The pandemic has changed how nurses work in Canada, with fewer willing to take jobs in long-term care homes and more decamping for private staffing agencies, according to a new report that reveals how the COVID-19 emergency affected all types of health professionals and the patients they serve.
The Canadian Institute for Health Information’s (CIHI) annual report on the health work force, released Thursday, also found that front-line professionals, including nurses, logged an unprecedented amount of overtime during the pandemic.
Hospitals across the country recorded more than 18 million overtime hours in the fiscal year 2020-21, a 15-per-cent increase over the year before. That volume of overtime is the equivalent of 9,000 extra staff working full-time, and it doesn’t even include overtime logged by doctors. The number of health workers who say they are taking overtime shifts has continued to grow, peaking in April of this year, according to Statistics Canada data featured in the CIHI report.
The amount of overtime that health care workers are putting in is both a symptom and a cause of the staffing crisis afflicting hospitals, nursing homes and community health agencies as they try to recover from the worst of the pandemic.
Many of those picking up overtime shifts are covering for jobs their managers haven’t succeeded in filling. Vacancies in the health and social services sector hit 126,000 in the fourth quarter of last year, an historic high and twice the number of vacancies in the category just before the pandemic.
“The Statistics Canada data is interesting because it’s showing trends that we haven’t seen in some time, including that increased amount of overtime,” said Lynn McNeely, manager of health work force information at CIHI, the country’s national health data agency. “Across health occupations, it’s the highest we’ve seen in over a decade.”
Nurses, by far the largest category of health workers, seem to be in particularly short supply. However, CIHI found their overall ranks continue to increase, with the supply of regulated nurses (including registered nurses, nurse practitioners and licensed practical nurses) growing by 2.4 per cent in 2021, 1.9 per cent in 2020 and 1.9 per cent in 2019.
But those figures only reflect the number of licensed nurses, not where or how much those nurses work. The CIHI report found that some sectors hit hard by COVID-19 have seen a decrease in the number of nurses providing direct care to patients.
About 500 fewer registered nurses were employed in long-term care in 2021 than the previous year, a drop of 2.2 per cent, and about 100 fewer licensed practical nurses worked for community health agencies last year than in 2020, a decrease of 0.8 per cent.
Over the same period, there was a 7.3-per-cent increase in nurses of all skill levels working in a category CIHI calls “other settings,” which includes jobs at private staffing agencies, cosmetic clinics and nurse consulting work.
Linda Silas, the president of the Canadian Federation of Nurses Unions, said overtime shifts, some of them mandatory, are among the reasons nurses are moving to jobs in the private sector. “We have to stop the bleeding,” she said. “You cannot let another nurse leave the system to go work in a Botox clinic or to go work in an agency. We just cannot let that happen. Canadian patients and their families are suffering and our work force is burned out.”
The CFNU is releasing a report Thursday that Ms. Silas said contains concrete suggestions for keeping nurses in the public system, including legislating minimum nurse-to-patient ratios and creating administrative support teams to slash the time nurses spend with paperwork instead of patients.
Ms. Silas said CFNU presented the report behind closed doors last week at a meeting of federal-provincial-territorial health ministers, but those talks fell apart before its recommendations could be discussed in detail. Ottawa wanted the provinces and territories to commit to a pan-Canadian health human resources action plan and a pan-Canadian health data strategy before it would agree to increase federal health care funding; the provinces wanted more money with no strings attached.
The CIHI report released Thursday is an example of the kind of national health care data that already exist in Canada. While rich in many details, the new report’s data is mostly one or two years old.
The report says that the supply of physicians in Canada continues to grow, but at a slower pace than in the recent past. Growth was particularly slow in family medicine, with the number of general practitioners rising 1.3 per cent between 2019 and 2021 compared with 3.4 per cent between 2012 and 2014.
But those figures don’t explain what share of registered family doctors practise office-based primary care, how many hours they work or the number of patients on their rosters.
Alika Lafontaine, president of the Canadian Medical Association, said he regularly hears from general practitioners who are moving away from office-based primary care because they are burned out and “heartbroken” they can’t provide patients with the care they deserve. Patients are older, sicker and require more care, while the administrative burden has become punishing, he added.
“As a result, people are not staying within family medicine because the working environments have deteriorated,” Dr. Lafontaine said.