CIHI report on hospital staffing and its impact on patient safety demands faster action

Oct. 19, 2023

A report on hospital staffing during COVID-19 and its effects on patient care and safety confirms what the Registered Nurses’ Association of Ontario (RNAO) has known and been saying for years: Unsafe workloads and a shortage of RNs results in burnout, stress and compromised patient safety. RNAO again calls for stronger and swifter funding investments to build up Ontario’s nursing workforce.

The report by the Canadian Institute for Health Information (CIHI) released Thursday examined sick time, overtime and the use of nursing agencies, all of which increased dramatically during the pandemic, along with so-called preventable harms patients suffered while hospitalized.

“This report calls for urgent action and backs up with more conclusive evidence the findings in RNAO’s Nursing Through Crisis report,” says Dr. Claudette Holloway, the association’s president. “We heard from thousands of nurses who risked their own health and safety during the pandemic, endured staffing shortages, and experienced unsafe workloads. They suffered moral distress because they knew what they should have done for their patients but often couldn’t.” 

Holloway says nurses know the factors that are essential to delivering excellent patient care: Continuity of caregiver, safe and healthy workloads, and more RNs because research is conclusive that their expertise and scope of practice is central to detect and prevent complications and harm to patients.   

Last year, RNAO issued a follow-up report, which details how these challenges can be overcome. Nursing Career Pathways provides a roadmap for the Ontario government and health employers on how to build the nursing workforce; essential for the future of the profession and critical to ensuring patient safety, quality outcomes and a well-functioning health system.

Holloway says she was heartened to see that many of the recommendations in the CIHI report mirror those detailed in RNAO’s reports such as a commitment to full-time employment, ensuring health-care providers are able to work to their full scope of practice, provisions for work-life balance, and mental health supports. In particular, she applauds efforts in B.C. and Nova Scotia to establish evidence-based nurse-to-patient ratios.

RNAO CEO Dr. Doris Grinspun says a crucial step is addressing the over-reliance on nursing agencies. “The current model is detrimental to patient safety and to budgets and the only way out of agency work is to improve the compensation and working conditions of permanent employees. Investing in nursing is investing in safe patient care. We also need to harmonize upwards compensation across all sectors and create work environments where nursing careers are nurtured. If we don’t fast-track solutions, we will continue to see RNs exit traditional employment in favour of agency work or leave the profession altogether. We call on the government and employers to create workplaces that recognize and champion the knowledge and skills of RNs and ensure there are enough nurses to safely meet the needs of patients.”

While RNAO is encouraged by news that provincial and territorial health ministers vowed last week to tackle the country’s shortage of nurses and other health-care workers, Grinspun says RNAO wants to see concerted efforts to retain and recruit more RNs, including efforts to fast-track applications of internationally educated nurses that already reside in Canada. She points to statistics showing that Ontario’s RN deficit increased from 22,000 to 25,000 during the pandemic compared to the rest of Canada.

Grinspun also calls for “investments in nurse practitioners (NP), in sectors such as primary care in NP-led clinics, and in hospitals where they can admit, diagnose, treat and discharge patients. NPs are crucial to help improve access to the services people need for better health outcomes.”

“A health system can only function with a healthy workforce, including a well-supported nursing profession that provides a solid foundation for patient care and safety,” adds Grinspun. “We have a way forward. What we need immediately is substantial investments to retain and recruit nurses – and we need them now. Failing to act promptly will continue to hamper people’s health and disrupt the functioning of our health system.”

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 X (formerly Twitter)Facebook and Instagram.

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Contact info

Marion Zych
Director of Communications
Registered Nurses' Association of Ontario (RNAO)