The latest statistics show some positive trends in Ontario’s nursing workforce. But there are some negative trends as well.

Although there were more nurses employed in Ontario in 2013 than ever before, lower and lower percentages of our nurses were employed in full-time nursing positions over the past few years. This negative trend is worrisome for our nurses and for our patients, especially since our province is beginning to face some unprecedented challenges.

Ontario’s population is growing and aging. There are more people who need health care than at any time in our province’s history. And higher proportions of our patients than ever before have more complex health care needs. These demographic pressures are resulting in longer shifts, more responsibilities, and heavier workloads for nurses and other health care professionals.

More patients with more complex health needs mean that we will need more nurses. As Ontario’s population grows and ages, the number of both Registered Practical Nurses and Registered Nurses employed in nursing in Ontario will have to grow too in order to ensure the delivery of accessible, quality health care services. The math here is pretty easy.

Determining exactly what that ‘right’ number of nurses might be at any given point in time is more difficult. The ratio of nurses to patients provides only a crude measure of nursing supply and demand, since a simple ratio cannot account for a number of complex factors that impact quality care, including variations in nursing practice and the needs of different patient populations. But this does not stop us from trying to figure out what that ‘right’ number might be.

So when the College of Nurses of Ontario releases its annual membership statistics report, we read it with much interest in hopes that it will answer some of our burning questions. This data provides some good information about the trends in Ontario’s nursing workforce, but without telling us very much about how these trends impact our patients. And although we are able to make some suppositions about what these numbers may mean for patient care, we are usually left with more questions than definitive answers.

When trying to understand the trends in our nursing workforce might be impacting our patients, the first number most people look at is the total number of nurses practicing in the province. This number has generally trended upwards over the past decade. There are more RPNs and more RNs employed in nursing in Ontario than ever before. There were 131,728 nurses employed in Ontario in 2013, compared to only 110,596 nurses in 2004. The number of RPNs employed in nursing in Ontario increased from 24,426 nurses in 2004 to 35,286 in 2013, and the number of RNs employed in nursing in Ontario increased from 85,638 in 2004 to 94,386 in 2013. There were 2,436 more RPNs and 1,507 more RNs employed in nursing in Ontario in 2013 than in the previous year.

Counts of nursing positions across the province (as distinguished from individual nurses) demonstrate that the numbers of nursing positions increased in every health care sector last year. There are more nursing positions in our hospitals, in our communities, and in our long-term care homes than ever before. But these counts of nursing positions – and the counts of nurses working in our health care system – should not be taken at face value. These numbers may look optimistic, but they really don’t tell us much about patient care.

The reason for this is simple. Although the number of nursing positions may have increased last year, the full-time employment rates for both categories of nurses decreased sharply. The drop in the full-time rate of RPNs was particularly drastic. In 2013, only 56.8 percent of RPNs employed in nursing in Ontario worked in full-time positions, compared to 60.9 percent in 2012, and 61.1 percent in 2011. These numbers are a far cry from the 70 percent full-time employment target that the government and the nursing community have committed to achieving.

Unlike some of the other numbers, this full-time employment data can tell us something definitive about what’s happening to patient care in this province. Because we know for certain that a drop in the full-time rates of nurses is never good news.

Research shows that a higher rate of full-time nursing employment enhances continuity of care and improves patient health outcomes, while contributing to the development of healthier work environments for nurses, which improves the retention of nurses in the health care system. The recent decreases in the full-time rates for nurses are therefore worrisome given the negative impacts that these trends are known to have on both nurses and their patients.

Although the College data may not be able to tell us many of the things we would like to know about Ontario’s nursing workforce, such as the number of hours nurses actually spend caring for patients, or the relative effectiveness of different nurse staffing models on patient outcomes, the data do tell us without a shadow of a doubt that in the last two years Ontario’s nursing care has become more fragmented, and therefore less effective.

And that is not good news for nurses or for their patients. No matter how the other numbers add up.

Category: Influencing Policy, Influencing CareDate: Tuesday, April 8, 2014