Health Human Resource Andrea Baumann Mary …...Health Human Resource Andrea Baumann Mary...

Health Human Resource Andrea Baumann Mary Crea-Arsenio Series Number # 25 Dina Idriss-Wheeler Mabel Hunsberger Jennifer Blythe

A Made-in-LHIN Solution: Identifying Local Needs in 70% Full-Time Nurse

Employment

70% Full-Time Nursing LHIN Engagement Initiative

HAMILTON HALDIMAND BRANT LHIN 4

March 2010

2 | Identifying Local Needs in 70% Full-Time Nursing Employment – HNHB, October, 2009

Made-in-LHIN Solution: Identifying Local Needs in 70% Full-Time Nurse Employment, October 2009

Andrea Baumann, RN, PhD, Associate Vice President, International Health,

& Director, Nursing Health Services Research Unit (McMaster University site)

Mary Crea, MSc, Research Coordinator, Nursing Health Services Research Unit (McMaster University site) Dina Idriss, MSc, MHA, Research Coordinator, Nursing Health Services Research Unit (McMaster University site) Mabel Hunsberger, RN, PhD, Associate Professor, Nursing Health Services Research Unit (McMaster University site) Jennifer Blythe, PhD, Senior Scientist, Nursing Health Services Research Unit (McMaster University site)

Acknowledgements The HealthForceOntario Marketing and Recruitment Agency Partnership Coordinator Jill Cappa, Hamilton Niagara Haldimand Brant LHIN 4, and Andy Clutton, Research Intern, provided the LHIN specific background information. Laurie Kennedy, Administrator, McMaster NHSRU, supervised the survey procedures and provided review of the final draft. This report has been reviewed in draft by Dr. Anita Fisher, Associate Professor (Nursing Health Services Research Unit, McMaster University), and Jane Underwood, Co-Investigator/Consultant (Nursing Health Services Research Unit, McMaster University). McMaster NHSRU Contact Andrea Baumann Phone: (905) 525-9140, ext. 22581 Email: [email protected] Website: www.nhsru.com

HealthForceOntario Marketing and Recruitment Agency Contact Jill Cappa Phone: (905) 687-6256 Email: [email protected] Website: www.HealthForceOntario.ca

This research has been generously funded by a grant from the Government of Ontario. The views expressed in this report do not necessarily reflect those of the Government of Ontario.


TABLE OF CONTENTS

Report Highlights .......................................................................................................................... 5

Introduction and Background ..................................................................................................... 7

How to Read This Report ................................................................................................ 7

The Evolution of the 70% Full-Time Commitment ................................................................. 8

Nurse Employment Trends ............................................................................................ 10

Work Environment of Community and Long-Term Care ....................................................... 11 Background to the Current Report ........................................................................................... 12

The Local Health Integration Networks ................................................................................... 13

Overview of LHIN 4 Employment Statistics ....................................................................... 14

Hamilton-Niagara-Haldimand-Brant LHIN 4 ...................................................................... 14

Trends in Nurse (RN/RPN) Working Status - HNHB LHIN 4 ................................................. 15

RN Employment in HNHB LHIN 4 ................................................................................. 16

RPN Employment in HNHB LHIN 4 ................................................................................ 16

FT Nurse Employment by Sector (MOHLTC Health Data Branch, 2009) ................................... 16 LHIN 4 - Specific Needs and the Human Resource Strategy.................................................. 17

Local Needs ............................................................................................................... 17

Staffing and Scheduling ....................................................................................... 17

Needs of Rural and Small Organizations ............................................................... 19

Demographic Changes ......................................................................................... 20

Sector Specific Challenges .................................................................................... 20

Employer/Employee Preferences .......................................................................... 21 Strategies Used to Increase and/or Maintain 70% Full-Time by Sector ............................... 22

Sector Specific Strategies .............................................................................................. 23

Creative Scheduling ............................................................................................. 23

Cross-Training .................................................................................................... 23

Integration With Community Partners ................................................................... 24

Combining Part-Time Lines ................................................................................. 24


Creating Specialty Lines Across Sites .................................................................... 25

Cross-Sectoral Strategies ............................................................................................... 25

Using RPNs to Full Scope of Practice ..................................................................... 25

Participating in Government Initiatives ................................................................. 26

Building Relationships With Academic Partners .................................................... 26

Other Strategies ................................................................................................... 26

Survey Results ............................................................................................................ 27

Employer Demographics ...................................................................................... 27

Use of Agency and Overtime Hours ...................................................................... 27

Current Recruitment of Nurses ............................................................................. 29

Organizations Achieving 70:30 Full-Time To Part-Time Target ............................ 30

LHIN 4 Strategies in Achieving 70% FT Nurse Employment .................................................. 31 Discussion..................................................................................................................................... 31

Conclusions .................................................................................................................................. 32

References .................................................................................................................................... 34

Appendix A: HNHB LHIN 4 Data Package ............................................................................. 37

Appendix B: 70% Full-Time Nursing LHIN Engagement Initiative © Survey .................... 45

Appendix C: 70% Full-time Nursing LHIN Engagement Initiative Employer Focus Group

Guide 2009 ................................................................................................................................... 50


REPORT HIGHLIGHTS

Geographical Context

HNHB is the second largest LHIN in the province with a population of 1.4 million

Located in the Golden Horseshoe, HNHB includes Brant, Burlington,

Haldimand, Hamilton, Niagara and most of Norfolk.

Made up of urban and rural communities rich in ethnocultural and linguistic diversity

Home to two Aboriginal reserves (Six Nations of the Grand River Territory and Mississaugas of the New Credit)

Healthcare Organizations

10 hospital corporations (operating on 24 sites), more than 105 community support service organizations, more than 50 community mental health and substance abuse services, six community health centres and the HNHB Community Care Access Centre

Nurse Employment

11% of all RNs and 12% of all RPNs working in Ontario are employed in HNHB LHIN 4

RNs: 62.7% were employed FT, 30.3% PT and 7.0% Casual (CNO, 2008)

RPNs: 58.6% were employed FT, 31.7% PT and 9.7% Casual (CNO, 2008)

By sector

64.6% of RNs were employed in hospitals, 18.9% in community settings and 9.5% in long-term care facilities

47.9% of RPNs were employed in hospitals, 35.5% in long-term care facilities and 11.8% in community settings

Nurse Vacancies


Acute care organizations: most recruitment for RNs and RPNs is occurring in the acute care organizations for both full-time and part-time positions.

LTC: no reported vacancies for RN and RPN full-time and part-time positions.

Community: few reported vacancies for full-time employment for RNs and RPNs; highest rate of available part-time positions for RNs, and few part-time positions for RPNs.

Achieving 70:30

For RNs: 43% of employer survey respondents across all sectors (acute, LTC and community) indicated they had achieved 70% FT target

For RPNs: 30% of employer survey respondents indicated that they had achieved the 70% target.

Average reported FT:PT mix across all sectors: o RNs: 69:31 o RPNs: 63:37

Key Strategies for Achieving 70%

1. Converting part-time to full-time positions

2. Creating clinical float team

3. Offering educational incentives to all nurses (RNs and RPNs)

4. Multi-site positions in areas of clinical specialty

5. Building strong relationships with academic partners and increasing clinical student

placements

6. Changing RN/RPN mix in some clinical areas to create more full-time positions


INTRODUCTION AND BACKGROUND

Since the economic downturn of the 1990s, when the province lost over 2,000 full-time nurses,

the stability of nursing employment has been a priority healthcare issue. In 1990s, the percentage

of nurses employed part-time increased dramatically, exceeding 60% in some hospitals, and

overtime hours became a major strategy to achieve adequate patient care coverage. Since 2000,

the Ontario government has introduced a series of focused strategies to improve recruitment and

retention of nurses, with the intent to attain a higher ratio of full-time nurse employment.

Specifically, a 70:30 full-time to part-time ratio was identified as the goal to be achieved in as

many organizations as possible.

This report examines the Ministry of Health and Long-Term Care’s (MOHLTC) priority theme

of “a 70% Full-Time Commitment” via an analysis of nurse employment in four collaborating

Local Health Integration Networks (LHINs) in Ontario. Information in this report was obtained

through a number of sources, including qualitative interviews, survey data, MOHLTC Health

Data Branch statistics, and College of Nurses of Ontario (CNO) statistics. Percentages presented

will vary according to source and are based on differences in data collection methods. The data

presented is not for comparative purposes; rather, it is used as descriptive information to provide

a picture of nurse employment across the participating LHINs.

How to Read This Report

This report provides general background literature about the 70:30 full-time to part-time nurse

employment model, a description of the Ontario LHINs and an overview of the project designed

as a collaboration between four participating LHINs: Hamilton-Niagara-Haldimand-Brant,

Central West, South East and South West. It also includes major findings and a discussion of the

review. Four similar reports have been created, (one for each LHIN) outlining this information.

The reports differ in terms of the LHIN specific data collected from the surveys and in the

recommendations for how to create a Nursing Human Health Resource Strategy to meet the local

needs of each LHIN.


The Evolution of the 70% Full-Time Commitment

Historically, being employed full-time was the norm for Canadian nurses. During the period

from 1960 to 1985, approximately 70% of nurses were employed full-time (Paddon, 1992). Part-

time staff were used for routine coverage and casual staff were called in during times of extreme

demand (Baumann & Blythe, 2003). Throughout the 1990s, downsizing as a result of hospital

restructuring led to an increase in part-time and casual work among nurses (Baumann, Blythe &

Underwood, 2006; Blythe, Baumann & Giovannetti, 2001). The proportion of registered nurses

(RNs) working full-time decreased from 64% in 1985 to 52% in 1998 (Canadian Nurses

Association [CNA], 2002). A slight increase occurred in the years that followed; but by 2001, the

full-time employment of RNs in Canada remained at only 54% (CNA, 2002). A similar

downward trend has been observed in Ontario. For example, in 1994, the percentage of RNs

working full-time in Ontario was 56% (Canadian Institute for Health Information [CIHI], 1999).

By 1999, this number had dropped to 52%; it remained at 55% in 2001, only one percent greater

than the national average (CIHI, 1999, 2001). Comparatively, in 2002 the percentage of

registered practical nurses (RPNs) working full-time was 42% in Canada and 49% in Ontario

(CIHI, 2001).

The risks associated with an increase in casual and part-time employment have been well-

documented by researchers and nursing bodies such as the Registered Nurses' Association of

Ontario (RNAO, 2003). The SARS crisis drew particular attention to the problems associated

with relying on casual, part-time and agency nursing staff as nurses were directed to work in

only one place (Baumann, Blythe, Underwood, & Dzuiba, 2003; Grinspun, 2007; RNAO, 2003).

It was evident that nurses were working in multiple job situations and making a full-time living

from various part-time jobs. In a background paper, nursing health services researchers noted

that casualization was becoming ever more apparent and threatening the continuity of care

(Baumann & Blythe, 2003). In the Final Report of the Ontario Expert Panel on SARS and

Infectious Disease Control (2004), Walker recognized these challenges and recommended that

"the Ministry should establish sustainable employment strategies for nurses and other healthcare

workers to increase the availability of full-time employment" (p. 189). Walker also

recommended that "progress reports should be issued on an annual basis with a final goal of

greater than 70% full-time employment across all healthcare sectors by April 1, 2005" (p. 47).


SARS was the turning point in recognizing the need for a stable, cohesive nursing workforce to

ensure preparedness in advance of another crisis. In the current A(H1N1) influenza pandemic,

over 414, 000 cases have been reported worldwide (World Health Organization [WHO], 2009).

Many countries have stopped counting the occurrences of mild cases leading experts to predict a

much greater occurrence rate than that reported by the WHO. The severity of this crisis raises an

important question: Are we any better prepared to deal with a mass outbreak?

Research has shown that staffing complements make a difference. Increases in part-time and

casual positions have been associated with poorer patient and nurse outcomes (Aiken et al.,

2001; Jamieson, Williams, Lauder, & Dwyer, 2008; Tourangeau, 2001). It is essential that

workforce planning focuses on recruitment and retention to achieve workforce stabilization. Part-

time is not necessarily a bad thing; it can be beneficial to meet demands for flexibility. In smaller

facilities where families and patients are known by the healthcare team, continuity and

accountability can be maintained, even though there is a high proportion of part-time staff.

However, in large facilities where health workers are continually changing, continuity of care is

challenged.

Part-time employees are often excluded from essential communication, are not recognized by

other healthcare professionals and are excluded from decision-making opportunities, all of which

limit their ability to participate in client care (Jamieson et al., 2008). Patients have also voiced

concerns about the increase of part-time and casual staff (Jamieson et al., 2008; Sharkey, 2008).

For example, Sharkey (2008) found that fragmented staffing impacted residents’ perceptions of

the quality of care they received. To improve clinical and system outcomes, a full-time stable

nursing staff is required (Grinspun, 2007); a recommendation that has been echoed throughout

the past two decades.

In 2000, the RNAO and the Registered Practical Nurses Association (RPNAO) jointly released a

report campaigning to raise the full-time employment of nurses to 70% (RNAO & RPNAO,

2000). By 2004, the MOHLTC responded by creating a multi-faceted program to increase the

number of nurses in the province and the percentage of nurses working full-time (MOHLTC,

2005; RNAO, 2005). As a result, in 2006, the percentage of RNs working full-time in Canada

was 56%, while the percentage of RNs working full-time in Ontario jumped to 62% (CIHI,


2006a). Similarly, in 2006, the percentage of registered practical nurses (RPNs) employed full-

time was 47% in Canada and 55% in Ontario (CIHI, 2006b). These numbers demonstrate the

effectiveness of the Ministry’s initiative in moving toward the recommended 70% full-time nurse

employment target.

Nurse Employment Trends

Nurse employment trends vary not only by employment status but also according to the number

of employers and place of work. The practice of having multiple employers has been associated

with changes in the economy and the reduced availability of full-time work (Baumann & Blythe,

2003; Grinspun, 2007). During periods of economic recession, the proportion of full-time

permanent jobs decreases and part-time and casual work increases (Zeytinoglu & Muteshi,

1999). Over the past few decades, there has been an increasing trend toward flexible, non-

standard work across industries in general and in the nursing profession in particular (Baumann

& Blythe, 2003). Consequently, some part-time employees must work for more than one

employer to obtain full-time hours. According to the CIHI (2006a, 2006b), 12.7% of RNs and

16.4% of RPNs reported working for more than one employer in 2006. In Ontario, only 9.4% of

RNs and 11.3% of RPNs reported having more than one employer, which represents a small

proportion when compared to the national averages.

This trend of having multiple employers can also be seen in small community and rural settings

where full-time employment is scarce (Baumann, Hunsberger, Blythe, & Crea, 2006, 2008). As a

result, nurses are forced into multiple employment situations to meet their financial needs and

ensure a more predictable work schedule. A study by Baumann et al. (2006), found that rural

hospitals experience difficulty attaining a 70:30 ratio of full-time to part-time staff due to small

numbers of staff, an unpredictable patient census and a need for flexibility in scheduling.

Managers preferred a high proportion of part-time nurses to ensure that patient care needs were

met. However, the practice of calling in part-time staff to work on unscheduled shifts led to

interference with personal lives, which nurses and managers reported as stressful for nurses.

Similarly, a study of rural hospitals in Ontario highlighted the need for an adequate pool of part-

time nurses to cover shifts left open by vacations, sickness and leaves of absence. Due to the

small size of the nursing staff at the hospitals, more than 30% of nurses needed to be employed

part-time (Sloan, Pong, Rukholm, Larocque, & Pitblado, 2005).


Employment patterns also differ across sectors. A greater proportion of RNs in Canada are

employed in hospital (63%) and community settings (14%), compared to long-term care facilities

(11%) (CIHI, 2006a). In contrast, a greater proportion of RPNs work in hospital (45%) and long-

term care settings (39%), compared to the community sector (6%) (CIHI, 2006b). A similar trend

can be seen in Ontario. In 2008, a greater proportion of RNs in the province were employed in

hospital (65%) and community (18%) settings, compared to long-term care facilities (8%);a

greater proportion of RPNs were employed in hospitals (45%) and long-term care facilities

(35%), compared to community settings (14%) (CNO, 2008).

Work Environment of Community and Long-Term Care

The community sector has changed over time because of privatization. Most community care is

now delivered by private companies, making data on employment conditions hard to collect.

Much of the information tends to be anecdotal. Nurses moving from community to hospital can

be tracked on an annual basis using the College of Nurses annual report (CNO, 2008). However,

this data gives us only a broad impression of trends. Anecdotal evidence suggests that the

community sector is characterized by hourly, part-time employment. There are many agencies

that provide home care services in Ontario and there is competition among them. Private sector

employers must periodically reapply to the Community Care Access Centres (CCACs) to renew

their contracts as service providers. These agencies might prefer to provide full-time

employment, but uncertainty over renewal of contracts prevents this. Thus, workers who are

funded through the CCAC system have little sense of job security.

The long-term care situation is different. A recent report recommends strengthening staff

capacity (Sharkey, 2008). According to the author, long-term care homes employ approximately

45,000 full-time equivalent staff to provide nursing care and program and support services. In

this report, residents indicated that fragmented staff complements due to shortage and

absenteeism affect quality of care. As dictated by legislation, every long-term care institution is

required to have a full-time RN on every shift. However, long-term care employers report

difficulties in recruiting and retaining RNs and RPNs.

Surveys of new graduates show that the majority want full-time employment. They are drawn to

the hospital sector because of preference and the desire to work full-time (Baumann, Hunsberger,


Idriss, & Alameddine, 2008). Data from the CNO (2008) demonstrate that there are very few

young RNs in long-term care compared to acute care.

BACKGROUND TO THE CURRENT REPORT

The 70% Full-Time Nursing LHIN Engagement project emerged at the request of the Nursing

Secretariat. A request for proposals (RFP) was sent by the Nursing Secretariat to all the Ontario

LHINs and included LHIN specific data packages that outlined full-time nurse employment

among RNs, RPNs and nurse practitioners (NPs). The LHINs were then invited to participate in

an initiative to identify their local needs in relation to 70% full-time employment for nurses and

provide them with the opportunity to develop a nursing health human resource planning strategy

that moves them closer to 70% full-time employment. Eight of the 14 LHINs submitted

proposals; 5 out of the 8 were chosen to participate. This project is a collaboration between the

Nursing Health Services Research Unit (McMaster University site) and four of the chosen

LHINs: Niagara-Hamilton-Haldimand-Brant (LHIN 4), Central West (LHIN 5), South East

(LHIN 10) and South West (LHIN 2).

The overall goal of the report is to identify local needs in relation to the 70% Full-Time Nursing

LHIN Engagement Initiative and develop a nursing health human resource planning strategy that

moves the LHINs closer to 70% full-time employmment. The objectives of the report are as

follows:

1. To conduct a literature review of relevant topics, including historical trends in nursing

employment, nursing preferences for employment status, existing nursing workforce

databases, existing government nursing employment initiatives and other relevant

literature.

2. To conduct a document analysis that compares existing databases (Canadian Institute for

Health Information and College of Nurses of Ontario) and the LHIN specific data

packages.

3. To conduct focus groups to determine local needs in relation to 70% full-time employment

and identify human resource planning strategies to achieve this target.


4. To survey select nursing organizations within the four LHINs to identify local needs in

relation to 70% full-time employment and identify human resource planning strategies to

achieve this target.

5. Conduct a workshop with key stakeholders to disseminate findings and develop nursing

health human resource planning strategies and a context tool kit to move organizations

closer to 70% full-time employment.

6. Background information on the formation of LHINs and their role in the Ontario

healthcare system.

THE LOCAL HEALTH INTEGRATION NETWORKS

In March 2006, the Local Health System Integration Act was passed to regulate the 14 newly

created LHINs (MOHLTC, 2009). The goal of the LHINs is to engage communities in health

system transformation and enhance their abilities to make changes at a local level. LHINs do not

provide health services directly. Instead they are responsible for planning, coordinating,

integrating, managing and funding local health services. This includes hospitals, CCACs,

community support services, long-term care, mental health and addiction services and

community health centres (MOHLTC, 2009). LHINs "facilitate effective and efficient

integration of health care services, making it easier for people to get the best care in the most

appropriate setting, when they need it" (MOHLTC, 2009). The LHINs were created as a made-

in-Ontario solution to better integrate and engage communities in local health planning. The

LHIN mandate is to provide accessible, quality healthcare at a local level that responds to the

needs of unique patient populations across the province. The responsibility of the LHINs to carry

out government initiatives such as the 70% Full-Time Commitment is paramount for identifying

local needs and developing a nursing health human resource strategy that supports these needs.

The HealthForceOntario Marketing and Recruitment Agency is an independent operational

service of the Government of Ontario. It is responsible for developing and executing marketing

and recruitment and retention activities for health professionals. The organization is a core

component of the HealthForceOntario (HFO) strategy--a multiyear, collaborative plan to provide

Ontario with the right number and mix of healthcare providers, working in communities across

the province to meet current and future health needs.


Partnership Coordinators work for the agency and are responsible for attracting and retaining

physicians and nurses, assisting LHINs with health human resources planning, managing

marketing activities and advising healthcare professionals on career decisions. They provide

community-based support to local healthcare organizations and collaborate as a province-wide

team in the sharing of best practices and in the reporting of important recruitment trends and

indicators.

Overview of HNHB Employment Statistics

Data obtained through the MOHLTC Data Branch and collected via self-reporting for 2007-2008

highlights the full-time to part-time nurse ratios across the 14 LHINs in Ontario (see Appendix

A). The findings demonstrate that across all sectors, 50% of the LHINS were above 70% full-

time nurse employment (RN and RPN). In the acute care sector, 47% of hospitals were below the

70% target. The lowest were the Champlain, South West and North East LHINs. In long-term

care, most organizations (85.8%) were below the 70% nurse employment target. The lowest were

the Champlain, South West and South East LHINs. All CCACs were above 70%. However this

data likely represents case managers employed directly by the CCACs and does not include

community health nurses employed by contracted private care organizations such as Victorian

Order of Nurses (VON), Extendicare, Comcare and St. Elizabeth. These nurses may be more

likely employed in a part-time capacity when compared to CCAC nurse employees. This data is

hard to find as there is no mandatory reporting. For the purposes of this report, the community

sector includes only those nurses working for CCAC-funded service providers and does not

include nurses working for public health.

Hamilton-Niagara-Haldimand-Brant LHIN 4

As the second largest LHIN in the province, the population of HNHB LHIN 4 is approximately

1.4 million. It covers 7,000 km2, encompassing Brant, Burlington, Haldimand, Hamilton,

Niagara and most of Norfolk. The LHIN is characterized by urban and rural communities, a

changing demographic rich in ethnocultural and linguistic diversity, variable incomes and levels

of education and a mixed economy in transition. The population mosaic is also enriched by two

Aboriginal reserves (Six Nations of the Grand River Territory and Mississaugas of the New

Credit) and a significant (28,000) Francophone population.


Approximately half of the First Nations population residing in the LHIN area live On-reserve. As

of August 2006, the total registered First Nations population living On- or Off-reserve in the

LHIN was 24,263, or 1.7% of the total LHIN population. Hamilton is known to attract the most

new immigrants per year and Fort Erie, in the Niagara region, accommodates the majority of

Canada’s refugees. The LHIN is significantly impacted by the number of migrant workers that

come to assist with Canada’s tourism and agricultural industries. This LHIN has the largest

number of residents over the age of 65 compared to other LHINs.

LHIN 4 is home to 10 hospital corporations (operating on 24 sites), more than 105 community

support service organizations, more than 50 community mental health and substance abuse

services, six community health centres and the HNHB Community Care Access Centre. Rates of

aging, poverty, single parent families and low educational achievement are above Ontario

averages. There is considerable room for health improvement in the areas of smoking cessation,

healthy body weight, addictions prevention, workplace health and safety and safe driving.

Chronic disease prevalence, persons living with diabetes and incidence of cancers are shaping a

health action agenda for better health outcomes.

Trends in Nurse (RN/RPN) Working Status - HNHB LHIN 4

According to the College of Nurses of Ontario, there has been a very slight increase in the

percentage of full-time nurses (RNs and RPNs combined) and a slight decrease in part-time

nurses during the past four years (2005-2008) in HNHB. The casual rate remained constant over

the same period. As of 2008, the full-time rate is just over 60%. The70% goal has not been

achieved in HNHB (College of Nurses of Ontario [CNO] 2008).


0

10

20

30

40

50

60

70

80

90

100

2005 2006 2007 2008

Per

cent

age

Year

Nurses Employed in Nursing in Ontario by Working Status

Hamilton Niagara Haldimand Brant LHIN 4

Full-Time

Part-Time

Casual

RN Employment in HNHB LHIN 4

In terms of nurse employment, 11% of RNs working in Ontario are employed in HNHB LHIN 4

(CNO, 2008). Of those, 62.7% were employed full-time, 30.3% were employed part-time and 7.0

were employed on a casual basis. Nearly two-thirds (64.6%) were employed in hospitals, 18.9%

in community settings and 9.5% in long-term care facilities (CNO, 2008).

RPN Employment in HNHB LHIN 4

According to the CNO, 12.1% of RPNs employed in Ontario in 2008 worked in HNHB LHIN 4.

Of those, 58.6% were employed full-time, 31.7% were employed part-time and 9.7% were

employed on a casual basis. The largest percentage of RPNs worked in hospitals (47.9%),

followed by long-term care facilities (35.5%) and community settings (11.8%) (CNO, 2008).

FT Nurse Employment by Sector (MOHLTC Health Data Branch, 2009)

According to the MOHLTC Health Data Branch statistics, 46% of acute care hospitals and 74%

of long-term care facilities in HNHB LHIN 4 were below a 70% full-time nurse ratio for RNs,

RPNs and NPs combined. Overall, HNHB ranked fourth among all of the LHINs, with a 72.33%


full-time nurse employment rate (RNs, RPNs and NPs combined). The full-time rate was 74.56%

for RNs, 64.74% for RPNs and 91.16% for NPs across all sectors (acute, long-term care and

CCACs).

HNHB - SPECIFIC NEEDS AND THE HUMAN RESOURCE STRATEGY

In order to describe LHIN specific needs, a variety of approaches were used. A survey combined

with interviews and focus groups identified needs and existing human resource strategies. Key

stakeholders were consulted throughout each LHIN. An online survey was distributed via email

to Chief Nursing Officers, Directors of Nursing and/or Unit Managers. It featured questions

around organizational demographics (such as sector and geography), local needs in relation to

70% full-time employment and recommendations for human resource planning strategies to

achieve the targeted 70% full-time employment (see Appendix B: Survey Instrument).

Hospitals, long-term care facilities and community organizations were chosen to participate in

focus groups and/or interviews to identify the most appropriate strategies for organizations to

increase full-time capacity based on sector and geography. Using the data provided by the

Ministry of Health Data Branch for each LHIN, focus groups were conducted with organizations

that had achieved a 70% full-time nurse employment rate, broken down by sector. Individual

interviews were conducted with organizations that did not achieve a 70% full-time nurse

employment rate, broken down by sector. Questions focused on identifying strategies used to

advance and sustain 70% full-time nurse employment (see Appendix C: Focus Group Guide).

The following sections will identify local needs in meeting the 70% target and discuss strategies

organizations used in moving toward this goal. The findings cited throughout this section are

inclusive of the four participating LHINs. Differences emerged across sectors and geographic

context (i.e., rural/urban) rather than across the LHIN regions per se.

Local Needs

Staffing and Scheduling

An issue that often arises in the literature and was identified in the interviews is the need for

flexibility in staffing and scheduling. Differences emerged by sector and geography in describing


the need for flexibility. In smaller acute care settings, unpredictable patient censuses mean that

staff should be part-time and come in on an “as-needed” basis. One Nurse Manager reported,

“it’s just the volume and flexibility when you have small groups of staff with particular clinical

areas.” Another commented “[w]e really do need the extra part-time staff to maintain the

flexibility in scheduling.” Full-time employees need to have skills to work in a variety of

different clinical areas; otherwise organizations need several part-time employees to provide the

clinical flexibility to cover the range of clinical units.

Full-time employees in small hospitals must be flexible and move around different units or

services:

You need to be able to work emergency, in-patient and likely some recovery room

or that type of work as well in order to maintain large proportions of [staff with

full-time status].

The other issue is vacation time and the need for replacement, which cannot always be met by

full-time nurses. One interviewee described the challenges for a small community hospital in

meeting the 70% target:

Because we have lower volumes and smaller units like a four-bed ICU or a four-

bed pediatric unit, we need a certain number of full-time, but we also need a

certain number of part-time to…replace those full-time when they go on

vacation.

Long-term care organizations described different coverage problems. The high rate of

absenteeism due to excessive workload made it difficult to maintain a high complement of full-

time nurses. Units work short or Nurse Managers are called in to cover shifts. With a high

proportion of full-time nurses, managers continually worried about staff shortages. Many argued

that there was a need for a higher part-time complement in organizations where workload is high

and the pool of registered staff is limited:

Never being sure because you have a small group to begin with, never being sure

if you’re going to have your [full] complement…is a stress to the staff.

Due to limited staff availability, scheduling was a challenge in community organizations, Heavy

reliance on contract work by CCACs means that nurse employment is characterized by a high


proportion of part-time and casual staff. As nurses often accept community positions as

secondary employment, they give primary commitments to their full-time employers. As one

Nurse Manager described:

Staffing is a major issue because the casual staff volunteer when they want to

work. It’s not like I can put out a schedule and say, "Okay, we need people to

work these days, who’s available?"

Other staff characteristics in the community sector include retired nurses who have moved into

part-time positions (e.g., visiting nurses) to supplement retirement incomes.

Needs of Rural and Small Organizations

Organizations with geographic and/or institutional size issues have difficulty meeting the 70:30

full-time to part-time ratio. Retention rates in rural areas are good because many nurses work

within their own communities. Nurses report that they often wait many years to achieve full-time

status. On the other hand, unions sometimes act as a barrier to assigning full-time staff because

seniority dictates who gets the positions:

We weren’t able to give our new grad a full-time job because somebody who had

more seniority than her actually got the position.

In all sectors, recruiting registered nursing staff (RN and RPNs) was problematic, but it was

particularly difficult in long-term care. A Director of Care in a private long-term facility noted

that:

There just isn’t the number of registered staff out there and specifically

registered staff who are interested in long-term care. We do compete quite

heavily with hospital centres.

Nurses attracted to rural areas would be unlikely to relocate because organizations could only

offer them part-time employment. New graduates would hesitate to move to a small town with

little prospect for work and social activities.


Demographic Changes

Contrary to retirement predictions, many older nurses do not want early retirement. According to

one Chief Nursing Officer, some nurses:

Don’t want to take early retirement because a lot of them [due to] the current

economic environment have lost quite a bit of money. The last two that we

thought might take early retirement have decided no, they’re not going to now

because of the current economic environment.

On the other hand, government initiatives and employer concern about loss of experienced

nurses have led to incentives to keep older nurses in the workforce. Since these nurses retain

their full-time positions, it becomes a challenge to employ full-time new graduates in small

organizations. In fact, new graduates have indicated that they are not staying in small

organizations because there are no full-time positions or full-time hours being offered, only part-

time and mostly casual. Some employers have decided not to participate in the Nursing Graduate

Guarantee (NGG) in the next year (2009-2010) because they do not have full-time positions to

offer the new graduate pool.

Sector Specific Challenges

Nurses (RNs and RPNs) prefer not to work in long-term care. Data from the interviews indicate

that excessive documentation is a deterrent. Moreover, RNs must bear unwelcome levels of

responsibility. Exit interviews reveal that they:

Don’t like being responsible for supervision of the non-registered staff. And if

the management team is not in the building they are responsible for the over-

all running of the building.

Long-term care employers indicated that new graduates are not interested in coming to long-term

care. If they do, they generally leave for acute care or simply work across the two sectors. This

practice makes it difficult to provide full-time positions and increases the need for employer

flexibility. One Director of Care voiced concern about the reputation of long-term care facilities

among nursing students and new graduates. She noted that young RNs had told her that their

instructors had discouraged them from working in long-term care.


Registered practical nurses are paid substantially less in private long-term care institutions and

retirement homes than in hospitals or long-term care institutions run by municipalities. One

Director of Care in a long-term care organization pointed out that, “Because we’re unionized our

wages are not really negotiable.”

Most long-term care facilities recognized the advantage of having enough RN staff and

commented that any potential RNs who walked through the door would be offered a full-time

position immediately. On the other hand, acute care settings are encouraged to employ personal

support workers (PSWs) in place of registered staff as a cost saving strategy. Due to the current

economic downturn, a majority of hospitals will be running deficits in the coming years. As a

result, cost saving measures may target nursing as an area where cuts could be made.

Community organizations also cited concerns about recruiting full-time nurses based on rate of

pay. In this sector, RNs are paid substantially less than RNs working in acute care or long-term

care. Community Nurse Managers report a pay differential of close to $10.00 per hour. Nurses in

community organizations also experience job insecurity. Contracts awarded to organizations

such as the VON or St Elizabeth’s are based on a two to three year period, with no guarantee of

renewal. For both these reasons, nurses are reluctant to leave permanent positions in other

sectors.

Employer/Employee Preferences

Although employers would prefer a stable workforce, they report that some part-time employees

do not want full-time jobs. Some of the reasons they give are other jobs and family

commitments. A predominantly female workforce may have different preferences during

successive phases of life (i.e., new graduates, childbearing years, mid-career and late career).

Many mid-career nurses prefer to remain in part-time employment to meet the demands of work

and family life. One Chief Nurse Executive gave an example of a nurse who "needs to work both

in the hospital as a nurse and on the farm . . . . So there’s a family commitment not only to

children but to other types of work."

Part-time employees sometimes worked for multiple employers. Long-term care and community

organizations compete with acute care institutions for nurses (both RNs and RPNs) because better


pay is more attractive to potential full-time employees. In rural organizations and acute care

settings in general, part-time staff had multiple employers because no full-time positions were

available.

Some new graduates have indicated that they would be willing to stay part-time in their area of

interest and wait for a full-time permanent position:

I want to work in medicine and the only job that’s there is a part-time

position, so that’s what I’m going to work.

Sectors varied in the availability of jobs. The majority of hospitals were not offering full-time

positions but had postings for permanent part-time jobs. Long-term care facilities did have full-

time postings, but the positions were for RNs and were thus difficult to fill. Community

organizations commented that they were not succeeding in filling full-time positions. They

believed that continuity of care was an issue because the majority of their nursing complement

was part-time and casual. They felt that having full-time nursing staff would lead to better patient

outcomes. One nurse manager commented:

“We are at the moment trying to increase our permanent full-time and permanent part-time positions. We’re no longer hiring casual… one of the huge issues is being able to provide continuity to our clients.”

STRATEGIES USED TO INCREASE AND/OR MAINTAIN 70% FULL-TIME BY SECTOR

An overarching theme across all sectors in moving toward and/or maintaining their 70% full-

time complement was the need for creativity. Both large and small organizations described

unique strategies to increase their full-time to part-time nurse employment ratio. One Director of

Care in a small long-term care facility reported being "forced to offer full-time positions in order

to retain staff." Some approaches were specific to the organization and sector, while others were

broader. In either instance, however, they highlighted the importance of understanding local

needs in creating a nursing health human resource planning strategy.


Sector Specific Strategies

Creative Scheduling

Interviews with individuals from organizations that had achieved the 70% full-time target

revealed that manipulating master schedules allowed them to offer more full-time positions and

increase their full-time complement. Some Nurse Managers created two or three schedules to

meet the 24/7 demands for coverage. One Director of Care described creating a weekday master

schedule that differed from her weekend master schedule. The weekend schedule included one

less registered staff and only one RN that worked a 7.5 hour shift (11am-7pm) that cut across

both the day and night shift.

Other strategies included moving from 8 hour shifts to 12 hour shifts and obtaining staff input

into the scheduling process. One Director of Care had met with each employee, beginning with

the person with most seniority, and tried to accommodate their preferences for 8 or 12 hour shifts

when creating her master schedule.

Manipulating master schedules was an effective way to create and maintain a greater full-time

complement, but it had limitations. Managers agreed that it created more work for them and

made it more difficult to track staff. It was hard to accomplish in larger organizations and most

effective in smaller organizations with fewer nursing staff.

Cross-Training

A second strategy involved cross-training nursing to work in multiple clinical units within one

organization. This strategy was most successful for acute care settings in small hospitals in rural

areas in which low volumes and unpredictable patient census meant that nurses were not always

needed in every clinical area (e.g., OB). By training nurses in more than one area, they could

then be scheduled across the hospital and not lose hours or full-time status because of a lack of

patients. One Chief Nurse Executive explained:

For our Women and Child Unit, in order to get full-time nurses they need to

be able to work in labour, delivery, surgery, gynecological surgery,

postpartum; all of those areas, and be competent in all of those areas in order

for us to have enough work for them to work full-time. I think we could

support them getting full-time work in this kind of environment much easier.


A similar approach used in larger organizations was creating a clinical float team that offers full-

time positions to nurses within one organization. Although an effective strategy for the

organization, not all nurses wished to be cross-trained. In particular, new graduates preferred to

work in one clinical area of their choice. In some cases, they chose to stay in a part-time position.

Mid-career and older nurses preferred to either be sent home or take a vacation day in slow times.

Integration With Community Partners

Managers in rural and small community organizations discussed the possibility of collaborating

across sectors within one community to create a full-time position. The nurse would work across

an acute care hospital, long-term care and possibly a community setting as one full-time

employee. S/he would be offered a predictable master schedule that included shifts across

settings with the same benefits awarded to full-time employees in one organization. This

arrangement could only be achieved in a small community with few organizations that could

offer a collaborative full-time position. Many factors would need consideration before offering

this type of position, including pay differences across sectors, union issues and concerns around

clinical support. However, in some small communities, these barriers could be overcome through

collaboration and coordination across participating organizations:

It may be easier for us to actually create a full-time position across sectors than it

is to create a full-time position between communities. For instance [in one small

community], there is a 66-bed long-term care facility that is really struggling to

maintain their RN complement and there is a small acute care facility and there is

a fair community presence of community nursing in that area . . . . I won’t say

that the hospital is struggling so much anymore, but that’s because we have done

a lot of work, not because it just happened that way. But I think we need to think

collaboratively across the sectors to be able to sort this out for nurses.

Combining Part-Time Lines

Another strategy used across organizations and sectors was combining two part-time positions to

make one full-time line. This strategy works especially well for larger hospitals where part-time

positions can easily combine into one full-time line, but it is more difficult in smaller

organizations. In addition to the need for a higher part-time complement, smaller organizations


may not have part-time lines that could be easily combined. For example, in some hospital

corporations, small hospital sites are geographically dispersed. Available part-time positions may

be in two sites that are a considerable distance apart. In larger organizations where there is more

movement among nursing staff, part-time positions arise more frequently and it may be easier to

combine them.

Creating Specialty Lines Across Sites

This strategy involves offering nurses the opportunity to work in a specialty area (e.g., surgery)

across a number of sites. In smaller acute care organizations where the need for specialty nurses

is minimal due to low volumes and lack of physician specialists in the area, this strategy could

provide a full-time position for an interested nurse. New graduates in particular may be

interested in a position that would allow them full-time work in a preferred clinical area. Young,

single new graduates may have the flexibility to take a position that would enable them to gain

experience in an area of their choosing:

If we had somebody who wanted to specialize in operating - as an operating

room nurse and could work across three sites or two sites, we have to have

vacancies in all of those areas.

Cross-Sectoral Strategies

The following section includes strategies that could be used across sectors and geographical

context.

Using RPNs to Full Scope of Practice

A number of organizations described using RPNs to their full scope of practice as a useful

approach to maintaining a higher ratio of full-time to part-time nursing staff. Acute care settings

described the benefits of placing RPN staff in clinical areas such as emergency and operating

rooms. As one Chief Nursing Officer described "Using RPNs to their full scope has made a

significant difference in our model of care.” Long-term care facilities described empowering

their RPNs to take on leadership roles such as educators and “care-plan champions and

documentation champions.” By doing this, employers were able to give RPNs additional shifts in

additional roles which bumped them to full-time status. In community settings, Nurse Managers


benefited from the recent change in practice for RPNs because they were able to utilize them

with higher acuity patients, freeing up the RN staff for the more complex client cases.

Participating in Government Initiatives

Government strategies such as the NGG and late career initiatives were identified as helpful in

recruiting and retaining nursing staff; however, not all organizations that applied were successful

in attaining the funding. Through the NGG, the MOHLTC provides funding for six-month

temporary full-time supernumerary positions for new nursing graduates who are matched with

employers through the NGG and portal process. Furthermore, the initiative provides employers

with the time to build capacity within their organizations, so that they might be able to offer

permanent full-time employment to new graduates. Many organizations described using this

initiative in recruiting younger nurses; however, smaller organizations found it difficult to

streamline that nurse into a full-time position once the NGG phase had ended.

In contrast, both large and small organizations identified the late career initiative as an effective

measure in retaining some of their older staff. As one long-term care Director of Care stated:

She’s one of our RPN staff. And I did ask her the question, you know, do you

think if you were thinking about retiring, having the opportunity to do this

would possibly change your mind? And she definitely said she thought yes it

would. So, you know, I was convinced it was quite worthwhile.

Building Relationships With Academic Partners

Collaborating with academic partners was also identified as an effective recruitment strategy for

organizations. Forging relationships with nearby nursing schools helped organizations create

clinical placements for students. In the long-term care sector, this strategy was especially useful

in helping to demystify some of the stereotypes around working in these types of facilities and

exposing students to the realities of working in a nursing home.

Other Strategies

Other strategies discussed included job shares and creating modified full-time positions for older

nurses (55+).


Survey Results

Employer Demographics

The majority of responding HNHB employers were long-term care (41%), followed by acute

care hospitals (32%), community (23%) and other healthcare organization(s) (5%). Table 1

provides the full breakdown of respondents. All nursing employers within the LHIN had the

opportunity to answer the survey. The breakdown of employers with a viable response is

provided.

Table 1: Demographic of Nursing Employer Survey Respondents in HNHB LHIN 4

Employer Type Percentage of Respondents

Long-Term Care Facility 41% Acute Care Hospital 32% Community 23% Other 5%

Use of Agency and Overtime Hours

Many organizations use overtime and per diem staff to cover temporary staffing shortages. The

major disadvantage is the large cost to the organization associated with the use of agency staff.

According to the Canadian Federation of Nurses Union (CFNU, 2009), hiring agency nurses

costs up to three times more and sick time and overtime cost two times more than a regular staff

nurse rate. Investment in employment strategies that reduce overtime, sick time and turnover can

significantly reduce costs over time (CFNU, 2009).

Acute care organizations reported the most use and highest numbers of RN agency hours,

followed by community and then long-term care. The trend is slightly different for RPN agency

hours, where the highest were found in acute care, followed by long-term care and then

community. Interestingly, long-term care reported a much higher use of RPN agency staff hours

over RN agency hours. Table 2 provides an overview of the average total paid RN and RPN

agency hours.


Table 2: HNHB Average Total Number of Paid Agency Staff Hours for Each of the Following Nursing Categories (2008/2009)

Acute Care Community Long-Term Care

Total paid RN agency hours 13,369 954 90

Total paid RPN agency hours 4,502 2,059 2,172

In Canada, it is estimated that overtime for RNs increased by 58% between 1998 and 2005, but

the average number of overtime hours remained the same at 6.4 hrs per week; this means that the

hours of overtime worked by each nurse remained the same, but many more nurses worked

overtime (CNA, 2006). Several factors must be considered with the use of overtime hours:

fitness to practice, fatigue, safety, ethical and legal responsibility of both employee and employer

and overtime standards. There must be consideration of ethical staff decision-making and health

human resource planning with the use of overtime hours (Alberta Association of Registered

Nurses, 2006).

Table 3 provides an overview of the average total number of overtime hours for each nursing

category by sector. On average, acute care respondents appear to use many more RNs (47,112)

and RPNs (6,472) to work overtime than do long-term care facilities (9,475 RNs and 2,045

RPNs) and community (293 RNs and 544 RPNs). This is because acute care organizations

generally employ a large number of nurses in comparison to both long-term care and community

employers.

For the acute care sector, converting the overtime hours to full-time equivalent (FTE) positions

(1950 hrs)1 would render, on average, 24 RN and 3 RPN acute care positions amongst the LHIN

4 respondents to the survey. If the average nurse works 6.4 hrs extra this means that 7,361 RNs

and 1,011RPNs, on average, are working overtime amongst the survey respondents.

1 A full-time equivalent represents the total number of hours (approximately 1,950), including benefit hours (vacation, sick leave, pregnancy leave, educational leave, etc.), which are allotted to a full-time position over a period of one year.


Table 3: HNHB Average Total Number of Overtime Hours for Each Nursing Category (2008/2009)

Sector Acute Care Community Long-Term Care

Total number of RN overtime hours

47,112 9,475 293

Total number of RPN overtime hours

6,472 2,045 544

Research indicates that long work hours without adequate rest time are associated with errors and

impaired performance, thus threatening the ability of RNs to provide safe, competent care (Jha,

Duncan, & Bates, 2004). Restricting work hours (i.e., overtime worked) is one way to reduce

fatigue-related risk and lost time worked while creating full-time positions using overtime hours

would increase the number of full-time positions available and reduce the higher costs related to

overtime pay.

Current Recruitment of Nurses

HealthForceOntario includes a number of innovative initiatives designed to help the province

keep its skilled healthcare professionals, encourage young people to consider health careers, help

internationally educated health providers who have chosen Ontario as their place to live enter the

workforce and reach out to those who have left Ontario (HFO, 2009). The HFOJobs website is

"managed by the HealthForceOntario Marketing and Recruitment Agency, [and] lists thousands

of jobs across Ontario for doctors and nurses" (http://www.healthforceontario.ca/Jobs.aspx).

LHINs and healthcare organizations and employers within the LHINs can create and manage

customized websites to advertise and market job opportunities and provide community

information to healthcare professionals (HFO, 2009).

The survey respondents were asked to provide the number of full-time and part-time nursing

positions they are currently recruiting for RNs, RPNs and NPs. Table 4 indicates that most

recruitment for RN and RPNs is occurring in the acute care organizations for the respondents

within HNHB. There is no activity for long-term care RN and RPN full-time and little activity

for RN and RPN part-time positions. The community sector has most activity for part-time RNs

and some activity for RPNs, but there is very little activity for full-time RNs and RPNs.

Differing hiring models and funding formulas that characterize community and long-term care


employers may be contributing to their lack of recruitment activity in the current economic

situation, compared to larger acute organizations that have a larger capacity to recruit.

Respondents did not provide detailed NP data.

Table 4: HNHB Average for the Number Of Full-Time and Part-Time Nursing Positions Currently Recruiting Outside the Organization for Each Nursing Category (2008/2009)

Sector RN FT RN PT RPN FT RPN PT

Acute Care 39 16 16 17 Long-Term Care 0 2 0 2 Community 2 16 4 4

Organizations Achieving 70:30 Full-Time To Part-Time Target

Each nursing employer completing the survey was asked whether they had achieved the 70:30

target ratio of full-time to part-time at their organization for RNs and RPNs. In HNHB, 43% of

the respondents indicated that they had achieved the target for RNs, while 57% indicated that

they had not. Similarly, 30% indicated that they had achieved it for RPNs and 70% had not.

Interestingly, when the average RN ratio was calculated for each sector, on average, the acute

care and community respondents indicated that they reached the target ratio, 72:28 and 90:10

respectively, while the long-term sector had a much lower ratio at 46:54. In the case of RPNs,

acute care and long-term care respondents averaged a lower full-time to part-time ratio at 59:41

for acute and 48:52 for long-term care. The average community care respondent in HNHB

indicated that they reached 83:17 ratio for RPNs. The ratio for NPs is high for both acute (95:5)

and long-term care (100:0), most likely due to NPs being hired on a full-time basis and the

number of NPs in an organization is usually quite small. Community respondents did not report

NP data. Table 5 illustrates that the average stated full-time to part-time mix from all LHIN 4

survey respondents was not at the 70% target mix for either RNs (69:31) or RPNs (63:37).

Table 5: HNHB Average Stated Full-Time to Part-Time Mix (in Percentage) for the Following Nurse Categories (2008/2009)

Nursing Category FT PT

Registered Nurse 69% 31%

Registered Practical Nurse 63% 37%


HNHB Strategies in Achieving 70% FT Nurse Employment

In addition to findings pertaining to the strategies used by organizations to achieve and maintain

a 70% full-time nurse employment, organizations responding to the survey were asked to

identify LHIN specific strategies. Of those organizations who responded to this question, the

following strategies were identified for HNHB:

1. Using RPNs to their full scope of practice

2. Converting part-time to full-time positions

3. Creating clinical float team

4. Offering educational incentives to all nurses (RNs and RPNs)

5. Access the NGG

6. Reinvesting NGG savings into mentorship programs for mid-career nurses (80/20: 80%

bedside care, 20% nurse development projects)

7. Multi-site positions in areas of clinical specialty

8. Building strong relationships with academic partners and increasing clinical student

placements

9. Changing RN/RPN mix in some clinical areas to create more full-time positions

10. Active recruitment within the community

11. Participating in the Nursing Graduate Guarantee (recruiting new graduates).

DISCUSSION

Hamilton-Niagara-Haldimand-Brant is comprised of both rural and urban areas with composite

distribution of healthcare organizations. It includes both large and small acute care organizations,

numerous long-term care facilities and community providers contracted through the CCAC. In

terms of population, it is the second largest of the 14 LHINs but the largest of the four LHINs

participating in this project. Consistent with provincial statistics provided through the CNO,

survey results indicated that the RN full-time nurse employment rate in HNHB LHIN 4 is

approximately 69%, while the RPN full-time employment rate is approximately 63%.

Due to its geographic structure, HNHB serves a large population within a relatively small

geographic area. This means that there are a greater number of large hospitals, long-term care

facilities and community service providers. Specific strategies in achieving a 70% full-time nurse


employment rate for HNHB should focus on decreasing the number of overtime hours and

agency use in larger acute care hospitals by providing incentives for hospitals to convert these

hours into full-time positions; better advertising for long-term care and community agencies to

breakdown negative stereotypes surrounding the work environment; and promoting pay equity

across sectors for both RNs and RPNs.

CONCLUSIONS

In an effort to identify local needs in meeting the 70% full-time nurse employment rate, a

collaboration between the Nursing Health Services Research Unit at McMaster University and

four participating LHINs (Hamilton-Niagara-Haldimand-Brant, Central West, South East and

South West) was developed. The purpose of this partnership was to create a nursing health

human resource planning strategy that would help organizations within each LHIN move closer

toward a 70% full-time rate. The importance of having a LHIN specific stratgey in achieving and

maintaining this target has been underscored by the analysis provided throughout this report.

Organizations faced unique challenges related to their size, geographic location and employment

sector. Overall, smaller organizations in rural areas had difficulty recruting nurses because they

were not able to offer full-time positions. They also idenitified a need for greater flexibility in

staffing and scheduling due to unpredictable patient censuses and variable patient volumes.

Because nurse retention was high in smaller organizations, full-time opportunities were scarce.

In larger organizations located in urban centres, greater opportunity for full-time employment

existed because of higher turnover rates and greater numbers of nurses looking for work.

However, this also meant greater competition for nurses within and across sectors.

Across sectors, long-term care facilities faced the greatest challenge in recruiting and retaining

nurses (RNs and RPNs). According to interview data, an unattractive workload (characterized by

excessive documentation and supervising non-registered staff) and pay inequity were two

significant reasons why nurses did not want to work in long-term care. For community service

providers, job security was a major factor limiting organizationss in successfully recruiting and

retaining full-time nurses. Due to the instability of employment based on time-limited contract

work from the CCACs, providers worried that nurses were not interested in leaving permanent

part-time positions elsewhere to take on a temporary full-time position within their organization.


In addition, significant pay differnces exist for both RNs and RPNs when compared to long-term

care and acute care settings.

In addressing these needs, many organizations voiced concerns around achieving and

maintaining the 70% full-time nurse employment rate. On a micro level, there may be a need for

some organizations, particularly smaller ones, to maintain lower full-time to part-time ratios to

meet their changing demands. In addition, nurses may be choosing to stay in part-time positions

for various reasons, including family commitments and waiting for a position in their preferred

clinical area. Overall, LHIN full-time nurse employment averages are quite good according to

both the Ministry of Health and CNO data. Additionally, statistics show that Ontario averages for

full-time nurse employment are high compared to the national average (CNO, 2008).

However, in examining individual organizations, these ratios drop considerably. Given the

limitations of some organizations in reaching the 70% target and nurse preferences for part-time

work, it may be more realistic to focus on achieving a 70% average by sector rather than by

organization within each LHIN. Therefore, in creating a nurse human health resource strategy,

each LHIN could conduct a needs analysis by sector to better target strategies based upon sector

requirements. Funding models would have to change accordingly to accommodate the diversity

across the LHINs in terms of sector and geographical context.

In conclusion, the strategies identified in this report are not an exhaustive list. Instead, they

provide a starting point for the four participating LHINs in creating a nurse human health

resource planning strategy geared toward the local needs identified by organizations within each

LHIN. The ultimate goal is to create a province-wide strategy that will represent a made-in-

LHIN solution to the issues inherent in achieving a 70% full-time nurse employment rate.

In September 2009, a workshop for the LHINs and other key stakeholders hosted by the Nursing

Health Services Research Unit and the MOHLTC was held in Toronto. Additional straetgies

were generated to further support the LHINs in moving towards the 70% nurse employment

goal. A toolkit (“8 Strategies to Advance 70% Full-Time Nurse Employment”) has been created

for organizations to use as a resource in working toward increasing FT nurse employment.

Across sectors and geographic regions, this toolkit includes strategies for organzaitions both

large and small.


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Canadian Institute of Health Information. (2006a). Workforce Trends of Registered Nurses in

Canada, 2006. Ottawa, Ontario: Author.

Canadian Institute of Health Information. (2006b). Workforce Trends of Licensed Practical

Nurses in Canada, 2006. Ottawa, Ontario: Author.

Expert Panel on SARS and Infectious Disease Control. (2004). For The Public’s Health: A Plan

of Action, Final Report. Toronto, Ontario: Ministry of Health and Long-Term Care.

Grinspun, D. (2007). Healthy workplaces: The case for shared clinical decision-making and

increased full-time employment. Healthcare Papers, 7, 85-91.

HealthForceOntario. (2009). Recent Initiatives. Available at: http://www.healthforceontario.ca/

Work/InsideOntario/OntarioNurses/WhatHFOCanDo/RecentInitiatives.aspx

Jamieson, L. N., Williams, L. M., Lauder, W., & Dwyer, T. (2008). The ‘realities’ of part-time

nursing: A grounded theory study. Journal of Nursing Management, 16, 883-892.

Jha, A. K., Duncan, B. W., & Bates, D. W. (2004). Fatigue, Sleepiness, and Medical Errors.

Taken from Evidence Report/Technology Assessment, No.43 Making Health Care Safer: A

Critical Analysis of Patient Safety Practices. Available at: http://www.ahrq.gov/clinic/

ptsafety/chap46a.htm

Ministry of Health and Long-Term Care (2005). RNAO Day at Queens Park: Speaking Notes

Presented by George Smitherman, Minister of Health and Long Term Care. Available at:

http://www.health.gov.on.ca/english/media/speeches/archives/sp_05/sp_012805.htm

Ministry of Health and Long-Term Care (2009). Local Health Integration Networks. Available

at: http://www.health.gov.on.ca/transformation/lhin/lhin_mn.html


Paddon, P. (1992). Nursing in Canada. Health Reports, 4(3), 321–29.

Registered Nurses Association of Ontario. (2003). Survey of Part-Time and Casual Nurses in

Ontario. Toronto, Ontario: Author.

Registered Nurses Association of Ontario. (2005). The 70 Percent Solution: A Progress Report

on Increasing Full-time Employment for Ontario RNs. Toronto, Ontario: Author.

Registered Nurses’ Association of Ontario and Registered Practical Nurses’ Association of

Ontario. (2000). Ensuring the Care Will Be There: Report on Nursing recruitment and

Retention in Ontario. Toronto, Ontario: Author.

Sharkey, S. (2008). People Caring for People: Impacting the Quality of Life and Care of

residents of Long-Term Care Homes. A Report of the Independent Review of Staffing and

Care Standards of Long-Term Care Homes in Ontario. Toronto, Ontario: Author.

Sloan, C., Pong, R., Rukholm, E., Larocque, S., & Pitblado, R. (2005). Full-Time/Part-Time

Employment of Nurses in Small Hospitals in Rural and Northern Ontario. Sudbury, Ontario:

Centre for Rural and Northern Health Research, Laurentian University.

Tourangeau, A. E., Giovanetti, P., Tu, J. V., & Wood, M. (2002). Nursing-related determinants

of 30-day mortality rates for hospitalised patients. Canadian Journal of Nursing

Research, 33(4), 71-81.

The World Health Organization. (2009). Pandemic (H1N1) 2009: Update 71. Available at:

http://www.who.int/csr/don/2009_10_23/en/index.html

Zeytinoglu, I. U., & Muteshi, J. K. (1999). Changing Work Relationships: Enacting Gender,

Race/Ethnicity and Economic Class. Amsterdam: John Benjamins Publishing Company.


APPENDIX A: HNHB LHIN 4 DATA PACKAGE

Full Time Nursing Employment

Moving Towards 70%

February 2009

Hamilton Niagara Haldimand Brant LHIN

Nursing Secretariat

HealthForceOntario

Nursing Secretariat

February 13, 2009

2

Key Findings*• 72.33% of Nurses (Registered Nurses (RN), Registered

Practical Nurses (RPN), and Nurse Practitioners (NP) combined) are employed full-time in hospitals, long-term care homes and CCACs in the Hamilton Niagara Haldimand Brant LHIN

• 46% of Acute Care hospitals are below 70% total full-time for all nurses (RN, RPN & NP combined)

• 74% of Long-Term Care facilities are below 70% total full-time for all nurses (RN, RPN & NP combined)

*Notes About Data:

•Obtained through Health Data Branch

•Only data for Acute Care Hospitals, Long-Term Care Homes and Community Care Access Centres were available for analysis

•Data aggregation resulted in some figures not summing to 100%


3

3

LHIN Rankings – Acute, LTC, CCACRank LHIN

IDLHIN NAME TOTAL RN RPN NP

%FT %PT %FT %PT %FT %PT %FT %PT

01 6 Mississauga Halton LHIN 77.46 20.7 78.55 19.77 66.14 30.48 95.86 4.14

02 7 Toronto Central LHIN 75.25 22.67 77.38 21.11 64.63 31.29 80.5 4.22

03 14 North West LHIN 73.07 25.69 76.39 22.98 66.4 31.26 93.06 2.31

04 4Hamilton Niagara Haldimand Brant LHIN

72.33 26.24 74.56 24.39 64.74 32.64 91.16 6.68

05 8 Central LHIN 72.18 23.78 74.91 21.18 61.53 33.9 99.21 0.79

06 2 South West LHIN 71.83 27.66 74.72 24.77 63.2 36.34 94.58 3

07 12 North Simcoe Muskoka LHIN 71.57 26.82 74.04 24.78 65.56 31.87 89.29 -

08 13 North East LHIN 69.92 28.85 73.97 25.12 60.13 37.98 76.73 14.85

09 9 Central East LHIN 69.72 28.82 73.01 25.84 62.2 35.64 100 -

10 5 Central West LHIN 69.12 27.8 71.95 24.75 58.15 39.59 - -

11 11 Champlain LHIN 69.05 29.55 72.18 26.6 57.26 40.63 94.77 5.23

12 10 South East LHIN 68.94 29.99 72.12 27.2 59.18 38.57 92.25 7.75

13 1 Erie St. Clair LHIN 68.82 30.56 72.13 27.52 57.7 40.8 91.04 7.96

14 3 Waterloo Wellington LHIN 65.89 33.24 69.5 29.79 55.92 42.77 83.59 16.41

* Acute Care, LTC and CCAC (does not include home care nurses)

4

HNHB LHIN Acute Care Hospitals

Percentage of Registered Nurses, Registered Practical Nurses and Nurse Practitioners Employed Full-Time


5

5

HNHB - Acute Care Hospitals

• Highlights slides (tables) POINT 5)

• By CCAC/LHIN, CCAC/LHIN maps etc Totals first % RN, FT, PT, RPN , FT, PT,

Fac. #LHIN

IDFACILITY NAME

TOTAL RN RPN NP


734 4 HALDIMAND West Haldimand General 54.3 44.6 61.2 37.4 37.8 62.2 - -

664 4 GRIMSBY West Lincoln Memorial 54.6 44.5 56.8 41.9 49.3 50.7 - -

648 4 DUNNVILLE Haldimand War Memorial 57.3 41.6 64.2 34.3 39 60.8 - -

675 4 HAMILTON St Peter's 60.9 38.8 74.4 24.8 66.6 32.3 92.7 -

854 4 SIMCOE Norfolk General 67.2 67.2 68.2 31.8 64.4 35.6 100 -

790 4 ST CATHARINES Hotel Dieu 70.5 29.5 89.8 10.2 59.4 40.6 - -

617 4 BRANTFORD Brant Community 72.8 27.2 75 25 65.6 34.4 - -

674 4 HAMILTON St Joseph's 73 26.1 74.4 24.8 66.6 32.3 92.7 -

962 4 ST CATHARINES Niagara Health System 74.8 24.6 77.2 22 66.1 33.9 - -

718 4 BURLINGTON Joseph Brant Memorial 76.8 21.4 80.5 17.7 60.8 37.2 - -

942 4 HAMILTON Health Sciences Corp 76.2 23.1 77.1 22.4 64.5 33 88.5 11.5

6

HNHB LHIN Long-Term Care Homes

Percentage of Registered Nurses and Registered Practical Nurses Employed Full-Time


7

7

HNHB– Long-Term Care Homes

Fac. #LHIN

IDFACILITY NAME

TOTAL RN RPN

%FT %PT %FT %PT %FT %PT

C571 4 TABOR MANOR - 72.63 - 100 - 100

C523 4 R. H. LAWSON EVENTIDE HOME - 97.34 - 100 - 100

2641 4 BLACKADAR CONTINUING CARE CENTRE 5.24 94.76 9.65 100 - 100

2678 4 VERSA-CARE CENTRE, BRANTFORD 9.55 89.45 - 80.41 19.59 80.41

2477 4 STONEY CREEK LIFECARE CENTRE 16.81 63.87 - - 100 -

2786 4 NORCLIFFE LIFECARE CENTRE 20.44 70.8 28.87 100 - 100

2721 4 CLARION NURSING HOME 20.44 79.56 32.17 95 - 95

2577 4 MOUNT NEMO CHRISTIAN NURSING HOME 26.67 73.33 21.21 62.75 37.25 62.75

1866 4 KILEAN LODGE 28.74 40.23 20.9 45 55 45

2739 4 TOWNSVIEW LIFECARE CENTRE 38.31 56.39 27.43 47.92 46.25 47.92

2799 4 HERITAGE PLACE 38.61 35.64 38.61 - - -

2621 4 NORFOLK HOSPITAL NURSING HOME (THE 38.85 61.15 30.77 55.43 44.57 55.43

M611 4 DEER PARK VILLA 41.67 52.08 41.67 - - -

2776 4 HERITAGE GREEN NURSING HOME 43.23 56.77 49.01 61.33 38.67 61.33

8

8

HNHB– Long-Term Care Homes (cont.)

Fac. #LHIN

IDFACILITY NAME

TOTAL RN RPN


2861 4 ALEXANDER PLACE 46.69 25.5 37.5 15.45 62.73 15.45

2844 4 MEADOWS LONG TERM CARE CENTRE (THE 48.58 43.26 43.07 46.21 53.79 46.21

2706 4 HAMILTON CONTINUING CARE 50.54 19.02 60.19 17.11 36.84 17.11

2742 4 TELFER PLACE 50.96 49.04 51.46 100 - 100

1056 4 DOVER CLIFFS 51.39 48.61 52.75 50.94 49.06 50.94

2321 4 EXTENDICARE ST CATHARINES 51.8 33.83 58.16 38.34 47.15 38.34

2570 4 LEISUREWORLD CAREGIVING CTR0BRANTFORD 52.28 47.72 43.17 35.29 64.71 35.29

2951 4 UNITED MENNONITE HOME 52.43 41.32 63.89 52.78 45.56 52.78

- 4NIAGARA HEALTH SYSTEM, WELLAND HOSP SITE, EXT.C.U.

54.05 22.01 46.81 11.16 57.21 11.16

2921 4 WILLOWGROVE (THE 54.6 40.9 48.97 37.58 57.14 37.58

C566 4 ST JOSEPH'S VILLA (DUNDAS 56.17 11.62 61.56 9.51 54.15 9.51

2961 4 GARDENVIEW LONG TERM CARE HOME 56.48 43.52 53.98 40 60 40

2741 4 GRACE VILLA 57.18 42.82 52 40.14 59.86 40.14

2927 4 ST PETER'S RESIDENCE AT CHEDOKE 58.66 29.04 53.02 27.89 61.16 27.89


9

9


Fac. #LHIN

IDFACILITY NAME

TOTAL RN RPN


2857 4 BURLOAK LONG TERM CARE CENTRE 58.7 35.33 47.59 32.18 67.82 32.18

M544 4 JOHN NOBLE HOME 59.41 40.59 49.49 34.88 65.12 34.88

2963 4EDGEWATER GARDENS LONG TERM CARE CENTRE

60.09 39.91 60 39.83 60.17 39.83

2408 4 MAPLE VILLA LONG TERM CARE CENTRE 60.19 39.81 63.56 43.88 56.12 43.88

2774 4 CAMA WOODLANDS NURSING HOME 61.11 38.89 64.58 45.83 54.17 45.83

C501 4 ALBRIGHT MANOR 61.65 38.35 33.77 14.81 85.19 14.81

2784 4 WELLINGTON NURSING HOME (THE 61.75 38.25 49.5 27.59 72.41 27.59

M587 4 UPPER CANADA LODGE 61.97 31.2 60 32.09 63.43 32.09

2700 4 PARKVIEW NURSING CENTRE 62.71 37.29 63.75 37.67 62.33 37.67

2581 4 VERSA-CARE CENTRE, HAMILTON 62.89 37.11 75 41.16 58.84 41.16

2846 4 HAMPTON TERRACE CARE CENTRE 62.98 37.02 60.19 34.85 65.15 34.85

2737 4 VALLEY PARK LODGE 64.34 35.66 59.6 20 80 20

M624 4 NORVIEW LODGE 64.36 35.64 63.06 34.39 65.61 34.39

10

10


Fac. #LHIN

IDFACILITY NAME

TOTAL RN RPN


2849 4 RIDGEVIEW LONG TERM CARE CENTRE 64.5 31.92 63.87 35.11 64.89 35.11

2720 4 HARDY TERRACE 64.73 35.27 67.5 37.21 62.79 37.21

- 4CHATEAU GARDENS LTC CENTRE/NIAGARA LTC CENTRE

64.89 35.11 66.11 36.69 63.31 36.69

2960 4 HEIDEHOF LONG TERM CARE HOME 64.94 27.09 53.6 21.43 76.19 21.43

2364 4 VERSA-CARE CENTRE, ST. CATHARINES 65.44 29.02 50.87 27.24 71.77 27.24

C527 4 INA GRAFTON-GAGE HOME (NIAGARA 65.79 34.21 43.48 19.12 80.88 19.12

2858 4 EXTENDICARE HAMILTON 65.83 22.88 62.35 17.95 67.09 17.95

M551 4 LINHAVEN 65.95 27.2 56.88 24.64 69.52 24.64

2922 4 REGINA GARDENS 66.96 11.01 68.29 16.02 65.75 16.02

2711 4 TUFFORD NURSING HOME 67.09 32.91 62.81 18.92 81.08 18.92

2931 4 IDLEWYLD MANOR 67.34 26.37 67.69 26.72 67.22 26.72

2854 4 VILLAGE OF TANSLEY WOODS (THE 67.99 29.89 67.71 29.79 68.09 29.79

2841 4 VILLAGE OF WENTWORTH HEIGHTS (THE 68.12 30 68.42 30.04 68.16 30.04

M617 4 WOODLANDS OF SUNSET (THE 68.57 20.88 56.52 17.35 73.82 17.35


11

11


Fac. #LHIN

IDFACILITY NAME

TOTAL RN RPN


M610 4 NORTHLAND POINTE 70.64 16.9 54.11 10.1 76.44 10.1

2661 4 OAKWOOD PARK LODGE 70.68 29.32 60.71 25.19 74.81 25.19

2909 4 HENLEY HOUSE (THE 71.65 16.45 76.67 15.06 69.23 15.06

M604 4 DOUGLAS H. RAPELJE LODGE 71.81 19.24 50.43 12.5 77.94 12.5

C558 4 SHALOM MANOR 72.02 24.7 56.67 18.06 80.56 18.06

2779 4 PARK LANE TERRACE 72.12 27.88 63.89 23.87 76.13 23.87

M515 4 MEADOWS OF DORCHESTER MANOR (THE 73 14.79 67.52 12.62 75.08 12.62

C590 4 FOYER RICHELIEU WELLAND 73.33 22.22 73.27 25.32 73.42 25.32

M592 4 WENTWORTH LODGE 73.34 26.66 65.19 23.69 76.31 23.69

M552 4 MACASSA LODGE 73.6 26.4 62.6 22.68 77.32 22.68

2768 4 CEDARWOOD VILLAGE 74.43 25.57 80.25 28.99 71.01 28.99

2775 4 SHALOM VILLAGE NURSING HOME 79.28 20.72 82.95 100 - 100

2930 4 ARBOUR CREEK Long-Term CARE CENTRE 81.71 18.29 82.4 19.01 80.99 19.01

2891 4 MAPLE PARK LODGE 82.11 17.89 79.35 16.26 83.74 16.26

12

12


Fac. #LHIN

IDFACILITY NAME

TOTAL RN RPN


2948 4 MILLENNIUM TRAIL MANOR 85.68 14.32 82.83 13.44 86.56 13.44

2938 4 BILLINGS COURT MANOR 86.1 13.9 94.51 16.61 83.39 16.61

2806 4 VICTORIA GARDENS LONG TERM CARE 90.68 9.32 87.91 5.71 94.29 5.71

2890 4 BELLA SENIOR CARE RESIDENCE 91.06 0.48 94.34 - 89.94 -

1500 4 WEST PARK HEALTH CENTRE 100 - 100 - 100 -


13

HNHB LHIN Community Care Access Centre*

Percentage of Registered Nurses, Registered Practical Nurses and Nurse Practitioners Employed Full-Time

*Data does not include home-care nurses

14

Hamilton HNHB– Community Care Access Centre

RankFac. ID CCAC Name

TOTAL RN RPN NP


11 156 BRANTFORD Ham.Niag.Hald.Brant CCAC 82.8 17.2 100 - 82.7 17.3 100 -


15

Full Time Employment Status Summary *

Acute Care Long-Term Care CCAC

FT RN%

FT RPN%

FT NP%

FT RN%

FT RPN%

FT NP%

FT RN%

FT RPN%

FT NP%

HNHB LHIN Average

72.6 58.2 93.5 55.2 66.0 --- 100 82.7 100

Provincial Average 71.8 61.6 92.7 53.4 56.0 --- 96.8 86.7 96.5

*Provides Overall Average Percentage of Nurses Working Full Time in Acute Care Hospitals, Long-Term Care Homes and CCAC


APPENDIX B: 70% FULL-TIME NURSING LHIN ENGAGEMENT INITIATIVE © SURVEY

INSTRUCTIONS

Carefully read each question

Base your responses on the total number of nurses in your organization

Please try to complete every question

Answers to questionnaire items must be entered under the ELECTRONIC tab to be returned by email;

While completing the questionnaire please SAVE frequently;

There are three possible ways to respond to questions

1. CLICK in a round option circle to indicate your selection

2. ENTER a number response into one of the shorter grey boxes:

3. ENTER a word response into one of the long grey boxes:

and PRESS ENTER

All data being requested in this questionnaire is based on the April 1st, 2008 to March 31st, 2009 budget year.

Definitions are provided at the end of the survey. The terms defined are marked with an asterisk *.

THANK YOU for your participation.

For any inquiries, comments, or feedback, please contact:

Laurie Kennedy

Administrator, Nursing Health Services Research Unit

McMaster University

1200 Main St. West, MDCL 3500, Hamilton, ON, L8N 3Z5

905‐525‐9140 ext. 22206

[email protected]

When completing the questionnaire, please SAVE frequently.

IMPORTANT

70% Full‐Time Nursing LHIN Engagement Initiative ©

Dear Nursing Employer,

In times of shortage, both federal and provincial governments are interested in the retention and recruitment of nurses in health care, particularly focusing on their employment status across the sectors and geographically. This project will address Ministry of Health and Long Term Care’s

(MOHLTC) priority theme of “70% Full‐Time Commitment” focusing on collecting data that will describe the current landscape of nurse employment in four collaborating LHINs in Ontario from which individualized strategies to achieve 70% FT employment will be developed.

This project is a collaboration amongst four Ontario LHINs: Niagara‐Hamilton‐Haldimand‐Brant (LHIN 4), Central West (LHIN 5), South East (LHIN 10) and South West (LHIN 2)] and the Nursing Health Services Research Unit at McMaster University.

You are being invited to participate in this research study because you are a chief nursing officer, director of nursing, unit manager or human resources representative at your organization.

The overall goal of the project is to identify local needs in relation to the 70% Full‐Time Nursing LHIN Engagement initiative and develop a Nursing Health Human Resource Planning Strategy that moves them closer to 70% full time employment. Employers from differing sectors across the four LHINs will provide insight through surveys and focus groups on the best strategies that can move them closer to 70% full time employment. This

study will contribute to the development of knowledge about the strategies to increase full‐time in nursing employment across acute, long‐term care and community sectors. Study findings have potential province‐wide application to helping other Ontario LHINs to increase their full‐time nursing

employment. There are no known risks for participating in this study.

Thank you for your participation!


Q.1 Please indicate your type of organization:

Acute Care Hospital (Academic)*

Acute Care Hospital (Non‐academic)

Addiction and Mental Health Centre/Psychiatric Hospital

Complex Continuing Care/Rehab Hospital

Community Care Access Centres

Community Health Centre

Community Mental Health Program

Public Health Unit

Hospice

Long Term Care Facility

Retirement Home

Homes for the Aged

Other (please specify):

Q.2 Which LHIN does your organization belong to:

Hamilton Niagara Haldimand Brant LHIN (4)

South West LHIN (2)

South East LHIN (10)

Central West LHIN (5)

Other (please specify):

Q.3 For 2008/2009, what is the total number of ACTUAL paid hours* at your organization for each of the following nursing

categories for each employment status? (Where you have no employees in a category please enter zero "0",

if not applicable, enter "n/a")

Permanent

Full‐Time*

Temporary

Full‐Time*

Permanent Part‐

Time*

Temporary

Part‐Time*Casual*

Registered Nurse (RN)*

Registered Practical Nurse (RPN)*

Nurse Practitioner (NP)*

Comment

Q.4 As of March 31, 2008, what is the total number nurses (head count) for each type of employment status in each of the

nursing categories? (Where there are no nurse in an employment status, please enter zero "0",


Permanent

Full‐Time*

Temporary

Full‐Time*

Permanent Part‐

Time*

Temporary

Part‐Time*

Casual Part‐

Time*




Comment


Q.5 For 2008‐2009 , what is the total number of paid agency staff* hours for each of the following nursing categories?

(Where there are no hours to enter in a category, please enter zero "0", if not applicable, enter "n/a")

Total paid RN agency hours

Total paid RPN agency hours

Q.6 For 2008/2009, specify the total number of overtime hours for each nursing category:

(Where there are no hours to enter in a category, please enter zero "0", if not applicable, enter "n/a")

Total number of RN overtime* hours

Total number of RPN overtime* hours

Q.7 How many full‐time nursing positions are you currently recruiting for outside the organization for each

of the following nursing categories? (Where you have no employees in a category please enter zero "0",


FT PT




Comment:

Q.8 Have you achieved at least a 70:30 full‐time to part‐time mix for RNs?

Yes, please proceed to Q.9

No, please proceed to Q.11

Q.9 Have you achieved at least a 70:30 full‐time to part‐time mix for RPNs?

Yes, please proceed to Q.9

No, please proceed to Q.11


Q.10 Please state your full‐time to part‐time mix (in percentage) at this point in time for the following nurse categories

(if not applicable, enter "n/a")

(example: enter 70 under FT RN if you have 70% of RN workforce in FT and 30 under PT RN if you have 30% of RN workforce in PT)

FT PT




Comment:

Q.11 (a)What strategies have you used in your organization to achieve 70% full‐time employment of RNs ?

(b)What strategies have you used in your organization to achieve 70% full‐time employment of RPNs ?

Q.12 If you have not reached the 70% full‐time of RNs and RPNs, what would enable you to reach this goal?

ACHIEVING 70% FULL TIME EMPLOYMENT FOR NURSES


YOU ARE FINISHED THE QUESTIONNAIRE!

Thank you for your participation. Please return the questionnaire today.

Laurie Kennedy

Administrator, Nursing Health Services Research Unit

McMaster University

1200 Main St. West, MDCL 3500, Hamilton, ON, L8N 3Z5

905‐525‐9140 ext. 22206

[email protected]

© Nursing Health Services Research Unit (2009); Modified from © Fisher & Baumann (2008).

A nurse practitioner (NP): is a registered nurse with advanced university education who provides personalized, quality health care to patients. Ontario

nurse practitioners provide a full range of health care services to individuals, families and communities in a variety of settings including hospitals and

community‐based clinics in cities and smaller towns in Ontario. (Nurse Practitioners Association of Ontario, 2009)

Type of Hospital: Acute Care Hospital Academic: An affiliation or working relationship between universities that have health profession schools, including a medical

school, and teaching hospitals that are involved in education, research and patient care and are responsible for providing the complex or specialized

care (i.e. tertiary and quaternary care) required for their communities, districts, regions, and in some cases, other parts of the province and the country (MOHLTC, 1998).

Overtime:

Overtime: Overtime will begin to accrue after sixty (60) hours in a two (2) week period averaged over the scheduling period determined by the local

parties. Additionally, overtime will apply if the nurse works in excess of the normal daily hours. All over time hours are paid at an overtime premium of

one and one‐half (1 1/2) times her/ his regular hourly rate. For the purposes of this survey, overtime hours should include both paid and unpaid. (ONA, 2008).

Type of Employment/Staffing:

Total Actual Nursing Worked Hours: The total number of hours that are actually worked by nursing staff to provide care to patients 24 hours per day,

and seven (7) days a week for a given period of time. This includes total actual worked hours by full‐time, part‐time, casual RN staff, in addition to

overtime and agency hours (Fisher, 2005).

DEFINITION OF TERMS

Type of Nursing Registration/Certification:

Registered Nurse (RN): In Ontario, an RN holds a Certificate of Registration with the CNO in accordance with the Regulated Health Professions Act, and

the Nursing Act (ONA, 2008).

Registered Practical Nurse (RPN): In Ontario, RPNs are community college graduates. Upon the successful completion of a national certification examination, they are registered as practical nurses by the CNO. RPNs are regulated by the CNO through the Regulated Health Professions Act, and

the Nursing Act. (Registered Practical Nurses Association of Ontario, 2008).

Nursing Hours:

Agency Staff: Employees hired to work on an as needed basis in the organization, and are employed and paid by an outside privately operated employment agency. Agency hourly charges for these employees exceed the normally contracted hourly rates of employees in the organization (Fisher,

2005).

Permanent Full Time Employee: An employee who has contracted with the organization to work in a full time capacity usually having committed to a

total of 1950 hours (1 FTE), including worked and benefit hours (Fisher, 2005).

Permanent Part Time Employee: An employee who has contracted with the organization to work in a part‐time capacity, having committed to a pre‐

determined number of hours per week. Benefits are prorated according to the number of hours worked and employees can receive money in lieu of benefits (Fisher, 2005).

Casual Employee: An employee, normally on the hospital roster, who works on an as needed basis, usually sporadically but sometimes on a pre‐

scheduled basis. These employees are paid the regular hourly rate and have no benefit coverage, irrespective of the number of hours they work. In some hospitals if these employees work more than full time hours they may be paid for overtime at time and one half (Fisher, 2005).

Full Time Equivalent (FTE): A full‐time equivalent (FTE) represents the total number of hours (approximately 1,950), including benefit hours (vacation,

sick leave, pregnancy leave, educational leave, etc.), which are allotted to a full time position over a period of one year (Fisher, 2005).Temporary Full‐Time Employee: An employee who has contracted with the organization to work temporarily in a full time capacity for a pre‐

determined period of time (i.e., to cover a pregnancy leave of a full time employee; Fisher, 2005).

Temporary Part‐Time Employee: An employee who has contracted with the organization to work temporarily in a regular part time capacity for a pre‐

determined period of time (i.e., to cover a temporary leave for a regular part‐time employee). (Fisher, 2005)


APPENDIX C: 70% FULL-TIME NURSING LHIN ENGAGEMENT INITIATIVE EMPLOYER FOCUS GROUP GUIDE 2009

ORGANIZATIONS THAT ACHIEVED 70%

1.0 What strategies are you using to achieve 70% FT employment of nurses in your organization? Prompts: Your organization has been identified by the Nursing Secretariat as having reached/surpassed the 70% FT employment for nurse – what experiences/steps did follow to increase your full-time complement of nurses (RNs, RPNs or NPs).

2.0 What challenges did you encounter in reaching 70% full-time employment for nurses and how did you

address them? Prompts: Was there a need for overtime and/or agency staff utilization - how were the needs met? What were the issues related to vacancies and the use of overtime, Agency Utilization and part-time/casual workers/sick time hours and how did you resolve them?

3.0 Do you foresee any change in your 70% FT status in the future? Is so what changes do you foresee and why?

4.0 What would you say are the most important conditions necessary to sustain the 70% FT complement?

5.0 What needs to be done to enable organizations in your LHIN to reach the 70% full-time employment of nurses?

6.0 What LHIN strategies are you involved in or have completed to increase the full-time employment of

nurses? Prompts: are there any linkages with the LHIN strategies underway or completed such as the Community Needs-Based Analysis, Diabetes Strategies, ER Wait times?

7.0 How many full-time nursing positions are you currently recruiting for outside the organization?

8.0 Do you have any additional comments?


ORGANIZATIONS THAT HAVE NOT ACHIEVED 70%

1.0 What needs to be done to enable your organization to reach the 70% goal of full-time employment of nurses? Prompts: what challenges do you currently encounter in increasing your full-time complement of nurses? Do you currently use overtime/or agency staff? What are the issues related to vacancies, the use of overtime/casual workers/sick-time?

2.0 Do you know of any strategies that would help reach the 70% full-time employment of nurses?

3.0 What would you say are the most important conditions necessary to sustain the 70% FT complement?

4.0 What LHIN strategies are you involved in or have completed to increase the full-time employment of

nurses? Prompts: are there any linkages with the LHIN strategies underway or completed such as the Community Needs-Based Analysis, Diabetes Strategies, ER Wait times?

5.0 How many full-time nursing positions are you currently recruiting for outside the organization?

6.0 Do you have any additional comments?

Date post:	16-May-2020
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Health Human Resource Andrea Baumann Mary …...Health Human Resource Andrea Baumann Mary...

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