July 2014
THE NURSING WORKFORCE
CANADIAN FEDERATION OF NURSES UNIONS
BACKGROUNDER
OVERVIEW
Internationally educated nurses
Nurses are the largest group of regulated health
professionals in Canada. As of 2012, there were
271,807 registered nurses (RNs)1, 88,211 licensed
practical nurses (LPNs/RPNs in Ontario) 2, and
5,404 registered psychiatric nurses3 working
as nurses in Canada (regulated as a separate
profession in the four western provinces and
Yukon only). In all there were 365,422 regulated
nurses working as nurses in Canada.4 87% of
public sector nurses are unionized. 5
•
Where RNs worked remained largely
unchanged: almost 89% work in direct patient
care.6 61.6% of RNs work in the hospital sector,
15.4% work in the community health sector,
and 9.6% work in nursing homes and longterm care.7
•
44.8% of all LPNs are employed in hospitals,
and 9.6% work in the community health sector.
36.7% are employed in nursing homes and
LTC. 8 97.5% work in direct patient care.9
•
Registered psychiatric nurses (Western
Canada) work mostly in the hospital sector
(44.7%), while 26.6% are employed in the
community health sector and 16.1% in nursing
homes.10 89% work in direct patient care.11
•
From 2008 to 2012, the number of employed
nurse practitioners almost doubled across the
country to 3,157 12 with the majority working in
hospitals and community health settings.13
Between 2008 and 2012, the supply of regulated
nurses eligible to practice in Canada grew by 9%
according to data from CIHI. However, CIHI also
reports that there are fewer RNs per capita today
(779 RNs/100,000 population) than there were in
the early 1990s (824 RNs/100,000 population).14
There is a significant provincial variability in RN
availability across the country with a high of 1,193
RNs/100,000 population in Newfoundland and
Labrador, and a low of 650 RNs per 100,000 in
British Columbia.15
© CFNU rev. Jul 2014
Internationally educated nurses make up less
than 7% of the total nursing workforce.16 8.2%
of RNs employed in Canada graduated from
an international nursing program, and British
Columbia, Ontario and Alberta had the highest
concentrations of internationally trained
RNs.17 Of the LPNs employed in Canada, 2.9%
graduated from an international program.18 Of
the internationally educated nurses employed in
Canada in 2012, the majority graduated from the
Philippines, with another 20% graduating in the
UK and India.19
Nursing demographics
Overall, the nursing workforce is aging. In 2012,
the average age of an RN representing three
quarters of the nursing workforce was 45.2; the
average age of an LPN was 42.6; and the average
age of a registered psychiatric nurse was 47.2.
In 2012, 25.8% of RNs were 55 years of age or
older, on the cusp of retirement, and 12.2% were
60 or older. 20 The percentage of LPNs under
30 to LPNs 55 and over is almost equivalent. 21
There is a current shortfall of 22,000 nurses
which is masked only by delayed retirements,
heavy workloads and excessive overtime. 22 The
Canadian Nurses Association predicts a shortfall
of 60,000 full-time equivalent nurses by 2022. 23
WORKING CONDITIONS
Overtime hours
Public sector nurses worked 21,537,900 hours of
overtime in 2012, the equivalent of 11,900 full-time
jobs, costing $952.5 million/year. On average,
almost 29% of nurses worked overtime on a
weekly basis, compared to 10.5% in 1992. 18.7% of
nurses worked paid overtime in 2012 while 13.1% of
nurses worked unpaid overtime. 24
Full-time vs. part-time work
CIHI reports that just over 40% of RNs and half
of LPNs work in casual or part-time positions. 25
However, national numbers hide regional
disparities. In general, both central and eastern
www.nursesunions.ca
1
WHERE KNOWLEDGE MEETS KNOW-HOW
Canada hover around the national average.
Newfoundland and Labrador is notable in
reporting that 74% of RNs worked full time in
2012. However, the picture in Western Canada is
very different. In all the provinces west of Ontario,
with the exception of Saskatchewan, RNs have
less than 50% full-time employment. In Alberta
less than 40% of RNs are employed full time. 26
Health and safety
A 2013 study commissioned by the CFNU
reported that an average of 18,900 publicly
employed nurses were absent from work each
week in 2012 due to illness or injury. Nurses had
a rate of absence 55% higher than the average
rate for all other occupations. The annual cost of
absenteeism due to illness or disability among
nurses was $734 million in 2012, up from 2010.
The rate of illness and disability was highest
among older nurses. 27
Workplace violence (verbal, physical,
psychological (including bullying) and sexual
abuse) is a frequent occurrence in health care
environments, and nursing staff are most at
risk. Health care workers are more likely to be
attacked at work than prison guards and police
officers. The CFNU and the Canadian Nurses
Association have issued a joint position statement
calling for “zero tolerance of any violence in the
workplace.”28
RECOMMENDATIONS
Reduce overtime and absenteeism rates
Short-term, stop-gap measures, such as overutilizing existing nursing staff, are untenable in
the long term. These strategies have a negative
effect on the health and well-being of nurses and
contribute to burnout and attrition. They also
deteriorate the quality of patient care. According
to a recent study, an increase in a nurses’
workload by one patient increased the likelihood
of an inpatient dying within 30 days of admission
by 7%, 29 but adding more nurses decreases the
length of hospital stays. 30
Comparing data from 2010 and 2012, the overtime
hours of nurses increased by almost 1 million
hours at a cost of almost 12,000 full-time jobs and
2
nearly $1 billion per year. 31
Excessive overtime is not only costly in financial
terms, it is also costly in human terms. Nurses
who are regularly required to work overtime are
less productive, more likely to make medical
errors, and more likely to leave their jobs. A
national nursing turnover study reported that the
average turnover rate is close to 20% per year, at
a transition cost of $25,000 per nurse. 32
Similarly, reducing absenteeism (due to illness and
injury) offers a significant benefit to our health
care system. A drop of 50% in absenteeism rates
would be the equivalent of adding 7,000 new fulltime jobs. 33
Value experience
The average nurse has 18 years of experience
which tends to be undervalued. Nursing
experience and levels of education can be
correlated with better patient outcomes.
Research has shown that retention of experienced
nurses improved with flexibility in scheduling,
work practices and arrangements. 34 Unions,
governments and employers need to work
collaboratively to ensure flexible scheduling
options are bargained into collective agreements
and made available to older workers. Reducing
exit rates to 2% for RNs under 60 and 10% for
those over 60 would reduce nursing shortages by
almost half. 35
Develop initiatives to attract and retain new
graduates
According to the 2005 Nursing Sector Study, we
would need to graduate about 12,000 registered
nurses per year to keep up with demand. In 2012,
we graduated 11,777 RNs36 so we are nearing
graduate level targets, but many of these new
graduates are not finding employment: the
number of RNs added to the nursing workforce
in 2011-2012 was 1,083. Among the nurses
who did find work, many are not finding fulltime employment. 37 The CFNU has called for a
moratorium on workforce redesigns and for new
graduate initiatives to secure the retention of
Canada’s 2013 graduates with the same strategy
for the 2014 classes.
www.nursesunions.ca
© CFNU rev. July 2014
WHERE KNOWLEDGE MEETS KNOW-HOW
Improve health and safety
To prevent and control the spread of infectious
diseases such as influenza, the CFNU believes
that occupational health and safety must be
anchored in three principles: the precautionary
principle which prioritizes safety, a successful
internal responsibility system, and a hierarchy of
controls to eliminate hazards at multiple levels.
Therefore, a comprehensive influenza prevention
and control strategy, including an evaluation
component, needs to be provided in conjunction
with other important factors that influence the
health and well-being of workers, including
hand hygiene, personal protective equipment,
overcapacity protocols, adequate staffing and
effective isolation policies. 38
Improve health human resources planning
As the patient population changes, and there is
a move away from acute care settings towards
community-based and long-term care, it is
essential that we develop an integrated panCanadian health human resource strategy. In
order to undertake long-term, evidence-based
planning, data collection measures must be
enhanced to provide a more comprehensive
picture of the health human resource workforce.
The Canadian Institute for Health Information
needs to be adequately funded so that it can
report data, analysis and trends on new nurse
graduates and nurse retirements. A jurisdictional
approach needs to be developed to ensure data
is collected, analyzed and reported on new nurse
graduates education and employment, actual
nurse retirements, and supply and demand
projections.
Improve accountability and transparency
A 2013 public inquiry at the Mid Staffordshire
National Health Service Foundation Trust (United
Kingdom)39 highlights the effects of staffing
level decisions driven by financial pressures to
the detriment of quality patient care, leading
to increased mortality rates. The public inquiry
cited a number of conditions that resulted in
safety issues. In particular, the resulting report,
the Francis Report, focuses on a patient-centred
culture and ensuring “openness, transparency
© CFNU rev. Jul 2014
and candour throughout the system.” It contains
290 concrete recommendations for improvement.
In addition to putting patients at the center of
decision-making, the recommendations also
explicitly detail how to solicit and engage patients,
their families and staff. The report illustrates
the importance of making staffing information
by unit/facility publicly available to ensure
organizational transparency and accountability.
Ideally, unit-based patient adverse events data
should be linked to staffing information.
In 2013, the International Council of Nurses (ICN)
released a policy statement40 on safe staffing
levels, which identifies the key principles to ensure
safe staffing. Aside from numbers of staff and mix
of competencies, the ICN points to manageable
workloads, a responsive and supportive workplace
culture, adequate supervision, appropriate
training, and a range of high-quality facilities and
equipment as being some of the factors necessary
for safe staffing levels.
Sources
1
Canadian Institute for Health Information. (2013). 2012
Regulated Nurses; Data Tables: Nursing Database.
Table #2. Author: Ottawa. https://secure.cihi.ca/estore/
productFamily.htm?locale=en&pf=PFC2385&lang
2
Ibid. Table #25.
3
Ibid. Table #39.
4
Ibid. Table #1.
5
Informetrica Limited. (2013). Trends in Own Illness
or Disability-Related Absenteeism and Overtime
among Publicly-Employed Registered Nurses – Quick
Facts. Report prepared by Informetrica Limited for
Canadian Federation of Nurses Unions. Ottawa. https://
nursesunions.ca/report-study/absenteeism-and-overtimequick-facts-2013
6
Canadian Institute for Health Information. (2013). 2012
Regulated Nurses; Data Tables: Nursing Database. Table
#11.
7
Ibid. Table #9.
8
Ibid. Table #32.
9
Ibid. Table #34.
10 Ibid. Table #46.
11
Ibid. Table #48.
12
Ibid. Table #16.
13 Ibid. Table #23.
www.nursesunions.ca
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WHERE KNOWLEDGE MEETS KNOW-HOW
14 Canadian Institute for Health Information. (2012).
Regulated Nurses, 2012 – Summary Report. Author:
Ottawa. https://secure.cihi.ca/free_products/
RegulatedNurses2012Summary_EN.pdf
15 Canadian Institute for Health Information. (2013). 2012
Regulated Nurses; Data Tables: Nursing Database. Table
#4. Author: Ottawa. https://secure.cihi.ca/estore/
productFamily.htm?locale=en&pf=PFC2385&lang
16 Canadian Institute for Health Information. (2013).
Regulated Nurses, 2012 – Summary Report. Author:
Ottawa. https://secure.cihi.ca/free_products/
RegulatedNurses2012Summary_EN.pdf
17
Canadian Institute for Health Information. (2013). 2012
Regulated Nurses; Data Tables: Nursing Database. Table
#15. Author: Ottawa. https://secure.cihi.ca/estore/
productFamily.htm?locale=en&pf=PFC2385&lang
18 Ibid. Table #38.
19 Canadian Institute for Health Information. (2013).
Regulated Nurses, 2012 – Summary Report. Author:
Ottawa. https://secure.cihi.ca/free_products/
RegulatedNurses2012Summary_EN.pdf
20 Canadian Institute for Health Information. (2013). 2012
Regulated Nurses; Data Tables: Nursing Database.
Table #7. Author: Ottawa. https://secure.cihi.ca/estore/
productFamily.htm?locale=en&pf=PFC2385&lang
21 Ibid. Table #30.
22 Winsten, I. (2011). Who will heal the nursing crisis? Canada
has a shortage of nurses that is expected to grow as the
population ages. The Gazette, February 26, 2011. Montreal.
23 Canadian Nurses Association. (2009). Tested Solutions for
Eliminating Canada’s Registered Nurse Shortage. Author.
http://www.cna-aiic.ca/~/media/cna/page%20content/
pdf%20en/2013/07/26/10/41/rn_highlights_e.pdf
24 Informetrica Limited. (2013). Trends in Own Illness
or Disability-Related Absenteeism and Overtime
among Publicly-Employed Registered Nurses – Quick
Facts. Report prepared by Informetrica Limited for
Canadian Federation of Nurses Unions: Ottawa. https://
nursesunions.ca/report-study/absenteeism-and-overtimequick-facts-2013
25 Canadian Institute for Health Information. (2013).
Regulated Nurses, 2012 – Summary Report. Author:
Ottawa. https://secure.cihi.ca/free_products/
RegulatedNurses2012Summary_EN.pdf
26 Canadian Institute for Health Information. (2013). 2012
Regulated Nurses; Data Tables: Nursing Database, Table
#8. Author: Ottawa. https://secure.cihi.ca/estore/
productFamily.htm?locale=en&pf=PFC2385&lang
27 Informetrica Limited (2013). Trends in Own Illness
or Disability-Related Absenteeism and Overtime
among Publicly-Employed Registered Nurses – Quick
Facts. Report prepared by Informetrica Limited for
CFNU: Ottawa. https://nursesunions.ca/report-study/
absenteeism-and-overtime-quick-facts-2013
28 Canadian Nurses Association and Canadian Federation
of Nurses Unions. (2007). Joint Position Statement on
Workplace Violence. Authors. https://nursesunions.ca/
position-statement/workplace-violence-joint-position-
4
statement-cfnucna
29 Aiken, L. et al. Nurse staffing and education and hospital
mortality in nine European countries: a retrospective
observational study. The Lancet, February 26, 2014.
http://www.ncbi.nlm.nih.gov/pubmed/24581683
30 Kane, R., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T.
(2007). The association of registered nurse staffing levels
and patient outcomes. Medical Care, 45(12), 1195-1204.
http://www.ona.org.3pdns.korax.net/documents/File/
pdf/KaneRNStaffingPatientOutcomesMedCare.pdf
31 Informetrica Limited (2013). Trends in Own Illness
or Disability-Related Absenteeism and Overtime
among Publicly-Employed Registered Nurses – Quick
Facts. Report prepared by Informetrica Limited for
CFNU: Ottawa. https://nursesunions.ca/report-study/
absenteeism-and-overtime-quick-facts-2013
32 O’Brien-Pallas, L., Tomblin Muphhy, G., Shamian, L.
X., & Hayes, L. (2010). Impact and determinants of
nurse turnover: a pan-Canadian study. Journal of
Nursing Management, 18, 1073-1086. http://www.
cna-aiic.ca/~/media/cna/page%20content/pdf%20
en/2013/07/26/10/39/roi_nurse_turnover_2009_e.pdf
33 Canadian Nurses Association. (2009). Tested Solutions for
Eliminating Canada’s Registered Nurse Shortage. Author.
http://www.cnaaiic.ca/~/media/cna/page%20content/
pdf%20en/2013/07/26/10/41/rn_highlights_e.pdf
34 Wortsman, A. and Crupi, A. (2009). From Textbooks to
Texting: Addressing issues of intergenerational diversity
in the nursing workplace. CFNU: Ottawa. http://www.
nursesunions.ca/sites/default/files/Intergen.Inside. en_.
pdf
35 Canadian Nurses Association. (2009). Tested Solutions for
Eliminating Canada’s Registered Nurse Shortage. Author.
http://www.cna-aiic.ca/~/media/cna/page%20content/
pdf%20en/2013/07/26/10/41/rn_highlights_e.pdf
36 Canadian Association of Schools of Nursing and Canadian
Nurses Association. (2013). Registered Nurses Education
in Canada, Statistics 2011-2012. Authors. https://www.cnaaiic.ca/~/media/cna/files/en/nsfs_report_2011-2012_e.pdf
37 Canadian Nurses Association. (2013). Problematic
trends for registered nurse workforce report reveals.
Author. http://www.cna-aiic.ca/en/news-room/newsreleases/2013/problematic-trends-for-registered-nurseworkforce-report--reveals
38 Canadian Federation of Nurses Unions. (2013). Effective
influenza prevention and control strategies: Time to get
serious about a culture of safety in health care. Ottawa.
http://nursesunions.ca/sites/default/files/influenza_
prevention_and_control_strategy.pdf
39 Francis, R. (2013). Independent Inquiry into Care
Provided by Mid Staffordshire NHS Foundation Trust,
January 2005-March 2009: Volume 1. UK. http://www.
midstaffspublicinquiry.com/report
40 International Council of Nurses. (2013). Policy Statement:
Safe staffing levels statement of principles. Geneva,
Switzerland. http://www.icn.ch/images/stories/
documents/pillars/sew/ICHRN/Policy_Statements/
Policy_statement_Safe_staffing_levels.pdf
www.nursesunions.ca
© CFNU rev. July 2014