The number of overtime hours worked and sick days taken by nurses across Canada spiked during the COVID-19 pandemic, according to a new report – a trend that experts say is continuing, as hospitals struggle to replace the burnt-out workers who quit or switched to part-time in the wake of the health crisis.
Difficult working conditions for nurses employed directly by hospitals have also prompted more of them to leave the public sector for private, for-profit nursing agencies, says the report released Thursday by the Canadian Institute for Health Information, the national health statistics agency.
By relying more on overtime shifts and temporary nurses to keep their wards open, Canadian hospitals are being sucked into what a leading expert in health work force policy called a “vicious cycle” – one that could be linked to the uptick in unintentional harm to hospital patients that CIHI noted in the report.
“Heavy workloads lead to more burnout, which leads to more attrition, which leads to heavier loads,” said University of Ottawa Professor Ivy Bourgeault, leader of the pan-Canadian Health Human Resources Network. “It’s what we call our vicious cycle and it needs to be interrupted.”
Tackling Canada’s health-human resources crisis, which goes well beyond nurses, was the top priority to emerge from a gathering of health ministers in Charlottetown last week. Federal Health Minister Mark Holland and his provincial-territorial counterparts acknowledged that they must retain experienced nurses and attract new ones, particularly from the ranks of internationally educated workers who live in Canada but struggle to get licensed here.
CIHI found that rates of unintended harm to patients in Canadian hospitals rose over the course of the pandemic to 6 per cent in both 2021–2022 and 2022–2023, after the rate had been steady at between 5.3 per cent and 5.4 per cent since 2014. The report highlighted increases in urinary tract infections, pneumonia and bed sores in patients admitted to hospitals as examples of harms that could be linked to lower staff-to-patient ratios and overworked nurses.
The CIHI report also found that hospital in-patient units across the country paid for 14.2 million hours of nursing overtime in 2021-2022, a 53-per-cent increase over the year before. That’s the equivalent of replacing 7,300 full-time nurses with overtime shifts. Sick time, meanwhile, increased by 17 per cent in the same period.
The number of registered nurses who reported being self-employed or employed by an agency rose by 6 per cent in 2022, meaning 867 more were working for private companies or for themselves than the year before.
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CIHI concluded that, in 2021-2022, the number of nursing hours that hospitals purchased from private agencies rose by 80 per cent to 1.5 million from 900,000 the year before, although private agencies still provided just 1 per cent of overall nursing on hospital in-patient units, CIHI concluded.
However, those numbers are an underestimate because they don’t include data from the Northwest Territories, Nunavut, Alberta, Quebec and Prince Edward Island. The figures on overtime and sick pay exclude Quebec and Nunavut.
Most of the figures in the new report are only as recent as the fiscal year that ended in March, 2022, when Canada was emerging from the Omicron wave of COVID-19, one of the most punishing phases of the pandemic. For that reason, it’s difficult to say if the spikes in overtime, sick time and the use of temporary nurses have continued at a similar pace in the past year and a half.
But Tim Guest, the chief executive officer of the Canadian Nurses Association, said the workers he speaks to are still seeing high vacancy rates in their hospitals, despite international recruitment campaigns.
“I would say that we’re probably in the same spot or worse,” Mr. Guest said. “This is one of the reasons why we’ve advocated for better data. The current data in Canada is just not specific. It’s not available in current time.”
Chaim Bell, the physician-in-chief at Sinai Health in Toronto, echoed that sentiment. He chaired an expert panel on health data sharing that released its final report on Thursday.
That report, spearheaded by the Council of Canadian Academies, concluded that Canada needs an organization to act as a national data steward, one whose job would be to help all the players in the country’s fractured medical system share their records quickly, effectively and safely.
“Once you have the data and have it close to real time,” Dr. Bell said, “you can make improvements to the care you’re providing. It’s what we do in every other industry. It’s just in health care, we’re well behind the times.”