Ontario’s Hospital Labour Force Is At A Breaking Point

No one will be shocked to learn that health-care workers across Canada are overworked and stressed out. Yet the extent of the problem revealed by each new study or poll can’t help but astonish.

This past Wednesday, the Ontario Council of Hospital Unions (OCHU), part of the Canadian Union of Public Employees (CUPE), held a press conference to present the findings from a recent poll of its hospital workforce. What OCHU reported was truly staggering.

Ontario’s hospital labour force is at a breaking point and is calling on a government with no effective plan to deal with the years-long staffing crisis to finally act.

The Nanos-conducted survey of unionized hospital staff found that 62 per cent of workers are dealing with exhaustion and high stress levels stemming from overwork. Additionally, 44 per cent of workers report having trouble sleeping, while 41 per cent say they dread going to work.

The OCHU represents roughly 50,000 hospital staff members across Ontario, including registered practical nurses, personal support workers, housekeepers and clerical staff. The Nanos survey polled more than 750 workers and is a rare opportunity to gauge the working experiences of staff other than doctors and registered nurses.

Like nurses, these union members have faced a health-care system buckling under the strain of underfunding and the continued fallout from the COVID-19 pandemic, though many earn lower wages and face greater employment precarity than their more credentialed coworkers.

As CUPE/OCHU have argued, Ontario’s health-care workers across the board are being forced to bear the brunt of a systemic crisis and they’ve simply had enough. According to the union’s polling, 69 per cent of workers felt hospitals didn’t have enough staff to deliver high-quality care, with nearly as many reporting doing the work of two or more people. Just under half of respondents said they are dealing with work-induced anxiety.

Additionally, 26 per cent of surveyed hospital workers are considering quitting their job and leaving the field. In a vicious cycle, stressful working conditions drive workers out of the sector, worsening the situation for those who remain and encouraging further staff to consider departing.

A persistent and significant shortage of trained staff has led to the current situation. According to the union, the two primary issues driving the staff shortages are overwork and poor compensation.

Sharon Richer, secretary-treasurer of OCHU/CUPE, highlighted that the sector continues to lose trained and experienced staff due to poor working conditions. “The whole system depends on workers – and yet their needs continue to be neglected,” Richet commented, adding that the Ford governments’ lack of any staff retention plan is “shocking.”

In early December, the acting auditor general of Ontario reported that the province had no central plan to tackle the nursing shortages leading to the long-running staff exodus as well as hospital emergency room closures.

Recruitment and retention have been long-festering issues in Ontario’s health-care sector — a problem dramatically worsened by the pandemic. As economy-wide job vacancies reached their peak in the second quarter of 2022, shortages in health care and social assistance also worsened. In the third quarter of 2022, health-care and social assistance job vacancies grew by 9.5 per cent and reached a record high of 150,100 nationally. At that time, vacancies among registered nurses and registered psychiatric nurses, nurse aides, orderlies and patient service associates, and licensed practical nurses accounted for 69.2 per cent of all health job vacancies. According to the most recent data — covering quarter three of 2023 — vacancies in health care still lead most other occupations, despite overall declines in vacant positions.

In a previous study, OCHU has documented the staff shortages throughout the Ontario health-care system. As troubling as the shortages of OCHU members are, however, the largest staff deficit remains in nursing and inpatient services. According to OCHU’s research, Ontario has 0.285 full-time equivalent workers per 100 people in inpatient services, compared to 0.395 in other provinces across Canada. This amounts to a 38.7 per cent deficit. As the report points out, “If Ontario had the same ratio of inpatient health care workers, there would be another 16,201 full-time inpatient jobs in our hospitals.”

As the CBC reports, Ontario’s Financial Accountability Office (FAO) found that the province needs to hire 86,000 nurses and personal support workers by 2028 alone to get back to pre-pandemic staffing levels in hospitals and home- and long-term care facilities. This wasn’t the first time that the FAO warned of the health-care staffing crisis and its long-term impacts.

Of course, a primary driver of staff shortages is low and/or stagnant wages. Unsurprisingly, the OCHU poll found that 52 per cent of surveyed union members reported being unhappy with their compensation. Health-care workers had their wages and salaries repressed for three years by the Ford government’s unconstitutional Bill 124. Now that that law is no longer in force, pay for some health-care workers has improved. For example, Ontario nurses received an average of an 11 per cent pay increase over two years through arbitration this past summer. Yet, for many other health-care workers, there has yet to be any recovery from the real wage losses incurred during the post-pandemic inflation.

As unionized hospital staff bargain for new collective agreements, it’s important to reiterate that poor conditions also have negative impacts on Ontario patients. For example, in December, the Ontario Health Coalition released a damning report tracking emergency room and other health facility shutdowns. The OHC’s study found that, up to November 24, there were 868 temporary or permanent emergency room closures across the province, along with 316 urgent care centre closures. In total, the health coalition tracked 1,199 hospital service closures, constituting 31,055 hours of lost care. Such closures and lack of care are often devastating for rural and under-served communities.

As well, in November, the CBC reported in advance the findings from the latest report of the Ontario patient ombudsman, who handles public complaints concerning the province’s health system. According to the ombudsman’s report, complaints grew by 33 per cent year-over-year, reaching 4,388 total complaints in 2022-23. Though roughly one in five complaints concerned primary physician care, which is outside the purview of the ombudsman’s office, the past fiscal year nevertheless saw a significant growth in patient dissatisfaction with Ontario’s understaffed and underfunded health system.

As OCHU argued at its presser, the Ontario government funding plans for the province's health-care system fall far short of what is needed. Surveyed union members strongly agree. Nearly 80 per cent of workers polled said they aren’t confident in the Ford government’s plans to improve Ontario’s health care, an understandable response after the government’s moves to outsource and privatize various services.

The hospital union council’s study demonstrates that its members are profoundly unhappy with their working conditions and it’s taking a major toll on workers’ mental health. As troubling as this finding is, it’s hardly new. Statistics Canada has been regularly studying and releasing reports on the deteriorating state of health-care working conditions and their deleterious impacts on worker mental health. A combination of excessive overtime, crippling workloads and the emotional burden of caring for patients in an underfunded system has been driving nurses and other health workers out of the field for three years.

With OCHU’s latest study, the union is again calling on the government to act, while offering its own proposals to address the staffing crisis.

As a first step toward a solution, the union is proposing that the Ford government invest an additional $1.25 billion annually over the next five years, on top of inflation.

The union also wants to see staff-to-patient ratios implemented to provide greater certainty to both workers and patients. British Columbia recently became the first Canadian province to introduce minimum staffing ratios for nurses, though they have yet to be implemented. Such ratios have also been a rallying cry among many unionized nurses in the United States.

Of course, the pay and conditions of health-care workers must be also addressed head on to recruit and retain staff. According to OCHU, only half of its members have full-time status. The union wants this improved to 70 per cent within five years, an entirely reasonable ask.

Health-care unions and the Ontario public are broadly in agreement when it comes to opposing the Ford Conservatives’ attack on public health care. Yet as sensible as OCHU’s proposals are, without a concerted fight the government will continue on their current, destructive path.

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