As Ontario’s Ministry of Health and Long-Term Care continues issuing medical directives and information materials to reassure Ontarians that nurses and other frontline health care workers are prepared to contain the spread of infectious disease in the province, the latest statistics from the College of Nurses of Ontario suggest that our nursing workforce is more fragmented and less stable than it was just a couple short years ago, signifying a deterioration in working conditions that we fear could undermine efforts to control infection, thereby endangering the health and safety of our nurses and the people they care for.
The root of the problem is the proliferation of part-time nursing positions, and the accompanying stagnation in the growth of full-time nursing positions, in Ontario. We know that as the full-time rate of employment drops, the number of nurses forced to work multiple part-time jobs increases, which requires more nurses to move among various health care facilities, potentially worsening the spread of infectious disease.
According to the CNO, only 55.9 percent of Ontario’s Registered Practical Nurses were employed on a full-time basis in 2014, compared to 61.1 percent in 2011, which was the peak year for full-time employment for RPNs in the past half-decade. The data is even more troubling for new graduate RPNs, who report an overall full-time employment rate of just 26.1 percent at their first year of renewal with the college. And the low rate of full-time employment for both new and experienced RPNs is not, on the whole, a matter of choice. Three-quarters (76.8 percent) of RPNs who were employed in nursing in Ontario prefer full-time employment, though many of these nurses, as we have seen, cannot find full-time jobs.
These data show that the increase in the number of RPNs employed in nursing in Ontario over the past few years is due mainly to the growth of part-time and casual employment. But even these dismal statistics may be too optimistic. There are two reasons for the extra note of caution. First, the CNO defines full-time employment as only 30 hours per week, in accordance with the Ministry’s minimum data set, instead of the standard 37.5 hours per week normally used in employment statistics. Second, the CNO statistics quoted above count nurses – not nursing positions. An individual nurse may report that she or he is employed on a full-time basis, but that nurse may not be employed full-time in one position: she or he may be working in two or three different positions, perhaps in different settings, to accumulate full-time equivalent hours.
The employment position statistics provided by the College of Nurses of Ontario bear this out. Less than half (46.0 percent) of RPN employment positions in Ontario were full-time in 2014, which represents a decrease of 5.5 percent since 2011. Unsurprisingly, considering the year-to-year drop in the full-time rate, the percentage of part-time employment positions for RPNs has increased for the third year in a row. In 2014, 35.1 percent of RPN employment positions were part-time, compared to only 31.3 percent three years ago.
The evidence suggests that nurses are trying to cope with the instability in the workforce by taking on two or more jobs. The statistics are particularly grim for Ontario’s RPNs. One in five (20.2 percent) RPNs employed in nursing in Ontario in 2014 reported having two or more nursing employers. Incredibly, there are now 881 RPNs in Ontario who report having three or more nursing employers.
A system that employs thousands of nurses in part-time jobs not only increases workplace stress, impacting our nurses’ quality of life, leaving many nurses feeling overwhelmed (and some feeling that they have no alternative but to leave the profession), it also threatens the safety of our frontline caregivers, our patients, and the general public. There is simply no good reason for allowing this system to continue – certainly not a financial one – especially in the event of a large-scale outbreak. The Ministry and our province’s nursing employers must therefore make fixing this problem a top policy priority.
If the Ministry wants to reassure Ontarians that the province is truly prepared to respond to the threats posed by enterovirus D68, the ebola virus, or the common flu virus, for that matter, it would do well to start by supporting our primary caregivers – Ontario’s nurses – who will be called upon to endanger their lives in the event of an outbreak of infectious disease in the province. The government must take steps to show that it is as concerned as Ontario’s nurses about the increasing instability and fragmentation of our province’s nursing workforce. And recommitting itself to achieving its own benchmark rate of 70 percent full-time nursing employment would be a good place to start.
We all know that our nurses will be there, on the frontlines of our health care system, in the coming days and months, willing to confront anything that threatens the people of our province. What they ask in return is to have the opportunity to work a full-time job, caring for patients, in a safe and secure environment – as far as that is possible in their line of work. And that is not too much to ask.
Director, Policy Development and Government Relations