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Nurses, Nursing Associations, and Health Systems Evolution in Canada

Canada and the United States are geographically large federal states with strong central (national) governments. These governments connect to partially self-governing provincial, state, and/or territorial governments that pose ongoing tensions in health systems. Like most countries, both are confronted with the need to contain spiraling costs while delivering better healthcare and promoting better population health. At the same time, they are challenged by global authorities, such as the United Nations, to deliver universal healthcare, primary healthcare, respond to development goals, and address the structural drivers of health inequities. Data from both countries affirms public trust in nurses, with the expectation that they will act in the public interest to improve care and population health. In this article, we focus on Canada. First, we briefly describe the history of health system development and reform, and then consider nursing policy and advocacy in the 21st century. Finally, we offer examples of nurse-led solutions from Canadian nurses and nursing associations to build, overhaul and improve health systems and influence health policy.