Briefing Note: Strengthening the Nursing Workforce for a Stronger Health Care System
1999 was a watershed year for nursing in Ontario. After a period of years of benign neglect, during which RN employment growth was stagnant while Ontario's population continued to grow and age, the mid - to late 1990s brought thousands of nursing layoffs, as then Premier Harris infamously likened nurses to hula hoops. A tough nursing HR situation dramatically worsened: workloads spiked for an aging nursing workforce, while enrolments in nursing schools were slashed and many thousands of RNs left the province or the profession. Only half of all RNs had full-time employment. Ontario earned the dubious distinction of having the worst RN-to-population ratio in the country, needing 13,000 RNs just to the catch up to the ratio for the rest of the country. Burnout was rampant and the profession was in dire straits. Nurses demanded and got a Nursing Task Force, whose 1999 report signalled a turning point in Ontario policy towards nursing. The government accepted the recommendations in the report, and was able to deliver partially on some of them. The McGuinty government made very substantial commitments to nursing, and has made significant progress in stabilizing the nursing workforce. But, recent messages from the Premier are creating fear amongst nurses and may once again destabilize the profession. This must be avoided at all costs as the damage would be irreparable.
As Ontario weathers stormy economic conditions it is particularly urgent that the government invest in the people, communities and infrastructure, including health care, of this province. That means, more than ever, the government must keep its promises to strengthen nursing.
Issue: Keep the Promised Additional 9,000 Nursing Positions On Track
RNAO calls for:
Issue: 70 per cent Full-Time Employment for RNs
RNAO calls for:
· Achieving the goal of 70 percent of nurses working full-time by 2011.
Issue: Full-Time Employment for all Nursing Graduates in Ontario
RNAO is pleased that the McGuinty government remains committed to:
· Continuing the guarantee of full-time jobs for new nursing grads, and, importantly, working with employers to ensure continuation of full-time employment for these new grads after the six months of government funding ends.
· In February 2007, the government announced an $89 million new nursing graduate guarantee program. Preliminary statistics show that 86 percent of participants retained their positions after their seven-month guaranteed period ended.
· We know that most new graduate RNs need and want full-time employment, but in the past most were unable to secure it. This made it very challenging for new graduates to develop clinical expertise and work attachment. The result was under-utlization of knowledge and skills, and an exodus from Ontario to other jurisdictions. Things have improved of late for new Ontario RNs, with those securing full-time employment rising from 39.1% in 2005 to 58.9% in 2007 and 75.7% in 2008. However, continued progress is required, particularly in light of the announced delay in creating 9,000 additional nursing positions. In order to attain 70 percent full-time RN employment, Ontario will require far more than 70 percent of new graduates to obtain full-time employment.
Issue: 80/20 Program for Late Career Nurses
RNAO calls for:
l Supporting innovation and healthy workplaces, and enhancing retention by providing funding that would allow participating institutions to offer an 80/20 option to late-career nurses (aged 55 and over).
· The 80/20 program is an innovative program that provides full-time, experienced RNs with the opportunity to spend 80 percent of their time in direct patient care and 20 percent of their time in mentoring or other professional development activities. This program will open up full-time positions for new graduates and help keep experienced nurses in the workforce. In trials to date, results have been very positive: 30.2 percent of respondents in one study indicated that their retirement plans had changed as a result, while another study showed reduced overtime hours, low sick time, no rise in variable direct labour costs, and higher patient satisfaction.
Issue: Equity for RNs Across Sectors
RNAO calls for:
l Equitable remuneration and working conditions for RNs working in the acute care, primary care/family practice, home care and long-term care sectors.
· There is a need to address the great variation of remuneration and working conditions across sectors. A shift from an illness-based model of care to a preventive one will require a shift of nursing services out of the hospital sector and into the community, yet wage differentials are a disincentive to nursing employment in home care. This sector has lost 27 percent of its nursing workforce between 1998 and 2004, and saw an increase in the share of older nurses working in the sector. Disparities in compensation from one public health unit to another and employment instability were identified as recruitment and retention issues for the public health workforce, a majority of which is comprised of public health nurses. To meet the increasingly complex needs of clients in long-term care settings with appropriate staffing, it is also essential that nurses in this sector receive comparable remuneration to the acute sector. In summary, to retain and attract RNs across all sectors, inequitable gaps in remuneration and working conditions must be urgently addressed.
Issue: International Recruitment? No: Let’s keep a Made-in-Ontario strategy
RNAO is pleased that the government remain committed to:
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