RNAO has the strategy for government to adopt in wake of auditor general report

Dec. 7, 2023

Audits of four core areas of Ontario’s health-care system – emergency departments, long-term care (LTC), Northern hospitals and Public Health Ontario – reveal a system with longstanding problems, according to the auditor general of Ontario’s (AG) 2023 annual report released on Dec. 6. The government has acted upon some solutions urged by the Registered Nurses’ Association of Ontario (RNAO), such as registered nurse (RN) prescribing, better registration processes for internationally educated nurses and more nursing education seats. However, core problems persist – notably, the failure to fund appropriately and sufficiently. The consequences: Reduced access to health care, lower standards of care and, ultimately, higher costs through nursing agency work.

RNAO has repeatedly called on government to respond to the staffing crisis. In its 2023 Nursing Career Pathways and 2022 Nursing Through Crisis: A Comparative Perspective reports, RNAO underlines the need to retain and recruit nurses as the source of the staffing problem. The increased use of agency nurses and for-profit clinics are symptoms of this crisis. Solutions include offering full-time positions, competitive compensation, safe workloads and professional development opportunities. “Overuse of agencies to address staffing concerns in hospitals, LTC and other sectors leads to much higher costs for poorer standards of care as well as lower access to care,” says RNAO President Dr. Claudette Holloway. “Investor-driven clinics offer lower standards of service for higher costs and decision-making distorted by profit motives. The lessons learned have come at a great cost to Ontarians in need of health care,” Holloway adds.

The AG’s report notes that “one in five emergency visits involved patients who went to emergency for non-urgent issues because they did not have access to a family doctor or other services.” This leads to overwhelmed emergency rooms, longer wait times and the persistence of hallway health care. “These circumstances are unacceptable given the innovative primary care models involving nurse practitioners (NP) that RNAO has offered to the government,” says RNAO CEO Dr. Doris Grinspun. In 2007, 26 publicly-funded and not-for-profit NP-led clinics opened in Ontario, serving tens of thousands of patients with outstanding clinical and health outcomes, yet many additional clinics – including ready-to-go teams in Orillia, Peterborough and Ottawa – are waiting for the green light and funding to open.

“NPs are waiting on the sidelines while their proposals are collecting dust on the minister of health’s desk, all while more than two million people in Ontario are without a primary care provider and only one in three Ontarians have timely access to care when they’re sick,” says Grinspun. “The government is sitting on solutions that could decrease costs and improve the health of thousands of Ontarians, leading nurses to ask: what is the hold up?”

The AG also pointed to the absence of a health-care strategy for Northern Ontario that addresses the region’s unique needs, including challenges related to geography, staffing, and Indigenous health. In 2015, RNAO had outlined 23 recommendations to help the government build such a strategy in Coming Together, Moving Forward: Building the Next Chapter of Ontario’s Rural, Remote & Northern Nursing Workforce. These recommendations included programs to increase access to nursing education, infrastructure renewal, and growth in rural and remote communities, and strategies to address compensation and benefit inequities for nurses between the community (including primary care) and hospital sectors.

“I was honoured to visit Pikangikum First Nation last week and saw firsthand the unwavering commitment and aspirations of its people,” Grinspun shares. “I saw the spark of pride in their eyes for the outstanding work they do, while struggling due to improper supports, including lack of electronic health records and overwhelming paperwork.” Northern regions, including remote communities, must immediately get access to electronic medical records. They would also benefit from a “Grow Your Own” nursing initiative, as detailed in RNAO’s Nursing Career Pathways report. This initiative would bridge Indigenous nurses through career pathways in nursing and provide primary care through NP-led clinics and Aboriginal Health Access Centres. “Such opportunities would allow for Indigenous nurses to help improve access to primary care in remote areas and Indigenous communities. It would also bring hope and health to Indigenous youth,” adds Grinspun.

Despite lessons from the COVID-19 pandemic, LTC and Public Health Ontario still face staffing challenges and inefficiencies, according to the AG. “Progress has been made such as increasing the number of NPs and introducing evidence-based RNAO Clinical Pathways,” says Holloway. Yet, the hours of direct nursing and personal care remain insufficient. Although homes have collectively reached interim provincial targets outlined in the Fixing Long-Term Care Act, 2021, at least a quarter of homes were unable to meet the staffing targets. “This shows that instead of a provincially targeted average, what is required is a minimum standard to be met by each home,” Holloway adds. To make matters worse, Ontario LTC homes currently have an average RN vacancy rate of 11 per cent, with up to 10 per cent of direct care hours provided by agency staff. As per RNAO’s 2020 Nursing Home Basic Care Guarantee, the AG comments on the high levels of acuity in LTC and the need to provide quality nursing care through safe staffing ratios.

Public health has yet to run in a coordinated and effective way, as noted by the AG, and what it requires is increased and sustained funding to rely on. “We are saddened that the government eliminated funding for the 625 public health nurse positions across Ontario schools that were introduced in the peak of the pandemic,” says Holloway, adding: “Instead of helping public health get ahead, this move perpetuates the sector’s challenges, with more people trying to access under-resourced primary care.”

Holloway concludes: “The health system needs to be a well-oiled machine, yet it’s currently running on fumes, as shown by the AG’s report. RNAO remains steadfast in our eagerness to continue working with government to make the health system work for all Ontarians.”

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

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