our national engagement process reinforces what nurses already know from practice. Of the 327 nurses who completed our survey, 55 per cent identified systemic racism as a top barrier to delivering culturally safer care. Fifty-four per cent pointed to insufficient education and training, and 51 per cent cited lack of infrastructure and support. These barriers are not simply matters of individual intent. They are rooted in systems, policies, education gaps, and infrastructure that do not consistently equip nurses to advance reconciliation and provide culturally safer care.

When nurses are supported with formal training on Indigenous health and cultural safety, confidence in delivering culturally safer care rises by 31 percentage points. But individual training and effort alone cannot transform health systems rooted in colonial foundations. Nurses are ready to learn, and that learning must be backed by system-level policy change, infrastructure, leadership and accountability.

And yet, urban nurses—the majority of the profession—have not been consistently supported with access to these kinds of resources and supports. This is not a problem contained to remote or rural settings. It is a national gap, concentrated in the places where the greatest volume of nursing care is delivered every single day.

CNA’s framework is organized around four streams—accountability, advocacy, anti-racism, and allyship—to reflect what nurses and Indigenous health leaders told us, consistently and directly, through surveys, interviews, focus groups, seven regional conversations across Canada, and four validation sessions with Indigenous-led organizations. Participants were explicit: they had seen enough symbolic gestures. They need tools they can actually use in their workplaces, in their practice, and in the work they are already trying to do.

The framework was co-developed with Indigenous nursing leadership, guided by CNA Indigenous policy analyst Hilary Fry, who is a Labrador Inuk nurse, and an advisory group of eight First Nations, Inuit, and Métis nurses. This is not a framework produced about Indigenous Peoples. It was produced with them.

Reconciliation within health systems requires federal partnership, not just organizational will.

CNA is calling on the federal government to take three concrete actions:

1. Expand access to culturally relevant education and training that addresses anti-Indigenous racism—including support for "The Path: Your Journey Through Indigenous Canada", CNA’s course on the history and contemporary realities of First Nations, Inuit, and Métis in Canada—so that nurses everywhere have what they need to consistently provide culturally safer care.
2. Renew and expand the Indigenous Research Chairs in Nursing program to ensure Indigenous-led research and innovation can grow in every region of the country, including Inuit representation that remains critically underserved.
3. Strengthen the Indigenous health workforce, especially nurses, through sustained, distinctions-based investments that dismantle systemic barriers and support Indigenous nurses and health workers across roles and settings for the long term.

These are not new asks. They align with what Canada has already committed to over the last decade: the Truth and Reconciliation Commission of Canada’s (2015) Calls to Action 18 to 24, the United Nations Declaration on the Rights of Indigenous Peoples Act (2007), and the National Inquiry into Missing and Murdered Indigenous Women and Girls’ report, Calls for Justice (2019). The commitments exist. What’s missing is the urgency to act on them.

Canada has approximately half a million nurses. They are in all parts of the continuum of care. They see, every day, how systems and policies shape people’s health and well-being. They are ready to do this work—and they shouldn’t have to do it without the tools, infrastructure, professional development and growth opportunities, to do it well.

The 4 Streams of Reconciliation is CNA’s commitment to do our part, embedded in our strategic plan, with public progress reporting and meaningful oversight. Credibility will be earned through action.

Valerie Grdisa is the chief executive officer of the Canadian Nurses Association.

The Hill Times