Ontario’s nursing workforce evolving to meet the needs of our growing and aging population
The College of Nurses of Ontario’s (CNO) 2016 membership statistics report provides good news about Ontario’s nursing workforce, which is growing in all health care sectors. This annual report, which draws on the aggregated information that you provide as members to your regulatory college, provides important information about provincial nursing workforce trends, including the number of nurses employed in Ontario, and the number of nursing positions in various health care sectors.
The 2016 report shows that most of the growth in the nursing workforce continues to be due mainly to increases of Registered Practical Nurses in the long-term care and home and community care sectors, which reflects the continual growth and aging of the province’s population, and the education and expertise that RPNs have in providing high-quality care to Ontario’s older adults. Today almost two-thirds of all nursing positions in the area of seniors’ care in Ontario are RPN positions, and the vast majority (97.0%) of these are direct practice positions at the beside. As Ontario’s population of older adults grows, we should expect the RPNs practicing in the long-term care and community care sectors to continuing growing to ensure the delivery of accessible, high-quality nursing care to the people who need it.
The report also shows that in 2016 the total number of nurses employed in Ontario increased. There are now 140,167 nurses employed in Ontario, an increase of 2,642 nurses (+1.9%) since 2015. The number of RPNs employed in nursing in Ontario increased in 2016 (+6.1%), as did the number of Nurse Practitioners (+10.4%), while the number of Registered Nurses remained stable (+0.0%). Most of the growth in Ontario’s nursing workforce in 2016 was attributable to sizeable but anticipated increases in the number of RPN employment positions in the long-term care sector (+5.5%) and in the community care sector (+9.2%), while there was a more moderate increase in the number of RPN positions in the acute care sector (+3.9%). The number of RN employment positions remained about the same in the community care and long-term care sectors and increased in the acute care sector, where the number of RN positions grew (+0.3%) for the fifth consecutive year. The growth in RN employment positions in our hospitals was also to be expected, given that the RN scope of practice and competencies enable them to provide autonomous care to patients whose conditions are more complex and less predictable.
Despite this good news, the CNO statistics also show that the full-time employment rate for Ontario’s nurses remains well below the 70% provincial target. For the fourth straight year, the full-time employment rate for RPNs decreased significantly (-0.9%). The rate of full-time employment for Ontario’s RPNs was 54.2% in 2016 (compared to 60.9% in 2012), while the full-time rate for RNs (66.2%) remained closer to the provincial target. The full-time employment rate for new graduate RPNs was only 24.0% in 2016, whereas the full-time employment rate for new graduate RNs was 43.5%. Because these low full-time employment rates, particularly for Ontario’s RPNs, threaten to undermine access to safe, high-quality nursing care in all health sectors, more work has to be done to reach the provincial target for both categories of nurses.
Although the annual report provides a general picture of Ontario’s nursing workforce, it gives no definitive information about the impact of provincial nursing trends on the actual contact hours that nurses have with their patients, residents, and clients. Therefore it may be the case that the overall nurse-to-patient contact hours have not increased in Ontario, despite the overall growth in nursing positions in the province in recent years. It is also worth noting that the report does not fix benchmarks for the numbers of nurses to patients, or measure ratios of nurses in different nursing categories or practice sectors, nor does it analyze the appropriateness or effectiveness of nursing skill mix decisions made at the point of care. For this reason, we believe it is wrong to use this system-level data to assess specific staffing decisions in specific working environments. It is the responsibility of the nursing leaders working at the point of care to make staffing decisions based on the correct nursing process and relevant nursing practice standards to ensure the provision of the appropriate nursing care necessary to meet the ever-evolving needs of their specific patient populations.
Because our health care budgets are under immense pressure, in the coming weeks and months we will continue working to optimize RPNs’ professional practice in order to improve patients’ access to nursing services and nurse-patient contact hours. In particular, our efforts will focus on improving value for money and the overall quality of care in the health care system by optimizing the RPN role and removing outdated and unnecessary barriers to practice that restrict you and your nursing colleagues from using your full knowledge, skills and competencies for the benefit of the people you care for. And we will work to increase the RPN full-time employment rate to meet the Quadruple Aim of enhancing the patient experience, improving population health, reducing costs, and improving the work life of nurses.
Together we will build a healthier Ontario.
Director, Government Relations, RPNAO