Ontario hospitals are falling further behind every year in their efforts to fill rising vacancies in nursing positions as they fail to stem the flow of staff walking out the door, according to data obtained by the Star that provides a unique glimpse at the staffing crisis in the health system.
The figures, collected by the Ontario Hospital Association, show resignations of registered nurses have doubled in the past five years and are the primary driver of growing turnover rates that are depleting hospitals across the province of vital staff.
Retirements have also increased during this time, but are nowhere near the rate nurses are resigning from full- and part-time positions, according to the data, culled from an OHA survey of Ontario hospitals in March. Portions of the survey were obtained by the Star through another source.
At some hospitals, the staffing crisis has only deepened into the autumn on the cusp of an expected wave of new COVID-19 cases along with a surge in seasonal respiratory illnesses.
And while the provincial government has worked to create more nursing positions and fill them — according to the Health Ministry, 8,600 nursing staff have been added to the health system since the start of the pandemic — the OHA data and the on-the-ground experience of hospital leaders struggling to fill shifts show it is not nearly enough.
Rising vacancy and turnover rates paint a picture of increasing demands on hospitals as nurses reduce their hours, quit their hospital jobs or leave the profession altogether.
“Concerning doesn’t even begin to describe it,” says Rachel Muir, a registered nurse who has spent more than 25 years working in the Ottawa Hospital’s birthing unit.
She says a combination of factors such as increased workloads due to staff shortages, longer hours and a lack of work-life balance is driving younger nurses to leave hospital jobs for agency work, where the hours and pay are better, or out of the profession, while more experienced nurses are taking early retirement.
“When your health-care workforce was already understaffed, to lose that many more nurses and to continue to lose them is frightening. Who is going to be there to look after us?”
To be sure, recruitment efforts are paying dividends: in addition to the more than 8,200 nursing staff the health-care system has hired over the past two-and-a-half years, Ontario’s nursing college reports that over the past year, it has seen a 3.6 per cent increase in the number of registered nurses, including those trained internationally — the fourth consecutive year of increasing registrations.
And just this week, the province announced a round of new measures aimed at boosting the number of health-care workers, including allowing nurses educated overseas to register in a temporary class with the nursing college so that they can work while becoming fully registered. There are currently more than 5,900 international nursing applicants without registration in Ontario. The province is also taking steps to make it easier for non-practising or retired nurses to go back to work.
This is no doubt good news. However, the Ontario-wide hospital vacancy rate for registered nurses, including those with specialties, such as critical-care nurses, was at 12.63 per cent as of March 1, 2022 — up from 4.85 per cent in March 2020, according to the OHA. A vacancy is defined as a position created by the hospital that remains unfilled.
Why, if we have more nurses in Ontario, are vacancy rates rising? Experts say there are a number of reasons.
The province says it has added more than 3,500 new critical care, acute and post-acute hospital beds that hospitals then need to staff, increasing the demand for nurses. As well, the pandemic forced hospitals to create new services, such as assessment centres and vaccination clinics, which also require nursing staff.
At the same time, hospitals are reporting very high turnover rates, which include resignations and retirements.
The OHA data shows that as of the end of February 2022, the Ontario-wide hospital turnover rate for nurses was 14.47 per cent — a 72 per cent increase since 2020. (This rate includes only permanent positions and does not include internal transfers or where employees moved, such as to another hospital or health-care provider.)
Anthony Dale, president and CEO of the OHA, says turnover and the increase in the number of beds and associated positions for more nurses “have resulted in an overall increase in the number of vacancies that have to be filled in hospitals to respond to continuously growing demand for hospital services, all while doing so in a competitive labour market.”
“This dynamic can be even more pronounced for some specialized health-care professions and also in small, rural and northern communities,” he said in an email to the Star.
The OHA data shows turnover is largely driven by resignations, which have more than doubled since 2016.
Nurses who’ve spoken with the Star say the increase in workload, combined with pressures of providing care in multiple COVID waves, is leading to burnout as they cover more shifts in tougher working conditions.
That can leave nurses feeling moral distress for not being able to provide patients with all the care they need, further increasing the risk of burnout, says Dr. Abi Sriharan, director of the System Leadership and Innovation Program at the U of T’s Institute of Health Policy, Management and Evaluation.
This, in effect, leads to a positive feedback loop: The more people leave, the bigger the workload for those who stay, which in turn leads to more people wanting to leave.
“And then the burnout causes you to feel hopeless, and then the only real way to fix it is to leave that environment,” says Sriharan, who is studying this condition in Ontario health-care workers.
At Sunnybrook Health Sciences Centre, the nursing vacancy rate is 18.6 per cent, a “much higher rate than what we’ve ever experienced in the past,” says Ru Taggar, the hospital’s executive vice-president, chief nursing and health professions executive. She notes staffing pressures, which she calls “persistent,” are typically highest for nurses with specialty training, including ICU nurses, for their regional cancer, stroke and trauma programs.
Retirements, nurses moving to different organizations or to roles with more flexibility, and those who want a change for personal reasons are among the reasons for Sunnybrook’s high vacancy rate, Taggar says.
And while the hospital is recruiting, it’s still facing a gap between the number of nurses it hires and the number who choose to leave, she says, adding that “for every nurse that comes in, 1.54 nurses leave.”
Retention efforts have led the hospital to look into creating more flexible scheduling and augmenting teams with other kinds of health-care providers, such as personal support workers (PSWs), to help lighten the load for nurses.
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Currently, Sunnybrook leaders meet multiple times a day to ensure they have enough staff to care for the sickest patients, which often involves shifting staff from one unit to another, something that wasn’t needed before COVID, says Taggar.
“Addressing the gaps … requires intensive discussions and planning and problem solving almost every hour to ensure that we are best meeting the needs of our patients. It goes into the weekends. It goes into the evenings and into the nights.”
Manson Locke, vice-president, people and chief human resources officer at Unity Health Toronto, said its network-wide staff vacancy rate was 8.95 per cent in the period between April and June of this year — about three times higher than in its 2018-19 fiscal year.
The network, which includes St. Michael’s Hospital and St. Joseph’s Health Centre, had to recruit more nurses early in the pandemic after expanding clinical services due to COVID, such as adding more ICU beds.
But in recent months, vacancies have been largely due to turnover and attrition, says Locke, noting that while the network has seen an increase in retirements, exit interviews suggest nurses are leaving due to the stress and burnout from high workloads.
Exit interviews also reveal nurses are sometimes leaving to move closer to family or to work part-time for better work-life balance.
“We’ve never seen the workforce have a stronger preference for part-time than we do right now,” Locke says. “It’s a big, big shift to what we saw four or five years ago, when most people in part-time or casual jobs would be striving to obtain full-time.”
To help retain nurses — and to fill a need within its hospitals — Unity has increased the number of registered nurses it supports through its critical care sponsorship program, with 90 now completing the program every year, up from 40 “in the years immediately prior to the pandemic,” Locke says.
The network pays for the nurses’ salaries while they are in school and, in partnership with Critical Care Services Ontario, covers their class fees.
Locke says Unity is considering similar programs for other areas with acute staffing vacancies, such as for operating room and emergency nurses and medical radiation imaging technologists.
He says staffing challenges across the system have intensified at the same time as demand for health care has gone up, in part due to the short-term goal of clearing surgical backlogs and long-term planning for an aging population.
“There are more nurses working in our sector than prior to the pandemic. But we are not ‘situation normal’ in terms of the demands on our health system.”
According to the OHA data, it’s not just nursing jobs that are seeing significant turnover rates. As of March 1, 2022, the Ontario-wide rate for what it classifies as service workers, such as registered practical nurses, PSWs, ward clerks and porters, had more than doubled since 2016 to 14.4 per cent, while turnover in paramedical jobs hit about nine per cent, up from just over six per cent in 2016.
At the same time, vacancy rates across these job categories have also increased. For example, the Ontario-wide vacancy rate for registered practical nurses in March was 10.2 per cent, up from 6.8 per cent from the same time in 2017. The PSW vacancy rate was 9.4 per cent, just under double what it was in 2017.
The Canadian Union of Public Employees (CUPE) estimates that roughly 47,000 health-care workers need to be hired in Ontario per year for the next three years to keep service levels where they are now.
To arrive at this number, the union made a number of assumptions, including that Ontario’s population would continue to grow, that the number of seniors using hospitals would increase every year, and that the overall hospital staff vacancies should be brought down to levels seen in 2015/2016. It also considered hires that would have to be made to deal with the current Ontario-wide hospital turnover rate of 14.95 per cent.
“Even 47,100 may not be enough given the impact of COVID, the flu and long COVID, which are expected to drive patient use of hospitals in the coming months,” said CUPE research representative Doug Allan.
In an email to the Star, the Ministry of Health said it has launched the “largest health-care recruiting and training initiative in the province’s history.”
“The Ministry of Health is working with partners in the sector to ensure a robust health workforce for the people of Ontario, now and into the future, and are implementing a human resources strategy that addresses staffing needs in the short, medium and long-term,” said spokesperson Bill Campbell.
Sriharan, the U of T expert in health human resources, says unless the health system changes the way it compensates nurses and restructures their workloads to have more flexibility and greater work-life balance, nurses will continue to leave the profession, no matter how many are recruited.
“The younger workforce coming through the pipeline is asking for a different work environment,” Sriharan says. “We’ve seen in our research that (the current situation) is driving people to say: ‘I’m leaving, and leaving early.’ ”
Ultimately, when senior- and mid-career nurses with their decades of knowledge and experience, and new nurses who are the future of the profession leave, patient care will suffer, says Muir.
And when fewer nurses are at the bedside, Muir says those who remain just “do what has to be done.”
“We no longer have time to sit and comfort. We no longer have time to comb hair and brush teeth,” she said, adding that the general public may not realize that tasks many would consider extra, such as back rubs, mouth care and bed changes, are integral to the job. “That’s when we do a lot of assessments. So when you don’t have enough staff, those assessments done through that type of nursing care are not done.
“It’s a crisis situation in which nobody wins and the most vulnerable members of our population suffer the greatest.”
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: email@example.com
Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie
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