Ministry Reports

Good Nursing, Good Health : A Good Investment

Progress Report on the Nursing Task Force Strategy in Ontario, Summer 2001


Executive Summary

Table of Contents

Introduction
About this Report
Methodology
The Current Environment
Highlights
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Introduction

Health care reforms in the 1990s caused some dramatic changes that negatively affected the nursing profession. Impacts included fewer nurses in the system, fewer permanent nursing positions, increased casualization of the nursing workforce, nurses leaving Ontario or the profession all together, and decreased nursing enrollments and graduates. Many of these changes, in addition to the aging nursing workforce, have had, and continue to have, a significant influence on access to nursing services in Ontario.

The Minister of Health, Elizabeth Witmer, established the Nursing Task Force (NTF) in September 1998 in response to growing concerns about the instability of the current nursing workforce, consultations between nursing professional organizations* and the government, a significant predicted nursing shortage, and nurses' concerns about their ability to provide safe care. The NTF was mandated to examine the impact of health care reform on both the delivery of nursing services and the nursing profession in Ontario and to recommend strategies to ensure and enhance quality of care through effective use of nursing human resources.

*RNAO submitted a proposal to, and met with, the Premier in March 1998 regarding the need for provincial strategies to stabilize and invest in nursing services.

In January 1999, the NTF presented its report "Good Nursing, Good Health: An Investment for the 21st Century" to the Minister of Health. The NTF report provided eight short, medium and long-term recommendations to improve nursing services in Ontario. NTF recommendation #1 was a permanent, annual investment of $375 M to create 10,000 new front-line and permanent nursing positions.

The Ministry of Health and Long-Term Care (MOHLTC) accepted all recommendations and announced an increase in funding for new nursing positions to approximately $484 M in fiscal 2000/2001. The government announced in March 1999 that its investments would support the creation of 12,000 new, permanent nursing positions - 2,000 more than the NTF report recommended. Other recommendations supported basic education reform for RNs and RPNs, increased clinical and ongoing education opportunities in priority areas, support for nursing scientists to conduct research to guide human resources planning for nurses in Ontario, and an aggressive recruitment and retention strategy to attract students and nurses who have left the profession in Ontario as well as to promote professional development and practice for nurses.


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About this Report

One NTF recommendation (Recommendation #8) was that a process be established to monitor the implementation, effectiveness and outcomes of, and ensure accountability for, the NTF recommendations. The Nursing Task Force charged the Joint Provincial Nursing Committee (JPNC) with this responsibility. The JPNC then established the Implementation Monitoring Subcommittee (IMS), co-chaired by representatives of the nursing profession and the MOHLTC. As part of its mandate, the IMS is responsible for providing progress reports on all eight NTF recommendations and the advancement of the provincial nursing strategy. This first progress report summarizes the most current information available on the implementation of the NTF recommendations.


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Methodology

Data/information on the implementation status of the NTF recommendations was collected from a variety of sources including an Audit and Review of selected health care organizations, hospital Nursing Plans, surveys, hospital Management Information Systems (MIS) data, College of Nurses of Ontario registration statistics, statistical reports to MOHLTC, progress reports and verification from leads for each recommendation to MOHLTC, and input from various stakeholders involved in implementation.


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The Current Environment

In Ontario, as in many jurisdictions, significant nursing human resource problems persist and are costly to the system. These include: continued casual employment (although this has decreased marginally, full-time employment is still approximately 50% for nurses), understaffing, and increased overtime and use of purchased nursing services from agencies. In many cases, these factors lead to increased absenteeism due to illness or injury and difficulty securing nurses with the required knowledge and skill sets for positions. There is a current shortage of highly specialized nurses in priority areas such as oncology, cardiac care, dialysis, critical care and emergency nursing, while some nurses, particularly new graduates, are unemployed or underemployed. Difficulties recruiting and retaining nurses in the community sector persist largely as a result of inequities in remuneration and unstable working conditions compared to other sectors, particularly hospitals. Mitigating efforts to address current and predicted shortages are underway, largely as a result of the implementation of the NTF recommendations and the provincial nursing strategy. The main goal of Ontario's nursing strategy is to stabilize nursing human resources through effective recruitment and retention strategies.


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Highlights

The findings in this report demonstrate that progress has been made in the last two years since the NTF submitted its report. The Ministry of Health and Long-Term Care projects that implementation of all eight recommendations will be completed by the 2004/2005 fiscal year.

Overall, the progress towards meeting the objectives outlined in "Good Nursing, Good Health: An Investment for the 21st Century," the original report of the Nursing Task Force, points to positive trends in addressing nursing issues in this province. These trends include the following :

  • Improved participation rate in terms of nurses working in their own profession.
  • Improvements in employment opportunities for all classifications of nursing in hospitals, home care, long-term care, primary care and public health.
  • Overall improvement in permanent employment opportunities.
  • Improved accountability of government-funded agencies regarding their efforts to implement Nursing Plans and other related activities.
  • Improvements in research in nursing human resources and the relationship between nursing services and outcomes to better inform future health policy, planning and human resource practices.
  • Improvements in continuing and clinical educational opportunities in terms of both the number and type of courses/programs available.
  • Enhanced knowledge and awareness of nursing issues among the profession, other professionals and health care practitioners, health sector management, health services providers, the provincial government and the public at large.
  • Progress in reforming basic education for RNs and RPNs to meet new practice competencies for today's health system.

There remain some significant unresolved issues, which are also addressed in this report. These issues include the following :

  • High rates of casualization and part-time employment, although improving, continue to persist in all sectors of the health services delivery system, but most particularly in the home health care sector where the model of service delivery significantly reduces opportunities for improvement in full-time employment.
  • Under-utilization of nurses in roles that maximize the use of their knowledge and skills remains an issue, as well as the lack of recognition by some providers of the potential health and economic benefits associated with appropriate utilization.
  • Increasing rates of overtime with corresponding increases in absenteeism due to illness and injury.
  • While the wages, salaries and benefits levels associated with different sectors and providers within the health services delivery system have converged somewhat, there remains significant disparity leading to staff shortages and costly competition for nurses between the various sectors and employers.
  • Nurses' participation in key decision-making roles within the health sector, while improving, could improve significantly more.
  • Problems with inconsistent nursing human resource data quality, availability and standards across the health sectors impede effective HR planning and management. However, Ontario's strategy is resulting in improvements in data quality and consistency and in its relevance to nursing HR planning.

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Progress Report on the Nursing Task Force Strategy in Ontario
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Summer 2001

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