Ontario’s Nursing Crisis : Looking Inwards for New Solutions

It is widely known that Ontario has been suffering an acute human resource shortage in the healthcare sector, heightened and exacerbated by the onset of the COVID-19 pandemic. One of the most important professions in this sector, and arguably the hardest-hit, is that of nursing. With the FAO projecting a stifling shortage of 33,000 nurses and PSWs in Ontario by 2028, and hospital emergency departments across Ontario being forced to close 158 times in the past year due to staffing shortages, we must ask ourselves : are we doing enough to address this shortage with the resources available within our province?

This article examines nursing and personal support worker shortages across Ontario, legislative attempts to address it, and the extent of untapped workforce potential available in our province at the post-secondary education level.

BACKGROUND

RPNs (or LPNs in provinces outside of Ontario) have seen the most rapid percentage increase in the number of vacancies of any occupation reported in Canada, according to a recent Statistics Canada report, with vacancies increasing 94% in one year. According to the Ontario Council of Hospital Unions (OCHU), in Ontario, RPN vacancies over the same period increased from 1,715 to 3,700 – an increase of almost 2,000or 116% in one year, while RN vacancies in Ontario saw a very significant 78% increase. In both cases, this is a more rapid increase than the reported cross-Canada increases. Ontario now faces a sobering reality : it has the fewest nurses per capita in the country.

Registered Practical Nurses (RPNs), also known as Licensed Practical Nurses (LPNs) elsewhere in the country, are college-taught professionals who use their skills and education to assist patients with general or straightforward health conditions. Registered practical nurses (RPNs) commonly work in hospitals, schools, clinics, and the community to provide safe and general care to people of all ages. While they study from the same source of knowledge as registered nurses, an RPN can obtain their diploma faster. In Ontario, anyone hoping to become either an RPN however, must be trained through the traditional public system, without exception.

This is not the case, however, in other provinces across the country. Regulated career colleges across the country in provinces such as British Columbia, Alberta, Quebec and New Brunswick offer RPN/LPN programs to their students, effectively utilizing their institutional training capacity to bolster their provincial healthcare workforces in a time of such dire need. The need for Ontario to follow suit and re-conceptualize its approach to training more nurses has never been so painfully evident.

TRACK RECORD

Ontario’s regulated career colleges have for many years been a crucial component of the training to employment pipeline in the healthcare sector. Let’s take a look back on the incredible contribution of Ontario’s career colleges to the field of Personal Support Work. When the Personal Support Worker Challenge fund was created, both Canada and Ontario offered to pay tuition fees for domestic students enrolling in PSW training, provided that they could find a training place. Many of these places were provided by career colleges. As a result of this funding, PSW training became the second-largest enrolment category in Ontario’s career colleges. 12,880 career college students took advantage of this Challenge Fund and ultimately led the career college sector in Ontario to be the leading producer of PSWs in the province. 80% of all Ontario PSWs are now trained in career colleges.

With a strong focus on experiential learning coupled with state-of-the art equipment and expert instructors, it’s no surprise at all that career colleges were able to rise to the occasion and heed the province’s call for more PSWs. It became very clear that when offered the same opportunities as their public counterparts, career colleges not only meet but exceed expectations.

In large part, this can be attributed to the type of students career colleges attract. Purpose-driven, mature students with prior professional training gravitate to career colleges as they provide versatile, flexible learning options. The focus on experiential learning, which is key in fields such as personal support work or nursing, attracts lifelong learners and is proven to result in lower levels of attrition. So why erect unnecessary obstacles for students and withhold the opportunity for career colleges to train RPNs, when they have time and time again demonstrated their excellence in healthcare training?

Medix College for example, a regulated career college providing industry leading healthcare career training at three campuses across the GTA, has trained 1623 PSWs, 1082 Medical Laboratory Technician/Assistants and 935 Dental Assistants since 2018, effectively contributing to the alleviation of labour shortages in all three of those fields. Medix College graduate Glenn Estante perfectly embodies the determination with which so many students come to Canada, as well as how challenging the pursuit of a nursing career in Ontario can be:

Not only have career colleges demonstrated their exceptional ability to adapt to evolving economic needs, they continue to pivot and adapt to the challenges presented by our changing global landscape through innovation and technology. Last year, IBT College developed a complex micro-credential project that would lead from a Home Support Worker program to a Personal Support Worker Diploma using Virtual Reality (VR) and Augmented Reality (AR). This project was designed to address community staffing shortages exacerbated by the COVID-19 pandemic, and did so by harnessing cutting-edge technology.

ISSUE

As the province continues to focus on alleviating rampant labour shortages in the healthcare sector, the government of Ontario has introduced Bill 60, known as the Your Health Act, 2023. Among its many clauses, the bill seeks to address these labour shortages in the nursing field by looking outwards to other jurisdictions in order to source much-needed labour in the healthcare system. If passed, Bill 60 will create “as of right” rules to allow healthcare workers licensed in other Canadian jurisdictions to work in Ontario without having to register with applicable Ontario health regulatory colleges.

Although this is a great step in an overall effort to address these crippling staff shortages across the system, the province has not yet exhausted the options available to it within its own jurisdiction. So the question remains: Why are we not harnessing this incredible institutional capacity  for healthcare training right here in Ontario, where it already exists?

For decades, we’ve been married to the idea of training our nurses exclusively in traditional public institutions, and we continue to adhere to this approach despite the vast socioeconomic changes our society has gone through. As we continue with the same approach, we can’t possibly expect to arrive at a different result. After all, was it not Einstein himself who described insanity this way?

When hospitals in our province are forced to close 158 times in a year, resulting in some 4430 hours when urgent care needs of many communities cannot be met, I think it’s safe to say it is high time to re-consider traditional approaches to training in the healthcare sector in favour of more innovative and expedient ones.

SOLUTION

For as long as viable healthcare training options within Ontario remain overlooked in the provincial government’s push for more nurses, the problem facing our healthcare system will never be adequately addressed.

Let’s look inwards. At a crucial time when communities are suffering emergency department closures, the need to look inwards and consider the multiplicity of factors that can and should be addressed before looking outwards, has never been more imminent. Let’s exhaust the untapped institutional training capacity that we have within our own jurisdiction, before turning to others.

Let’s embrace innovation. As a vital sector, we have always been ready and able to develop programs and curricula to address rapidly changing and shifting workforce demand. In recent years especially, we highlighted the agility and nimbleness with which our sector can pivot, and how it can harness technology and innovation to improve efficiency with ease.

Let’s embrace flexibility. We demonstrated that regulated career colleges are an effective way to prepare for economic instability by providing up-skilling and re-skilling options. We have continued to grow and develop the shift in postsecondary education from traditional institutions that are publicly funded to a more nimble and agile ideology that focuses on how students learn and what works best for them.

Let’s empower all post-secondary students. The solution to this problem cannot come uniquely from sourcing skilled labour from out of province, or from relying exclusively on our publicly funded institutions. It needs to come from recognizing that there are many students like Glenn Estantes from Medix College who have the skills, the drive, and the passion to pursue a career in nursing but continue to face unnecessary barriers in achieving it. The students that gravitate to career colleges do so because of the direct training-to-employment pipeline they offer, which is exactly the kind of pipeline currently missing from the field of nursing.

Let’s learn from others. Career colleges in other provinces across the country offer RPN/LPN programs to their students.

What are we waiting for?