According to the Canadian Nurses Association, Canada's nursing shortage could reach as high as 60,000 full-time equivalents by 2022 (Tomblin Murphy et al. 2009). Retention and recruitment are known to be particularly difficult in rural and remote settings (Forbes and Edge 2009), and the health of Canadians in these settings is worse than average (CIHI 2006).

The nursing literature suggests that skills upgrading and professional development opportunities can help alleviate nurse burnout and thus promote retention (Ferguson-Paré et al. 2002; Messmer et al. 1995). Nurses who are satisfied at their workplace are likely to stay on the job, and development opportunities promote job satisfaction (Ingersoll et al. 2002; Lowe 2002; O'Brien-Pallas et al. 2001).

Skills upgrading is particularly advantageous for rural and remote communities, where a limited number nurses are often called upon to provide a wide range of specialized care (Tarlier and Browne 2011). However, given their limited resources, many rural and remote communities are unable to provide specialized training.

Two of the Research to Action (RTA) pilot projects provided opportunities for skills upgrading. These projects aimed to provide a nursing workforce better equipped to meet the needs of the local population while also promoting job satisfaction and so retention and recruitment.

• The Prince Edward Island project began providing certification in critical care and emergency nursing on the island. Previously, nurses were forced to travel to Halifax for the 13- and 15-week programs. This arrangement was onerous for nurses and employers alike. Project partners believed that bringing the programs to the island would enhance the learning culture and promote high-quality practice environments.
• The Nunavut project brought clinical educators and experienced staff from the Ottawa Hospital and staff from the Ontario Critical Care Education Network (CRI) to deliver specialized courses and workshops that address six identified areas of need, such as the management of chronic disease. Newly trained nurses were also supported through a mentorship program.

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