U.S. President Barack Obama's health-care package, although in political limbo, has nursing experts in Canada concerned about another exodus in their profession if provincial governments aren't vigilant in retaining nurses. 

Canada will be short almost 66,000 registered nurses by 2022, says the Canadian Nurses Association. As of 2007, the country had 217,000 registered nurses delivering care but needed about 11,000 more, it added.

"We're always very concerned when we see potential of a renewed migration," said Rachel Bard, the CEO of the association.

"What is happening in the U.S. is a potential threat, because we already know that the United States is (going to be) short over 750,000 registered nurses (by 2020)."

House and Senate Democratic leaders in the U.S. are scrambling to see if they can salvage Obama's ambitious health-care plan, which Republicans almost universally oppose.

If it passes, the U.S. could embark on a renewed search for nurses abroad, Bard said.

The country's emergence from the recession could also play into a demand south of the border for nurses.

The worldwide recession has reduced inpatient admissions and decreased the demand, but Linda Aiken, a professor of nursing at the University of Pennsylvania, said her country will see a surge in the call for nurses as the economy improves.

"The U.S. Department of Labor estimates that over the next decade more jobs will be created for RNs than in any other job category," Aiken said.

Health-care stakeholders who have fought for almost two decades to keep nurses in Canada say that find those trends troubling.

In the early '90s it was called "nurse poaching," as recruiters snatched up health-care professionals from Canada looking for better opportunities in the U.S.

Doris Grinspun, the executive director of the Registered Nurses Association of Ontario, said the change happened quickly in the province. Nurses would simply "take their luggage and go," she said.

At the time, about 70 per cent of the positions for nurses in the U.S. were full-time, but in Ontario and several other provinces many nurses could only get part-time or casual work. They were often commuting between two or three different employers to make ends meet.

"We lost tons (of nurses)," Grinspun said, lamenting the years that the association spent trying to lure them back home.

Slowly, some provinces bounced back. The Ontario government introduced the nursing graduate guarantee, which secured full-time employment for young nurses. From 2003, Ontario increased the full-time employment of nurses to almost 70 per cent.

"The ghosts are there all the time," said Grinspun, as she compared recruitment agencies to vultures. "They are ready to find the weaknesses to poach the nurses for other places, because - remember - it's a business."

Plastered to the walls inside a Toronto subway platform a giant advertisement from a recruiting agency encourages nurses to work in Saudi Arabia.

For Grinspun, that's also a worrying sign.

"Always we will need to be very vigilant in Ontario," she said. "The moment that we let our guard down in terms of ensuring that our new graduates have full-time work, is the moment that we are opening the door for them to go somewhere else."

This is already the case in Alberta, where only 40 per cent of the graduating class this year will be able to find work. The remaining 60 per cent are searching outside the province for employment, said Mary-Anne Robinson, the executive director of the College & Association of Registered Nurses of Alberta.

The health regions cut budgets significantly last year and, as a result, there are less RNs available for patient care, she said.

"When you have a graduating class coming out that has student loans to pay they're going to look for a job and they need to find one," said Robinson.

Nurses in Alberta have become accustomed to seeing ads in newspapers enticing nurses to work overseas or in the U.S.

"Our concern is: Can we get them back?" Robinson said.

"The track record isn't good on getting them back."

Alberta has forecast a shortage of 6,000 RNs by 2012.

The nursing shortage in Canada is also a global nursing shortage, said Ivy Bourgeault, a professor at the University of Ottawa.

Bourgeault, who holds a research chair in health human resource policy at the university, said although she's not as worried as she once was about the effect of Obama's plan, she is still concerned.

"When we implemented medicare here in Canada there was an instantaneous shortage of physicians and so we had a huge influx from internationally educated countries," said Bourgeault.

Obama's initial push for universal health care has since been watered-down and likely won't have the explosive impact on the nursing shortage in the U.S. as once feared, she added.

Saskatchewan has sought out international nurses to fill its shortages. The province and the Philippines have signed memorandums of understanding to allow these nurses to come and work in Canada.