RNAO’s 70 per cent Full-Time Employment for Nurses Survey: Hospital and Long-Term Care Sectors
The 70 per cent Full-Time Employment for Nurses Survey was initiated by the 70% Full-Time Nursing Employment Working Group (FTNEWG), a working group of the Joint Provincial Nursing Committee (JPNC). RNAO led the project, which was implemented in July 2012 and targeted all employers of nurses in the hospital and long-term care (LTC) sectors. The findings of the report are relevant to nursing human resource (HR policy), and are targeted at government, employers, nursing associations and the College of Nurses of Ontario.
The purpose was to get a snapshot of progress towards 70 per cent full-time employment for nurses, and to identify opportunities and barriers from the perspective of employers. Of 762 known employers in those sectors, 275 sent responses which were included in the report. The response rate and engagement of respondents was indicative of strong interest in full-time performance.
The response rate for hospitals was 70.5 per cent and that for the LTC sector was 27.7 per cent, for an overall response rate of 36.1 per cent. The results were at times surprising. Summing of nursing head counts over all employers yielded totals that were large relative to the total population of nurses: for example, for hospital RNs, the survey summation equaled almost 89 per cent of all Ontario hospital RNs. This reflected two phenomena: broad coverage of the survey, and double counting of nurses with multiple employers. The size of the facilities responding was reflective of the sectors as well: there were 236 beds per responding hospital vs. an average of 203 in the province, while there were 137 beds per responding LTC facility vs. 123 in the province. The mean size of responding facilities was on average somewhat larger than that for the province.
Full-time shares of nursing employment were lower in the survey than they were in the province, for both sectors and for RNs (60.7 per cent vs. 65.5 per cent for all Ontario) and RPNs (47.8 per cent vs. 57.9 per cent for all Ontario). The results were the same for front-line nurses: frontline RNs (58.8 per cent vs. 63.4 per cent) and RPNs (47.5 per cent vs. 57.2 per cent) both had lower full-time shares than their non-frontline counterparts. Adjusting the numbers for double-counting of multiple jobholders can account for all of the discrepancy in the hospital sector, but not for all of the LTC sector. The substantial issue raised by double counting raises the consideration of an FTE (full-time equivalent) target, which would avoid that problem. A target of 80 per cent of FTEs delivered by full-time nurses would be roughly equivalent to 70 per cent full-time by headcount. This FTE target would be particularly useful at the facility level as a way of guiding progress to 70 per cent full-time by headcounts.
Nursing intensity as measured by nurses per bed was much higher in hospitals, for each class of nurse, ranging from over 25 times as many RN FTEs to over four times as many RPN FTEs. There was some modest positive correlation between the size of the facility and full-time performance for hospitals, but very little for LTC facilities.
Most respondents had not attained 70 per cent full-time, but very few indicated they were not attempting to achieve it. Respondents were keen to explain the challenges they faced in reaching 70 per cent full-time. The biggest single factor cited was funding – mentioned more frequently by LTC facilities. Scheduling was also commonly cited, especially around coverage for time off. Additional targeted government funding was generally seen as beneficial; certainly, the Nursing Graduate Guarantee (NGG) was widely used by respondents, particularly by hospitals. The NGG provides six months funding for full-time positions for recent nursing graduates, and is responsible for dramatically increasing full-time employment for new grads. The limitation for respondents was the availability of permanent positions. The Late Career Nurse Initiative (LCNI) allows late career nurses to spend 20 per cent of their time doing less physical activities like mentoring. This enhances retention of late career nurses and integration of new nurses. The use of LCNI was widespread in hospitals and reasonably widespread in the LTC sector.
- There has been significant progress towards 70% for RNs, and some progress for RPNs. The goal has been exceeded for NPs.
- There was keen interest among respondents in the survey, and a high response rate, particularly by hospitals.
- Reported full-time shares were lower than provincial averages for both sectors. A major explanatory factor is double-counting of nurses with multiple employers. Based on CNO aggregate data, double-counting can account for all of the discrepancy for the hospital respondents. It accounts for some of the discrepancy for LTC respondents, but not all of it.
- As with CNO aggregate data, the survey data show lower full-time shares for RPNs than RNs, and lower shares of full-time in LTC facilities (LTCFs) than in hospitals.
- Frontline nurses had significantly lower full-time shares of employment than other nurses, which has implications for continuity of care.
- Hospitals used nurses much more intensively (per bed and per client day) than did LTCFs. RN hours per client day in LTC were less than half of the hours recommended by the Casa Verde coroner's inquest.
- Changes in the way CNO reports nursing employment data has made nursing HR analysis more difficult. Problematic are the redefinition of full-time employment as 30 or more hours per week and no longer reporting headcount data below the aggregate level.
Get the full report with footnotes below.