Declining number of RNs means a weakened health care system

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More than 1,500 registered nurses (RN) and nursing students have followed the lead of their professional association and emailed letters of concern to Premier Kathleen Wynne, the province’s minister of health, opposition leaders, and opposition health critics about Ontario’s declining RN-to-population ratio, which has been falling steadily since 2009. There are 6.99 RNs/1,000 people in Ontario, compared to the national average of 8.3 RNs/1,000 people.

Given this troubling shortfall of almost 16 per cent, the Registered Nurses’ Association of Ontario (RNAO) says the provincial government needs to hire more RNs if it is to live up to its promises of a transformed health-care system that meets the diverse care needs of Ontarians.

Job openings have dried up as RN employment has stagnated, the association says, which may help to explain why almost 6,000 Ontario RNs are working in nursing outside of the province. More than 3,000 of them work south of the border. The health ministry’s much vaunted action plan and its promise ‘to provide the right care, at the right time, in the right place’ simply can’t be realized if Ontario’s RN-to-population ratio continues to decline.

“Too many RNs across this province are experiencing excessive workloads, and job openings for new grads have dried up,” says Rhonda Seidman-Carlson, president of RNAO. According to the association’s calculations, 12.9 per cent of newly registered RNs were unemployed in 2012. A further 4.1 per cent were working outside of nursing. Seidman-Carlson argues “this is alarming and wasteful.”

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In their November letter to Premier Wynne, Seidman-Carlson and RNAO CEO Doris Grinspun wrote “…we know from the 1990s that when new nursing graduates are unable to find work, they move away – especially to the U.S. Once they move away, it is very difficult to bring them back, even if there are jobs available. Most have put down roots in their new communities. Ontario invests substantially in educating its nurses, and other jurisdictions like the U.S. are only too glad to take them because of the quality of the education and close equivalence of Canadian credentials to American credentials.”

The province took years to recover after the fiasco of the exodus in the 1990s, RNAO’s president adds, noting it is shameful “…to educate RNs and then fail to create meaningful opportunities for them to work in their chosen profession. The evidence that links hours of RN care with better quality patient outcomes and system performance is conclusive.”

Based on RN-to-population ratios from the Canadian Institute for Health Information (CIHI), Ontario needs to hire 17,600 nurses to catch up with the rest of the country. RNAO has called for 9,000 more RN positions by 2015 to start that process.

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“RNs play a pivotal role when it comes to delivering health care in this province. A system without enough RNs who have the knowledge and skills to deal with patients with complex care needs, and to help those requiring expert care in the community, is doomed to fail,” says Grinspun. “How can the province deliver on its promise to improve access to primary care and home care, and live up to its pledge to lower chronic disease rates such as childhood obesity and combat smoking without more RNs?”

In its letter to Premier Wynne, RNAO requested an urgent meeting to discuss the magnitude of the gap that has opened up between Ontario and the rest of the country. “Not acting now will endanger the public,” Grinspun says.