“A bed is just a bed without a nurse to provide care”
The crisis in health care in Canada has many dimensions, but the most obvious is the problem with labour shortages. For years, researchers, advocacy groups, and various government commissions identified the need for a national health care labour force strategy. It isn’t as though it is a puzzle about what to do. Ensuring an adequate supply of well-trained labour in any area does not just happen because it is needed – it needs to be planned.
While health care is a provincial issue, all across the country governments either did not understand the seriousness of this issue, or did not have the competence or will to change the situation. It is an especially big problem for nursing. Not ensuring adequate labour supply in all areas that need nurses is serious and jeopardizes the health of all of us.
The shortage of nurses is not new and was not initially created by the pandemic, but it has gotten much worse. Among health workers, nurses have had the greatest risk of COVID-19 exposure and mortality due to their workplace conditions, conditions that contributed to both labour shortages, high stress levels, and burnout.
The last job vacancy figures for Canada indicate that since the beginning of the pandemic two years ago, the vacancies for registered nurses and registered psychiatric nurses is up 117 per cent. It’s even worse for licensed practical nurses, which is up 190 per cent over the two-year period. There are severe shortages for nurses’ aides and orderlies as well, up 81 per cent. All aspects of nursing, from those requiring many years of training, to those whose training can be accomplished more quickly are short-staffed.
The results of these labour shortages make the jobs so much more difficult for those still working. Very long shifts in hospitals and long-term care homes, shifts going beyond the current normal 12-hour work day, are much more common, contributing to sky-rocketing stress levels. A survey by the College of Nurses of Ontario found that nurses reported declining mental health, with “37 per cent saying they have poor mental health.” Another survey indicated that among the youngest RNs, those in the 26-35 age group, the group that could be the backbone of the future labour force, 13 per cent indicated they were likely to leave the profession soon.
There is much about the conditions of nursing that needs fixing. Wages are relatively low and often exceptionally constrained by public sector bargaining mandates that even limit reasonable increases just to keep pace with prices. There are serious risks associated with the work, aside from the risk of acquiring COVID-19, with nurses experiencing high rates of violence and abuse. The litany of the disadvantages of the job, historically women’s jobs with a high proportion being racialized immigrants, reflects a historical undervaluing of the work.
Care work is demanding work that is crucial to the health of our society. The working conditions for care workers affect the workers themselves, but also those people who need this care. The urgent need to plan for more nurses, at all levels of skill, needs to be tied to health transfer payments to the provinces. Provincial governments are vociferous in their insistence that all new money from the federal government should be sent without conditions. The federal government must resist this demand and insist that all levels of government work together to ensure long-term planning for an adequate nursing labour force.
Pat Armstrong, Marjorie Griffin Cohen and Laurell Ritchie are members of The Care Economy Group.
Pat Armstrong is a Distinguished Research Professor Emeritus of Sociology at York University in Toronto.
Marjorie Griffin Cohen is a feminist economist and Professor Emeritus at Simon Fraser University.
Laurell Ritchie is a former National Representative with the Canadian Auto Workers/Unifor and a long-time organizer and activist