As Ontario’s nursing workforce staggers under the strain of COVID-19, nursing organizations say little effort has been made to retain the province’s nurses. The focus on recruitment rather than retention and wage-restraint legislation are major factors driving overworked and stressed nurses away.
“The nursing shortage is horrific,” says a clinical program director in a large hospital in the Greater Toronto Area, who asked not to be identified because she did not have approval to speak publicly. “Anyone can have the best nursing recruitment strategies, but all hospitals are bleeding out. We are all vying for the same people.”
The nursing shortage has long been predicted by the Canadian Nurses Association as a result of changing health-care needs and an aging population. The pandemic has exacerbated the shortage, leading to understaffing and hospital unit closings. It has taken a significant mental-health toll on nurses and resulted in some quitting their jobs.
The nurse-per-capita ratio has been in steady decline in Ontario since 2014 as population growth outpaced the number of employed nurses. In 2020, Ontario had the lowest nurse-per-capita ratio in Canada, with 665 registered nurses (RNs) for every 100,000 people. The Canadian average is 814; Ontario would require 22,003 more working RNs just to reach the national average.
Ontario government investments this year are expected to add up to 2,000 new nursing school positions and allow hospitals to employ more than 4,000 health “externs,” nursing students supervised by nurses who work as unregulated care providers as part of health-care teams. While recruitment strategies are viewed as positive by many in the nursing profession, they say the strategies miss the mark.
The Ontario government has “been doing some things around recruitment, and that’s all well and fine, but they aren’t doing anything in regard to trying to retain the nurses they have,” says Vicki McKenna, president of the Ontario Nurses Association (ONA). McKenna estimates that thousands of nursing vacancies exist in Ontario, though no one can say exactly how many.
“Recruitment is cheaper than retention,” says a critical-care nurse with more than 30 years’ experience who asked not to be identified for fear of appearing critical of her employer. She says that before the pandemic, hospitals were already getting by with the bare minimum staff. COVID has turned “a crack into a crevice … If employees are leaving at unprecedented rates, there’s a reason.”
The reason, say nursing representatives, is working conditions. “What a nurse will decide upon will be the quality of nursing, or the area of nursing they want to be in,” Linda Silas, president of the Canadian Federation of Nurses Unions, told the Toronto Star. “But the key (factor) is the workload.”
Among other issues noted by nurses were lack of control of their day-to-day lives, lack of respect from patients/hospital leadership, being overworked due to other co-workers calling in sick or being unable to staff their departments fully (with no fewer patients), and workplace violence.
Job vacancies for registered nurses and registered psychiatric nurses in Canada in the second quarter of 2021 were up 85.8 per cent compared to two years ago, the largest increase among all occupations in the country.
Nurses become exhausted and demoralized when they see patients getting deficient care, Doris Grinspun, CEO of the Registered Nurses Association of Ontario (RNAO), told CP24. Normally, nurses in intensive-care units (ICUs) care for only one or two patients at a time. Because hospitals are so short-staffed, ICU nurses are often now caring for three or more patients, which can negatively impact health outcomes, says Grinspun.
About 1,000 nurses have indicated in an ONA exit survey over the past four months that they are leaving, or planning to leave, their jobs because they are switching to a different profession, retiring or have been recruited elsewhere, including the United States, where some hospitals pay up to $40,000 in signing bonuses.
Quebec is among several provinces offering recruitment or retention bonuses. On Sept. 23, Quebec announced a $1-billion plan to fix the province’s nursing crisis. The funds will pay nurses bonuses of $12,000 to $18,000 to stay in full-time jobs, encourage part-timers to go full-time and attract 4,300 nurses back into the profession. However, some Quebec nurses say this money won’t fix the problem because their concerns are about the province’s forced overtime and poor working conditions.
COVID has turned “a crack into a crevice.”
In Ontario, $10,000 recruitment bonuses are offered through the Community Commitment Program for Nurses. To be eligible, a nurse must not be employed in Ontario in the six months before being hired. That means the bonuses are going mainly to new graduates and to nurses returning to the field or from other provinces. For the mid- to late-career nurses who have stuck with it through the pandemic, no bonuses are available. ONA president McKenna says it isn’t good for morale when some nurses have received a bonus and are working side by side with others who have not.
McKenna says while Quebec is acknowledging all nurses’ efforts and the bonuses could help stem some of the flow, Ontario has not done the same. “At this point, (it has) refused to acknowledge or do anything other than to call nurses ‘heroes.’ I can tell you that that’s the last thing that nurses want to hear (from government). It’s not anything they want to write down and put on a bumper sticker.”
What nurses want is respect, say both McKenna and Grinspun. Nurses’ wages are currently constrained by Bill 124, passed into law in 2019, which ensures that increases in pay for public-sector employees reflect the fiscal situation of the province. Under this law, pay and other compensation increases are limited to a maximum of one per cent a year for a period of three years.
“Nurses are angry,” says McKenna. “We’re under this Bill 124 wage restraint … and other groups, primarily male-dominated professions such as police and fire, were exempt … This further just demoralizes what is predominantly a female workforce.”
At this point, Bill 124 should be repealed for symbolic reasons – Grinspun would like the premier to say to nurses, “I respect you for real, that bill is gone” – and the government should permit immediate wage increases for nurses. Repealing Bill 124 would also allow another key nurse-retention strategy – badly needed mental-health support improvements for nurses and other health-care professionals.
A recent arbitration decision that upheld Bill 124 enraged the ONA because of its “insulting one-per-cent total wage and compensation increase for the next year.” The ONA says it could not negotiate improved mental-health benefits because the costs are more than allowable under the legislation.
The Ontario COVID-19 Science Advisory Table’s recent report Burnout in Hospital-Based Healthcare Workers during COVID-19 says that more than 60 per cent of health-care workers surveyed in multiple Canadian studies have experienced severe emotional exhaustion. During the pandemic, nurses were consistently reported as having higher levels of burnout than other hospital-based health-care professionals, in Canada and internationally. The report says that elevated burnout and other indicators of stress will persist long after the pandemic.
“The pandemic has meant countless hours of overtime for nurses, back-to-back 12-hour shifts, and cancelled time off,” says Silas. “To top things off, many provinces are balancing their budgets on the backs of nurses through wage freezes, cutbacks and layoffs.
“We are done asking for the basics; we demand (government) action to fix the nursing crisis.”
McKenna says actions needed in Ontario include a human resource plan that addresses nursing needs now and in the future; secure employment for nurses that provides committed, full-time hours; competitive salaries and benefits; and the ability for nurses to care for patients according to the standard of care for which they are trained.
“We have to hold on to every nurse we can,” she says, “and that is about listening to the concerns they have about their ability to care for people and taking their concerns seriously.”