Perils of Casual and Part-time Nursing
"I became a nurse at
36 years of age. It was a dream come true for me, as I
always wanted to be a nurse. My patients deserve the best
of care and it is getting harder and harder to do so as
the workload is horrible. I will not decrease the quality
of my nursing care; I will quit instead. That is why I
went from full-time to part-time. . .I will not cut corners
and change the way I care for my patients. I will work
less hours instead and if that doesn't work for me, I
will change professions."
– Respondent to
RNAO's Survey of Casual and Part-Time Registered Nurses
in Ontario |
|
One of the most striking features of Ontario nurses’ current
reality – indeed the reality of registered nurses across Canada
– is the high number of RNs who are working on a part-time
or casual basis. In recent years, upwards of half of working RNs
have not had full-time employment. This is a most unusual circumstance
for any profession, and serves as a stark contrast with other jurisdictions,
like the U.S., where 71.6 per cent of RNs are full-time. This disproportionate
amount of part-time and casual work is a threat to the quality of
patient care, to the viability of the health-care system, and to
the nursing profession itself. Continuity of care is at risk with
such low levels of full-time employment. It is particularly problematic
for recent nursing graduates who are having difficulty obtaining
essential mentoring because they cannot attain full-time employment.
An already stressed health-care system is further strained by the
many potential hours lost due to part-time and casual employment.
As a consequence, we lose precious resources, with registered nurses
looking elsewhere for better career prospects.
RNAO is pleased that the Ontario government has committed over
$29 million to fund its nursing strategy, which it is hoped will
help stem the flow of new nursing graduates to the south.
Learning from SARS
The SARS outbreak, marked by heroic efforts on the part
of nurses and other health-care providers, also dramatically underscored
the problem of relying on casual nursing positions. Many nurses
were directed to work in one place only. This reality heightened
the staffing shortage, placed nurses under extreme duress from even
heavier workloads and added additional financial stress to those
nurses who were unable to continue their practice in other settings.
SARS was a reminder that we currently have no redundancy or safety
cushion in our health-care system, and left us gravely concerned
about its capacity to deal with another crisis.
A piecemeal approach to career-making
An unacceptably high 41.3 per cent of registered nurses in Ontario
are working part time or on a casual basis. This means less continuity
of care for patients and their families. This means decreased opportunities
for nurses to engage meaningfully with their patients, leading to
disillusionment with a profession that bills itself as caring, but
is confronted with conditions compromising its ability to deliver.
It also means that new graduates -- often bearing the brunt of casual
and part-time employment – receive insufficient mentoring.
The government has promised to move Ontario’s RNs to 70%
full-time, meeting the recommendation in a number of reports, including
the interim report from the Walker
Commission on the SARS outbreak in Ontario.
How we got here
For over a decade, Ontario’s registered nurses have faced
growing challenges. Stop-go funding, unstable employment, increased
casualization of work, and rapidly rising workloads have led many
RNs to leave the province, the country and even the profession.
By 1999, the situation had reached crisis proportions, and the
Ontario government committed itself to funding 12,000 permanent
nursing positions. This commitment was a response to recommendations
made by the nursing community in Good
Nursing Good Health, Report of The Nursing Task Force. These
recommendations included:
- Targeted money for hiring nurses
- More meaningful participation by nurses in decisions affecting
patient care
- Career days/job fairs
- Educational opportunities
- Career counselling
- Marketing campaigns to enhance the desirability of nursing as
a career choice
These initiatives served to temporarily improve the situation –
to buy some breathing space. CNO data for the year 2002 indicates
that nursing employment in the province did rise over 1999 (the
lowest point of nursing employment since 1988), although not by
the promised 12,000 positions 10 (actually, by 5,333 RN and RPN
positions). The share of employment held by full-time RNs is also
rising. The two factors imply a rise in full-time-equivalent employment.
However, nurses state that work circumstances have not substantially
improved. This reflects two factors. First, RN employment has been
unstable, falling again in 2001 to 81,026, before rising in 2002.
Second, Ontario’s population continues to grow quickly. These
factors combined mean deteriorating population-to-RN ratios. By
2001, the ratio for RNs had risen back close to its worst level
ever.
Consequences of part-time and casualization
The inordinate amount of part-time and casual employment causes
unsustainable workloads and stress on Ontario’s RNs. The impact:
inadequate access to nursing care for Ontarians in all sectors and
services, high levels of injuries among nurses resulting in increased
and costly sick time and absenteeism, and premature departures from
the profession. Access to RN care is currently compromised in Ontario.
Research shows that insufficient registered nursing care leads
to increased rates of complications including infections, and to
more deaths. The evidence is sufficiently strong that the high-profile
Hospital Report of the Ontario Hospital Association is now collecting
and reporting four complication-related indicators in its nursing-related
outcomes section.
Reversing the trend
By far the best recruitment program is a good retention program.
If RNs are given sustainable workloads, they can better deliver
the quality of care they are educated and eager to provide and their
patients need and deserve. If the work environment is collaborative
and supportive, RNs will remain in nursing. RNs need time to re-energize
and replenish their knowledge. Life-long education is not a frill.
It is a necessity. Wages are an important indicator of fairness
and respect, but RNs did not enter the profession to get rich. They
became RNs because they wanted to make a real difference in the
lives of patients and their families. They need the knowledge, energy,
and resources to do so.
Professionally fulfilled RNs are the best recruiters. We need greater
accessibility to education programs and better clinical placement
experiences. We need enhanced access and support for those entering
the profession, particularly individuals from under serviced areas
and populations. We must continue to support ongoing education,
reflecting the need for life-long learning for members of this complex,
challenging and rapidly changing profession. And we need better
access to graduate education for RNs to help provide the public
with adequate numbers of advanced practice nurses and to provide
future students with qualified nursing faculty. In Ontario, we are
expecting that 23.4 per cent of tenured nursing faculty will retire
between now and 2005. This declining faculty pool will only worsen
given that 90.4 per cent of faculty is over 45 years of age.
RNAO was haertened by the government's announcement in the fall
of 2004 of more than $29 million for graduate education.
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