Canadian Nursing Shortage: Why Canadian Nurses are Leaving Permanent Staff Positions

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Canada's Healthcare System Crumbling

It's no surprise that the pandemic caused huge burnout and stress to nurses worldwide. However, nurses were burned out before this. Specifically in Canada, it was estimated in 2018 that by 2030, there would be a shortage of 117,600 nurses¹. Statistics state that in 2021 Canada had a growth in RNs of 2.5 %, in RPNs of 1.6%, and 3.6% of Registered Psychiatric Nurses from 2020².

Despite this rise of eligible Nurses to practice, the Health Care and Social Assistance job sector had the largest jump in open vacancies from 2019-2021, increasing by 40,800 open vacancies (59.9%), with the largest occupation increase in that sector being RN's and Registered Psychiatric Nurses. Their open vacancies increased from 10,400 to 22,400 (85.8%)³.

Canada's healthcare system has been falling short of what the population needs to sustain adequate patient care for a long time. The lack of nurse retention has been one tremendous contributing factor, which was affected much further during the Covid-19 pandemic. As this country is seemingly increasing the number of eligible nurses to practice, the problem still lies in retaining these nurses. Nursing is a very taxing job mentally and physically, but it is also gratifying when the proper resources are given, including enough staff to do the job safely. The country has needed more nurses for decades, and the pandemic has worsened that need.

Pre-Pandemic

Going back to the 1990s, contributing factors to the nursing shortage were:

A recession resulting in a lack of healthcare funds
An aging nursing population
Rising nursing education requirements
Increases in unregulated health staff positions

At the beginning of the year 1990, Canada was in a recession, forcing both the federal and provincial governments to decrease public funding⁴. The lack of funding greatly declined the amount of regulated practicing nurses. Without funding, no new full-time jobs for new graduates were available, and nursing positions were cut. Unregulated healthcare professionals like nursing aides and orderlies grew substantially in the '90s, essentially a cost-effective way to replace caretaker roles held dominantly by nurses prior. Nursing roles were not available due to the lack of funding but also because the available roles were retained by senior nurses (30% being over 50 years of age by 2003)⁵.

Without jobs available for new graduates, this forced Canadian trained nurses to leave Canada to work elsewhere, like the USA. It also deterred people from entering the profession altogether⁶. Another deterrent to people choosing not to enter the profession was the education requirements changed for RNs and RPNs. Previously a 3-year nursing college diploma was needed to become an RN, and RPNs were trained in hospitals. In the '90s, the education for RNs increased to a 4-year baccalaureate degree, and RPNs needed to receive education from a post-secondary institution⁷.

Canada's growing population did not have the number of nurses they needed. It was a challenging time to endure the profession. Nurses did not have the proper resources to do the job efficiently and safely. It was a stressful and unreliable environment to work in.

From the '90s Until the Pandemic

After the '90s, there wasn't a miraculous surge of hired nurses that allowed Canada to catch up. The situation remained relatively the same. Canada's nurses have been short-staffed for decades in almost every aspect of patient care.

Working bedside is physically rough on one's body, keeping up with the physical tasks that patients need (Ex. turning, toileting, ambulating). But many would argue that the mental effect of the responsibility of having higher workloads poses a greater demand than the physical demand, causing moral dilemmas when one cannot provide the proper/ safe care that patients need. To top this all off, many nurses work in this environment more exhausted because they work one, two or three overtime shifts past their full-time commitment in a pay period. Nurses make extra money working overtime, and it's available because units are usually short-staffed and desperate to fill the missing needs.

Wage Suppression in Ontario Months Before the Pandemic

Fast forwarding to more recent times, another contributing factor to the Canadian nursing shortage, specifically in Ontario, was a bill passed suppressing nurse wage increases to less than a 1%/ year increase. This bill, Bill 124, was passed in November 2019 by the Ontario Premier, Doug Ford, lasting until 2022. Little did we know that three months later, the need for nurses would become that much direr with the COVID-19 pandemic. With the stresses of nursing before Covid, a less than 1% wage cap made nurses feel undervalued, decreased staff morale and made them feel underpaid for a job that was very demanding mentally and physically. In 2019 when Bill 124 started, the recorded inflation rate in Canada was 1.95% and rose to 6.9% by 2022⁸. Nurses' wages only saw a 1% increase to the 7% increase in expenses in Canada. Where is the incentive?! Nurses don't work in glamorous, safe, or reliable environments; they work in high-stress and perform physically demanding duties. The government chose to and is still fighting today to suppress nurse wages. On November 29th, 2022, after labour organizations challenged the bill as unconstitutional under the Canadian Charter of Rights and Freedoms, the Supreme Court of Canada ruled it unconstitutional. The Ontario government is currently appealing this decision⁹.

The Stress of the Pandemic

At the beginning of the pandemic, nurses were praised in the community and referred to as front-line heroes. Still, Bill 124 exemplifies how Canadian governments thought of their nurses. If nurses' jobs are idolized and respected, why aren't they entitled to a fair raise? Covid-19 brought on a great deal more stress to practicing nurses. It brought on stress to everyone. But nurses had to work with patients who had contracted the virus, performing head-to-toe care, not knowing if they would catch it at work or bring it home to their loved ones. Covid-19 also made people very sick, and nurses are a part of the patient's frontline team caring for them and ensuring they're doing everything they can to keep patients alive. This amount of responsibility takes a toll on a person. Covid-19 was everywhere we turned. On the news, in public and in conversation. If it wasn't directly affecting people, it was still passively affecting them. Intensive care units saw a great deal more death during the pandemic.

Death is witnessed during a nurse's career at one point or another (usually, not always), some areas experience it more, but the magnitude of the deaths in hospitals was nothing like before. The amount of death tremendously impacted the stress contributing to nursing burnout throughout the pandemic. Other stresses that came with the pandemic were different role expectations from normal practice, changes to policies like the use of personal protective equipment, and changes to visitation policies which allowed harassment from patients' families to fall on nurses. A survey stated that nursing had changed forever for some, mentally affecting them so much that they wanted to change their job or step away from nursing completely, with the number one reason being increased stress and burnout for 70.9% of nurses. Concern for their mental well-being and then dissatisfaction with their jobs were the following reasons nurses wanted to leave¹⁰.

Nursing Retention Strategies: Are There Any?

The current nursing situation has grown bleak in Canada. The system has been unwilling to give appropriate resources and funding to staff needed positions and provide safe working environments for decades, and then March 2020 happened, which exacerbated this situation. The Ontario government's actions explain why nurses feel unsupported while overworked without proper compensation. The government appealing the Supreme Court's decision this past November is just another notch on the belt to how nurses feel unseen after the pandemic. So, if so many nurses are changing positions, retiring early, or choosing a new career, what is being done to keep our current nurses? The main thing that they can do for retention is to increase wages. Obviously, this hasn't happened yet.

There was one point in 2022 when the Ontario government sent out a 1-time bonus as a retention strategy, a payment of 5000 dollars in 2 installments. The payment was valid if nurses were practicing on March 31st, 2022, for the first payment and September 1st, 2022, for the second payment. Part-time and Casual workers could receive a prorated payment of up to 5000 dollars if they worked eligible hours¹¹. This one-time payment attempted to act as a retention strategy. Nurses were taxed almost half of this retention bonus. This lumpsum payment was a distraction from the real problem:

The government is unwilling to pay nurses fair wages for the expectations of the job and isn't keeping up with the astronomical cost of living.

Nurses feeling defeated, have been forced to look for a better way to earn appropriate income.

Private Nursing Staffing Agencies

So, if these nurses leave their full-time positions, how are hospitals staffing their units? What are these nurses doing with their specialties? Simply put, these nurses are still working as nurses, and getting compensated like working full-time, just not in a full-time permanent position. Baby boomers fit well into the aging population (currently aged 59-77); plus the decades-long surgical backlog, hospitals have needed staff more than ever with these increased patient loads. Private agencies have been around before the pandemic to staff line gaps in long-term-care homes and hospitals, but we know the staffing crisis increased significantly during the pandemic. With a greater need for nurses, private agencies were able to increase their rates and pay rates for nurses.

What is happening is that nurses are seeing the benefits of working as agency nurses, seeing double or more the rate of staff pay, having more flexibility to schedule shifts, and overall creating a better work-life balance. Some nurses keep their full-time staff jobs and choose to work agency elsewhere instead of picking up overtime in their home unit. Some are just working as part-time staff and also working agency on the side, and some have left staff nursing entirely, only working shifts through agency, sometimes even in their old staff unit. Doesn't this seem odd?

The government won't pay staff nurses a higher rate. Instead, they are losing them to another private organization, where they are getting paid double the amount to work the same job, essentially in the same hospital and identical unit. It seems a little crazy. Private agency nursing is another crisis, another expense that is unsustainable in the Canadian healthcare system.

In America, for-profit private systems have funds for agency nurses, providing higher rates and tax-free stipends. In Canada, the provincial government allots budgets for healthcare and receives some funds from the federal government. Canada is not a privatized system; this money comes from the public budget at some level. From pre-pandemic rates, Toronto's largest teaching and research hospital network, University Health Network, saw a 550% increase in spending in their 2022 fiscal year compared to 2018. In 2018 they spent 1.035 million on private agencies, and in 2022 they spent 6.7 million¹². As the government refuses to increase staff wages, the results end up paying nurses more privately. Make it make sense.

A Call to Action

Briefly reviewing some of the recent Canadian Nursing shortage history, the same problems still remain now as they did in the '90s. Nurses want fair pay and adequate resources to perform their job safely and efficiently. This isn't just nurses' problems. This issue is something the public also wants, to feel confident they are receiving the care they need and given it by individuals who can do the job. We're all trained appropriately here in Canada, but when patient care loads become too large, it becomes unsafe, and the capacity to care for more individuals starts to dwindle because there are too many tasks to do. Nurses can't keep up with the expectations. The patients end up suffering. Nurses and labour unions have been fighting and protesting this issue and have had some small victories, like the Supreme Court ruling on Bill 124, but we are not where we need to be yet. We have to keep fighting for what we deserve and for what our patients deserve.

The information provided focuses the majority on Ontario, but this is the largest provincial population in Canada, holding 14 million out of the 38 million total country population. There are a lot of nurses and patients in this province who need to see a change. The future of this profession and this country's health care depends on it. I hope to see nurses still go to their protests, fight for their earned rights, and fight to be respected and supported to do a job that they love. I want to see nurses be able to focus on nursing again, not focus on needing to fight for it.

References/Resources

1 Canada's nursing shortage at a glance: Canadian Federation of Nurses Unions

2 Nursing Statistics: Canadian Nurses Association

3 Job vacancies, second quarter 2021: Statistics Canada

4 Managing health reform through an economic downturn: Nuffield Trust

5 Employment trends in nursing: Statistics Canada

6 The Nursing Labour Market in Canada: Review of the Literature: Groupe de recherche interdisciplinaire en santé (santecom.qc.ca › GRIS)

7 Employment trends in nursing: Statistics Canada

8 Canada: Inflation rate from 1987 to 2028: Statista

9 Bill 124 declared unconstitutional: Miller Thomson

10 Experiences of health care workers during the COVID-19 pandemic, September to November 2021: Statistics Canada

11 Ontario Making Historic Investment in Provincial Nursing Workforce: Ontario.ca