CIHI report confirms we must act decisively to address the nursing crisis

Aug. 2, 2023

A report released today by the Canadian Institute for Health Information (CIHI) confirms what the Registered Nurses’ Association of Ontario (RNAO) has been saying year after year: Canadians are experiencing challenges with access to primary care and increased wait times for surgeries and procedures due to a worsening human resources crisis – and, especially, a severe shortfall of nurses.   

RNAO commends this new annual report and its effort to address from a pan-Canadian perspective the state of our health system. As the report notes, the COVID-19 pandemic – combined with a growing population – has placed enormous strain on health human resources.

Hospitals are at or over capacity, surgeries and procedures have been delayed and there is increasing need for mental health services. Adding to the pressures, health-care providers are burnt out and some are leaving their profession — most of all, nurses.

Surgeries were down across Canada during the first two-and-a-half years of the pandemic – 13 per cent on average. Ontario was worse, with a 15 per cent reduction in the number of surgeries – although not the largest percentage drop, this represents the largest drop in absolute number of surgeries across the nation due to our province’s larger population. “It is an enormous concern to RNAO, nurses and the public that jurisdictions like Alberta and Ontario are choosing to use this huge need for more surgeries as a lever to privatize health-care services in the province,” says RNAO President Dr. Claudette Holloway.

Instead of investor-driven for-profit care, Canada and Ontario must move vigorously with cost-effective solutions, and that means investing in our public hospitals for extended surgical care. “Every minute we wait, the more patients are paying for it as the surgery backlog grows and nurses are leaving the profession,” says Holloway. “Nurses need to be compensated fairly, full stop. And, they need to have safe workloads, healthy work environments and an expanded scope of practice to feel valued and appreciated.”

As noted by CIHI, the number of nurses working in some health-care settings has decreased –including the number of registered nurses giving direct patient care in hospitals and in long-term care homes. This validates RNAO’s findings from a survey of more than 5,000 nurses, revealed in its 2022 report, Nursing Through Crisis. Survey results showed that more than 75 per cent of Canadian nurses were burnt out, with higher percentages among hospital and front-line workers. Sixty-nine per cent of nurses said they planned to leave their position within five years. And, among those who indicated they wanted to leave their position, 42 per cent said they were planning to leave the profession altogether and seek opportunities elsewhere or retire.

“Although important steps have been taken by the Ontario government targeted to nurse recruitment, including adding new seats for all categories of nursing students and improving registration processes for internationally educated nurses residing in Ontario; retention strategies must speed up to address the nursing crisis,” urges Holloway. “We must create thriving work environments. This means ensuring safe workloads, addressing pay disparities across health sectors, expanding the scope of practice with RN prescribing and NP scope in mental health and substance use, as well as enabling opportunities for all nurses to advance in their chosen profession,” Holloway insists, adding that Bill 124 – a wage-suppressing bill – had a hand in tipping the nursing profession in Ontario into crisis during the largest pandemic in more than a century.

“While we applaud the Ontario arbitrator’s decision in July to increase hospital nurses’ compensation, it should never have gotten to that point,” says Holloway. “Now, there needs to be a laser focus on increasing full-time employment, as well as reducing the use of agency nursing services which impact continuity of care and staff morale.”

The CIHI report also highlighted that millions of Canadians are struggling to access primary care. “It is good that Ontario has the highest percentage of people who have a regular primary care provider (90 per cent as compared to a Canadian average of 88 per cent),” says RNAO CEO Dr. Doris Grinspun. Despite this, “the fact that Ontario has the largest population, means we also have the largest absolute number of people without a provider (10 per cent of about 14.2 million Ontarians in 2021: 1.42 million without a health provider),” Grinspun adds. “Moreover, more recent data by Innovations Strengthening Primary Health Care Through Research (INSPIRE-PHC) shows there were 2.2 million Ontarians without a regular source of primary care in 2022.  This is why we will continue to call on Minister of Health Sylvia Jones to release the funding for the six NP-led clinics that are ready to go and have been waiting for two years to get a green light,” urges Grinspun. 

While the CIHI report provides an average for each province, it hides the variations within the province. We know that the percentage of Ontarians without a health provider in rural, northern, marginalized and Indigenous communities is far larger than 10 per cent. All this demands a more vigorous response nationwide and in Ontario. It also reinforces the call to action issued by RNAO in its 2021 Vision for Tomorrow report to optimize NP utilization through more NP-led clinics and expand the NP scope of practice. NPs are a proven workforce to ensure health equity and access to health care in Ontario’s post-pandemic health system. “Without swift action, Canadians will live with an eroding health system delivering worse and worse health outcomes,” predicts Grinspun.

“NPs must be central to delivering primary care services in rural and remote areas and to marginalized and vulnerable populations, including Indigenous health – one of the CIHI report’s four pillars,” says Grinspun. “There are still only 16 NPs per 100,000 people in Canada, all while millions of Canadians are struggling to access primary care. There is a dire need for more NPs and NP-led clinics here in Ontario and across Canada.”

RNAO fully supports access to online health information, which the CIHI report highlights. The need for better data, better electronic health records and online access is a must says Grinspun, while emphasizing the need for privacy protections and protecting the use of this data for commercial and privatization purposes.

The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health system, and influenced decisions that affect nurses and the public we serve. For more information about RNAO, visit or follow us on TwitterFacebook and Instagram.

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Contact info

Victoria Alarcon
Communications Officer/Writer
Registered Nurses' Association of Ontario (RNAO)
Madison Scaini
Communications Officer/Writer
Registered Nurses' Association of Ontario (RNAO)