Nurse numbers rise, but Ontario still lagging
May 6, 2011
Elvira Cordileone
SPECIAL TO THE STAR
As one of Ontario’s nearly 94,000 practising registered nurses, Miyuki Iwano’s story is emblematic of the progress — and the challenges — facing the nursing profession.
At 36, she’s young in a field where 43 per cent of her colleagues are over 50 and headed toward retirement. A further 25 per cent are over 40, according to a workforce report released in February by the Registered Nurses’ Association of Ontario.
Iwano works in the trauma and neurology unit in a Toronto hospital. She and her husband, Colin Rivers, a theatrical producer and agent, have two young daughters, Natsuki, 4, and Akane, 14 months.
The workload at home demands energy. So do her 12-hour shifts at the hospital, two weeks on days and two weeks on nights. The day shift starts at 7:30 a.m., with four to five patients in her care. On the night shift, she looks after six or seven.
“It’s hard. I don’t like doing the night shift,” Iwano says. “The older you get, the harder it is to adjust.”
Nurses bore the brunt of hospital budget cuts in the late 1990s, says Doris Grinspun, executive director of the RNAO. During that “dark age,” she says the province lost 10,000 RNs, and many of the remaining positions turned into part-time jobs.
After the Liberal government took office in 2003, it increased nursing positions by more than 9,000. It promised another 9,000 during its second term, but with an election set for later this year, it has yet to reach the half-way mark.
“It’s the economy,” says Deb Matthews, Ontario’s Minister of Health and Long-term Care. “We are increasing the numbers and we’re going to continue to do that. We’re getting there as quickly as we can.”
Matthews points out Ontario has 11,000 more nurses working today than in 2003, with about 5,000 employed in hospitals, 3,000 in long-term care, and others in family health teams and public health.
The workforce report puts RN employment at about 94,000, up from about 86,000 in 2004. A net gain of about 6,300 positions occurred between 2004 and 2008. But fewer than 2,000 were added between 2008 and 2010.
The association is “alarmed” by such a slow rate of growth, considering the large number of nurses nearing retirement age, coupled with a growing population.
In a pre-budget submission to the province this year, the nurses’ trade union, the Ontario Nurses’ Association, expressed fears that hospitals would continue to balance their budgets by cutting nursing positions.
“For RNs, this has amounted to the elimination of over 2,500 RN full-time-equivalent positions,” ONA states. “For our patients, this has meant the loss of 1,950 hours of care for every direct care RN position eliminated, and over 4.3 million hours of RN patient care cut since the spring of 2009.”
Having fewer nurses in the system puts a heavier burden on those who remain, ONA adds. That leads to higher rates of injury and absenteeism and ends up costing Canadian taxpayers $15.5 million per week, in addition to an overtime bill of $18 million per week.
“The link between registered nursing hours and patient outcomes is very clear,” says Grinspun.
Ontario has 72 nurses for every 10,000 people, compared to an average of 83 across Canada. Among provinces, it sits second from the bottom, just above B.C. In 1986, the Ontario ratio stood at 100. The lower the ratio, the more patients each RN must care for.
“For Ontario to catch up with the rest of Canada, it would have to add 14,481 RNs to its workforce,” says the RNAO report.
Nevertheless, Grinspun says Ontario has made significant gains in the proportion of full-time nurses in the system, which means better continuity of care and increased hours of care for patients.
Today, almost 65 per cent of the RN workforce has full-time employment — close to the 70 per cent target recommended by the RNAO. In 1998, only 49 per cent had full-time jobs.
Grinspun also applauds the province for changes that have given nurses a greater voice, including:
• Hospitals must now have a nursing executive on their boards.
• By 2012, all 37 public health units must appoint a chief nursing officer.
• An expanding role for nurse practitioners.
• New programs to attract and keep nurses, including an employment program for new grads, and education grants and fellowships.
Iwano trained as an RN in Japan and worked in a hospital in Tsukuba City, near Tokyo, for three years.
“I was dreaming of working as a nurse in North America but my English was too poor. I knew it would require a huge amount of effort in time and money. I didn’t know if I could make it,” she says.
She came to Toronto for the first time in 1998 for a week-long English course. By 2004, she had not only learned English but was a full-fledged registered Ontario nurse.
“The work is exhausting,” she says. “It’s very busy. But, at the same time, it’s really stimulating.”
Marketing the profession
After realizing how well the U.S. markets its nursing profession, Doris Grinspun got the idea to create an Ontario-based marketing tool for all things nursing.
“Ontario has so many programs, but we don’t market them well,” says Grinspun, executive director of the Registered Nurses’ Association of Ontario.
The association plans to launch a comprehensive website ( www.careersinnursing.ca) on May 13 to give would-be nurses and registered nurses in every stage of their careers vital information about professional opportunities.
It pulls together information normally hard to obtain because access is scattered among various associations and organizations.
The website will offer details on everything from how RNs can apply for educational grants to mentorships and job opportunities.
It has one section for students and teachers, another for mid-career nurses, and more on late-career programs and retirement planning.
Vignettes describe the programs and provide links for applying. RNs looking for jobs will be able to post resumés.