The role and influence of nursing associations (NAs) are evolving, making their collective power more vital than ever. This reflective piece traces my professional journey from direct care to executive leadership, showing how active engagement in NAs shaped my career and deepened my understanding of their pivotal impact on the nursing profession and health policy across Canada. Readers are invited to consider a nursing leadership challenge and reflect on their own involvement with provincial/territorial NAs and the Canadian Nurses Association. Amid current system pressures, united and active participation in NAs is essential to strengthen nursing's voice and drive meaningful, lasting change.

Introduction

The purpose of nursing associations (NAs) is evolving, and their collective power has never been more essential. In this reflective piece, I will trace my professional journey – from direct care to executive leadership – illustrating how active involvement in NAs shaped my career and awakened me to the critical role NAs have in shaping both the nursing profession and nursing and health policy across Canada. I invite you to review the nursing leadership challenge posed near the end of this paper and reflect on your own journey and involvement with your provincial or territorial (PT) NAs and the Canadian Nurses Association (CNA). With today's health system challenges, it is critical that nurses and nurse practitioners (NPs) unite, engage and invest in their NAs to amplify our collective voices, continue to advance the profession and drive meaningful and lasting change. Throughout the journey, I will demonstrate how the CNA is uniquely positioned to use its platform with boldness, urgency and unshakable clarity for the profession, for health systems across Canada, and for the people we serve.

The Professional Practice Journey

I became a registered nurse (RN) because I wanted to make a difference in people's lives at their most vulnerable moments, as a proud and trusted professional. When I was asked to share my thoughts and insights for this paper and to focus on the “evolving role of nursing associations,” (D. Foster Kent, personal communication, August 21, 2025) my immediate thought went back to my fourth-year culminating course, NUR 400Y, Professionalism, taught by Gail Donner at the University of Toronto (UofT), Faculty of Nursing. During our class discussions, Donner reflected on her experiences and insights as executive director (1984–1989) at the Registered Nurses' Association of Ontario (RNAO). It was a privilege to learn about the power of nurses and the importance of joining my provincial NA and CNA.

As a new graduate nurse (NGN), I began to appreciate the power of NAs and their advocacy efforts to drive healthy public policy, support and amplify nursing excellence, demonstrate nurses' value and lead health system transformation efforts. Today, the CNA team, its members and partners regularly present the value and impact of NAs to students and collaborate regularly with the Canadian Nurses Students' Association. It is critical that all nursing leaders enculturate the next generation in understanding how NAs advance our profession (e.g., specialty certification credentials, professional development events or conferences, leadership development programs, quality improvement programs, CNA Code of Ethics for Nurses, publication opportunities in association journals and nurse-led research projects).

For my first RN position, I took a detour to Detroit, MI, and practised at Children's Hospital of Michigan (CHM), caring for infants and children requiring hospitalization for various complications from HIV infection and tragically, AIDS. I was inspired by the resilience of my patients and their families coping with this “new” disease process. I was also fascinated by the professionalism and power of the CHM nurses collaborating at all levels of the organization – leading and implementing evidence-informed strategies and solutions – to improve patient, team, organizational and/or system outcomes. From that NGN experience onward, I sought employment experiences where nurses are recognized as professionals and the impact of their continuing education, specialty knowledge and skills, expertise, intrapreneurial spirit and leadership are highly valued and rewarded. Today, the CNA Stellar Certification Program recognizes the efforts of nursing leaders and direct care teams that co-create safe, supportive and empowering work environments that are committed to high-quality care (CNA 2025a). This workplace excellence credential is awarded to acute care or long-term care settings that meet six required standards, including leadership excellence, education and career progression, resourcing, practice environment, optimizing care and nursing voice. These six standards were co-developed with an expert panel comprised of nurses and operational leaders and based on a literature review and jurisdictional scan.

By 1998, I was back in Toronto working at the Hospital for Sick Children (SickKids), and I crossed paths again with Donner, as she served as director of nursing education and research at SickKids. At our first encounter, Gail asked me if I was a member of RNAO and the CNA. I proudly confirmed that I had taken advantage of the automatic withdrawal feature from my SickKids pay cheque – it was a “given” that I would be part of both my provincial and national NAs. By 2000, I was actively engaged on RNAO committees and interest groups, which linked me to CNA's network of national specialty nursing associations (SNAs). I had my first abstract accepted for an oral presentation by the Canadian Federation of Mental Health Nurses (CNA affiliate and partner to RNAO's Mental Health Nursing Interest Group). This experience demonstrates how active participation in professional associations, supported by employer investment, can accelerate professional growth, expand networks and create meaningful opportunities to contribute to the profession. Today, the CNA team is revitalizing membership benefits and offers, crafting a membership engagement strategy and launching its next strategic plan to ensure that CNA is responsive to today's members.

Through my participation in RNAO's innovative Political Candidate Training Program (PoliTrain) and my active roles as a voting delegate, scrutineer and interest group representative, I gained a deep appreciation for how strategic engagement with policy makers and mastery of the political process empower nurses to shape health policy and lead systemic change. Since January 2025, CNA has produced eight major advocacy positions (e.g., pre-budget submission, federal election platform, Canada Health Act [1985] modernization), presented at the House of Commons and participated in more than 90 meetings with elected officials from all levels of government. Effective nursing leadership today is defined by the ability to advocate boldly and navigate the political landscape, with associations uniting to turn nurses' expertise into meaningful, system-wide policy change.

As my professional network grew, I was invited to join the Board of Directors of the Registered Nurses' Foundation of Ontario, where I was fortunate to develop a mentorship relationship with the legendary Dorothy Wylie – founding member of this journal and a former President of the College of Nurses of Ontario. Early in my career, I learned that NAs are catalysts for exponential professional growth; when nurses collaborate and amplify one another's contributions, our collective impact becomes unstoppable. Today, the CNA continues this legacy through the Inspire Nursing Leadership Program (INLP), a joint initiative with the Canadian College of Health Leaders that integrates the leadership principles of the Dorothy Wylie Institute (CCHL 2025). Watch for a revamped INLP program coming this year!

In 2002, I completed a policy internship supervised by Kathleen MacMillan, Ontario's first Provincial Chief Nursing Officer, who led the Nursing Secretariat within the Ministry of Health and Long-Term Care. MacMillan affectionately called my internship project, the Trojan Nurse Project. It focused on the value proposition of NP role integration into the Ontario health system. By then, I had joined the Nurse Practitioner Association of Ontario (NPAO), and I was actively engaged in its advocacy efforts. MacMillan strategized with the Registered Practical Nurses Association of Ontario (now called WeRPN), RNAO, NPAO and other nursing and health system partners – bringing forward, co-creating and implementing countless nursing policy initiatives and programs to benefit our profession. By 2004, I was serving as the Director, NP Programs at the UofT, Lawrence Bloomberg Faculty of Nursing, and I participated in the CNA-led Canadian Nurse Practitioner Initiative, a part of the Primary Health Care Transition Fund. Twenty years later, CNA continues to advocate for better optimization of the NP workforce, including full implementation of the Canada Health Act (1985) Services Policy across the nation. CNA advocacy complements the efforts of the nine stand-alone PT NP associations, the Nurses and Nurse Practitioners of British Columbia (NNPBC) and the Nurse Practitioner Association of Canada (NPAC). From advocacy to system-wide impact, NAs continue shaping the evolving role of NPs, with employers and other partners.

From 2014 to 2016, I served as the Senior Nursing Advisor and principal nurse advisor (PNA), an Assistant Deputy Minister-level position at Alberta Health, and I chaired the provincial nursing leadership network, which reported directly to the deputy minister. It was comprised of nursing leaders from all parts of the profession, including the College and Association of Registered Nurses of Alberta, the College of Licensed Practical Nurses of Alberta and the College of Registered Psychiatric Nurses of Alberta. The strategic foresight of the three NAs and the power of nurses was profound as we collaborated and co-created solutions that enabled me to lead policy imperatives and modernize nursing regulation (e.g., RN prescribing, expanded scope of practice for licensed practical nurses [LPNs]) while advancing the profession (e.g., NP role integration, provincial nursing strategy). I attended my first CNA biennial convention in Winnipeg, MB (2014), and to my delight, my doctoral dissertation supervisor and trailblazer, Gina Browne, was the keynote speaker. I also attended the two subsequent CNA conferences in St. John, NB (2016), and Ottawa, ON (2018). A decade later, it is still incredible to participate in pan-Canadian strategic dialogues about our collective future and experience the power of nurses – and focus advocacy and policy on unleashing the true value of the nursing workforce to meet population health needs. In September 2026, CNA will convene Canada's nurses and NPs together in Winnipeg, MB, for its first conference in eight years.

The International Council of Nurses (ICN) has been advocating for the establishment of the position of Government Chief Nursing Officer (GCNO) since the 1930s. “ICN firmly believes in the importance of this role in order to provide policy advice and support governments in strengthening the nursing and midwifery workforce; ensure cost-effective planning and sustainable delivery of health services; advance the agendas for universal health coverage and primary healthcare; and steer the development and implementation of health policy, strengthening of health systems and access to healthcare” (H. Catton, personal communication, February 26, 2025). In 2023, the Chief Nursing Officer (CNO) of Canada position was reinstated, due to the combined advocacy efforts of all parts of our profession, with bold leadership by CNA. In all communications with policy makers, CNA emphasizes the critical significance of the GCNO position in guiding policy changes for Ministers of Health and governments, as well as the essential roles they play in shaping health and nursing policy. Today, the CNO of Canada and the PT PNAs ensure that NAs are at the right table, speaking to the right people, bringing forward nurse-led strategies and proven solutions.

From 2016 to 2018, I served as the director, International Affairs and Best Practice Guidelines Program at the RNAO, and I developed first-hand experience in the profound impacts of RNAO's best practice guidelines (BPGs) and best practice spotlight organization (BPSO) programs on nursing excellence and improved patient, team, organizational and system outcomes – in Ontario, across Canada and around the globe. These programs have evolved since the 1990s and demonstrate the power of nurse-led innovations and their impact around the globe. Since 2019, I served in executive leadership roles first as a Chief Nurse Executive/Executive Vice President (2019–2020) at Thunder Bay Regional Health Sciences Centre/Health Research Institute and then as Chief Executive Officer (CEO) (2020–2024) at Canadian Mental Health Association – Simcoe County Branch. Those five years further informed my perspective on the “evolving role of NAs,” as I relied on all benefits of NAs – BPGs, BPSO, Code of Ethics, specialty certification, accredited education programs, nursing and health policy reports and professional network of experts to implement strategic and operational strategies and initiatives. Today, CNA, NAs and their partners unite as a national force, driving evidence-based policy, innovation and a bold vision for the future of healthcare.

I shared earlier that I entered the nursing profession to make a difference in people's lives, and today, more than ever, it is critical that CNA collaborates with all parts of the profession to collaboratively lead bold policy change and innovation. In 2018, CNA and its members unanimously passed a motion to include LPNs (or registered practical nurses in Ontario) and registered psychiatric nurses (RPNs), and now CNA represents all categories of regulated nurses, retired nurses and nursing students. Canada's health system is buckling, and the pressure is falling squarely on the shoulders of all nurses. We are the lifeblood of the system, but too often treated as interchangeable labour rather than as the highly educated, knowledge-based professionals and leaders we are. While we hold the system together every day, we are too often excluded from the rooms where decisions are made. Our collective power is formidable, and politicians and decision makers know it – nurses and NPs, retired nurses and nursing students represent over 500,000 individuals (1 in 57 voters) and more than $40 billion in purchasing power.

I have spent my first year as CNA's CEO, assessing CNA's evolution and the structural changes in governance affecting our national NA and the provinces and territories. The separation of the regulatory body from the professional association resulted in significant changes in CNA's governance structure and membership models (Guest and Villeneuve 2024). The automatic CNA membership benefit as part of annual registration fees slowly discontinued jurisdiction by jurisdiction over the past decade. We have countless conversations with nurses and NPs about CNA, who were astounded to learn that they were no longer CNA members due to the structural separations. CNA had one of the largest NNA membership bases at ICN for decades, with membership fees from the combined regulators and associations as guaranteed revenue to fund CNA advocacy, programs and projects in collaboration with its partners.

As of today, there are 22 nurse regulators and one government regulator for LPNs in Yukon. There are eight stand-alone PT NAs: (1) NNPBC; (2) Alberta Association of Nurses (AAN); (3) Association of Professional Nurses of Saskatchewan; (4) Association of Regulated Nurses of Manitoba (ARNM); (5) Northwest Territories and Nunavut Association of Nurses; (6) WeRPN; (7) RNAO; and (8) Nurses Association of Nova Scotia. In addition, there are more than 40 national specialty nurse associations/interest groups (SNAs/IGs), nine stand-alone NP associations (exception, NNPBC) and NPAC. Currently, CNA has 34 active SNA/IG affiliate members as part of the Canadian Network of Nursing Specialties (CNNS; CNA 2025c). Some provinces and territories also have specialty SNAs/IGs that align efforts with their national SNA and CNA counterparts. This mosaic of governance can fragment our influence unless we intentionally embrace it as a platform for unity, strategy and collective leadership. In 2025, CNA introduced several new membership models with new and “more affordable” fee structures to bring NAs and SNAs together. This includes the new affiliate plus model for SNA/IG members in CNNS, the organizational affiliate model for AAN and the Chapter model for the Province of Newfoundland and Labrador (CNA 2025b, 2025c).

Over the past year, CNA has implemented many new strategies to drive membership growth and improve membership benefits, including the introduction of the CNA store (CNA 2025e), and since November 2024, there has been a 134% growth in membership! Also, nursing student membership is now free, as belonging should never be a barrier. Recent publications (Grdisa 2025a, 2025b, 2025c) and CNA's Policy Roadmap for 2025 and Beyond (CNA 2025d) highlight the challenges nurses are facing and the critical importance of CNA's advocacy efforts, policy roadmap recommendations and long-standing nurse-led programs.

CNA's advocacy efforts (i.e., anti-racism and truth and reconciliation initiatives, ethical recruitment, integrated health workforce planning and nursing workforce optimization), flagship nurse-led programs (specialty certification, accreditation, Stellar certification, educational programming) and membership benefits (e.g., professional networks, professional development) continue to evolve in response to the needs and expectations of our members and the health system pressures. Also, CNA established the Canadian Academy of Nursing (CAN) in 2020, designed as a “comprehensive hub” to educate, empower and support nurses to lead, advocate, innovate and influence public policy that brings about sustainable change (CNA 2025f). It is essential that both CNA and CAN flourish for another century and that begins with you and your leadership.

Five Challenges to Nursing Leaders: Strengthening the Future of NAs

Strengthening the future of our NAs to advance the nursing workforce requires collective leadership. As you reflect on your own leadership journey, I encourage you to think about how you can contribute to these five areas.

1. Reimagine governance and embrace structural evolution: Nursing leaders must engage with and help shape the evolving governance and membership models of NAs, ensuring that they remain relevant, inclusive and financially sustainable. By embracing innovation in structure, leaders can turn complexity into opportunity, strengthening CNA and its partners as an integrated ecosystem that reflects the full diversity of Canada's nursing profession.
2. Engage directly in policy and advocacy networks: Leaders are challenged to collaborate with GCNOs and/or PNAs in their jurisdictions – understanding ongoing health policy initiatives and contributing nursing expertise where it shapes decisions and care system design.
3. Champion the visibility and authority of nursing leadership roles: It is not enough to have advisory positions in name only; leaders must advocate for the sustained, funded authority of GCNOs and PNAs as legitimate levers of structural reform and accountability in health systems.
4. Invest in and amplify NAs' collective impact: Leaders must model engagement – by joining, supporting, promoting and investing in participation in CNA and provincial, territorial and SNAs/IGs – and by leveraging the professional development programs and credentialing centre, position statements, policy reports and networks to influence decision making.
5. Cultivate the next generation of engaged nurse leaders: Nursing leaders are called to mentor and empower students and early-career nurses to see association involvement not as optional, but as a professional responsibility – essential for sustaining nursing's influence and shaping Canada's health future.

If nursing is to remain a transformative force within Canada's health system, every nurse must recognize the power that lies in unified, strategic advocacy. We can no longer afford passive engagement or fragmented structures that dilute our collective voice. The future of nursing – and the health of our nation – demands that we collapse silos, reject complacency and fully leverage all associations (i.e., provincial, territorial, national, global, specialty and interest groups) as the formidable, interconnected ecosystem they were always meant to be. Nursing leaders have proudly contributed at a global level for generations, and CNA and Canadian nurses are actively engaged in many of the programs and initiatives led by ICN and other global nursing bodies.

Our professional strength hinges on sustained investment – not just financial, but intellectual, political and relational. We need renewed, robust partnerships between employers, academic institutions, regulators, NAs, unions, Canadian Association of Schools of Nursing, Canadian Nurse Regulators Collaborative, Canadian Federation of Nurses Unions and all other partners. We need bold leadership at every table, from clinical practice to the highest levels of government. And we must insist on the full, funded authority of PNAs and the CNO of Canada – not as symbolic roles, but as levers for structural reform.

Every nurse – whether a nursing student, retired nurse, LPN, RPN, RN or NP – must ask: Am I a member? Am I engaged? Am I informed? Because nursing is not just a job, it is a profession rooted in purpose, impact and political power. To stand still now is to lose ground. If we want to shape policy instead of reacting to it, if we want health equity instead of erosion, if we want to lead rather than be led – then unifying, amplifying and investing in our NAs is not a luxury. It is a professional imperative.

The time to act is not tomorrow. It is now – just as nursing leaders paved the way in the past for our current generation, we must pave the way for future generations to come.

Correspondence may be directed to Valerie Grdisa by e-mail at executiveoffice@cna-aiic.ca.

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