Melissa Mastroianni, 21, a recent graduate of the nursing program at the University of Windsor, stands outside Windsor Regional Hospital - Met Campus where she's soon starting a permanent job on the oncology ward, on June 14.Dax Melmer/The Globe and Mail
As Melissa Mastroianni prepared to finish nursing school, she knew she would have more job options than most health care workers in mid-sized Canadian cities.
That’s because Ms. Mastroianni, a University of Windsor student who wanted to start her career close to home, could choose to live in Windsor and work in Detroit, where prominent research hospitals have always been eager to hire Canadian nurses.
Despite the lure of a salary paid in American dollars, Ms. Mastroianni accepted a job on the oncology unit at Windsor Regional Hospital before she graduated in May.
Her decision was influenced by two COVID-era provincial government programs that have helped reduce the nursing vacancy rate at Windsor Regional to its lowest level since before the pandemic, and which could serve as solutions for hospitals elsewhere in Canada looking to beef up their nursing ranks as they recover from the worst of the pandemic.
As of April 1, just 2.7 per cent of registered nursing jobs were vacant at Windsor Regional, the only acute-care hospital network in the city of 230,000. That was down from a high of 12.5 per cent in 2021. At one point during the pandemic, 28.5 per cent of registered nurse jobs in the emergency department were vacant.
Recruitment leaders at Windsor Regional credit the turnaround in part to the Ontario government paying $25,000 signing bonuses, which have helped neutralize incentives long offered by Michigan hospitals, and to an “externship” program that Ms. Mastroianni said was instrumental in her decision to stay in Canada.
She briefly considered applying for jobs at a large cancer centre in Detroit. But her time working on the Windsor Regional cancer ward as an extern – a new category of part-time job for which nursing students are paid $20.60 an hour to help patients with tasks such as bathing and feeding – persuaded her to accept a permanent, part-time job offer there before she graduated in May.
“I really fell in love with the environment on the oncology floor,” Ms. Mastroianni said. “There’s nurses that have worked there for 20 years and you can see that they’re still affected by what they do and that they care so much.”
Karen Riddell, acting president and CEO at Windsor Regional Hospital, at Windsor Regional's Met Campus in Windsor, Ont., on June 11.Dax Melmer/The Globe and Mail
Windsor Regional was one of the first hospitals in Ontario to shore up staffing with paid nursing students early in the pandemic, said Karen Riddell, the hospital’s acting chief executive officer. “Without those externs,” she said, “we wouldn’t have been able to do all of the work that we did in a quality way. We would have been very short staffed.”
As the pandemic dragged on, spurring an exodus of experienced nurses, the externship program became a recruitment tool that helped Windsor Regional replenish its ranks. The province stepped in with dedicated funding in 2021, eventually making the externship program permanent and available to all publicly funded hospitals.
Windsor Regional has since hired 231 former externs as registered nurses and registered practical nurses, while 7,300 nursing students have worked as externs provincewide, according to the office of Ontario Health Minister Sylvia Jones. Nearly half were later hired as full-time staff.
Also, since 2021, Windsor Regional has hired 308 nurses through the Community Commitment Program for Nurses, a provincial program that offers $25,000 signing bonuses to nurses who agree to work full-time hours in a community for two years. As a check against poaching within the province, the bonus is only available to nurses who haven’t worked in Ontario in the past six months, a category that includes new graduates and veteran nurses enticed back from jobs in the United States.
It’s not clear how many Canadian nurses cross the border to work, but the think tank SecondStreet.org reported last year that border states have issued licences to 8,909 nurses and 879 doctors with Canadian mailing addresses. Drawing on a survey of Ontario registered nurses with Michigan nursing licences, SecondStreet estimated that nearly 2,000 regularly commute to Michigan for work.
The proximity of Detroit hospitals to Windsor means that Erin Hodgson, Windsor Regional’s external recruitment co-ordinator, faces fiercer competition for nurses at job fairs than her counterparts at other hospitals.
“I’ve been to several events at the University of Windsor where there’s a lot of Canadian organization representation but then the American hospitals come up and they’re able to offer jobs on the spot, signing bonuses on the spot,” she said. “It’s a struggle as far as recruitment goes to compete with that.”
Human resources manager Laura Janisse, right, and external recruitment co-ordinator Erin Hodgson, left, at Windsor Regional Hospital - Met Campus, in Windsor, Ont., on June 11.Dax Melmer/The Globe and Mail
Nurses who choose Detroit over Windsor tell Ms. Hodgson and Laura Janisse, Windsor Regional’s manager of HR, that American dollars are a big draw, but so is the fact that non-unionized U.S. hospitals often offer Canadian nurses full-time jobs right out of school with the flexibility to set their own schedules. Ms. Janisse said that, because of agreements with the nursing union, full-time jobs in Windsor Regional have to be posted internally first, meaning it is more common for new graduates to be offered part-time jobs.
On the other side of the Canada-U.S. divide, Patrick Irwin, vice-president of human resources at Henry Ford Health, said it can be difficult for Detroit hospitals to compete with Canadian maternity-leave policies, which offer nurses who want to have children in the future up to 18 months off work, far longer than is common in the U.S.
Henry Ford’s Detroit location is about a 10-minute drive from the Detroit-Windsor tunnel.
Henry Ford’s goal is not to raid the Canadian nursing supply, he added, but rather to improve medical care in a co-operative Windsor-Detroit region where health staff who work in both systems at some point in their career share their knowledge.
Ms. Riddell, the acting CEO of Windsor Regional, is a case in point. She started her career as a nurse in neurosurgery at Henry Ford.
Henry Ford Health currently has 1,100 Canadian employees out of about 32,000 staff. Approximately 900 of the Canadian employees are nurses, a spokeswoman for Henry Ford said. The hospital network’s nursing vacancy rate in June was 7 per cent, more than twice the nursing vacancy rate at Windsor Regional.
During her time as an extern on the Windsor Regional oncology floor, Ms. Mastroianni recognized – and appreciated – that some of her future colleagues had worked at the Karmanos Cancer Institute, a large cancer centre affiliated with Wayne State University and other facilities in Detroit, before deciding to come home.
“Then we’re all able to learn from each other,” she said.