Tag Archives: Blythe

The Production of Critical Care Nurses: A Collaborative Evaluation of Critical Care Nursing Education in Ontario

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Authors: Fisher, A., Baumann, A., Hunsberger, M., Blythe, J., & Fitzpatrick, L.

Executive Summary:The Ministry of Health and Long-Term Care (MOHLTC), through the Critical Care and Nursing Secretariats, is committed to providing system supports to improve critical care education for nurses and assisting hospitals in meeting their human resource needs for safe and accessible care. Commissioning and supporting the development of new Critical Care Nursing Standards (CCNS) by the Nursing Subcommittee of the Critical Care Expert Panel was the first step in achieving this vision. In order to determine the extent to which these standards have been incorporated into college and hospital-based critical care nursing education programs in Ontario, the Nursing Health Services Research Unit at McMaster University was asked to conduct a collaborative evaluation of selected programs in the province.

 

The CCNS were positively received by critical care nurses in this study as a basis for improving basic critical care nursing education and specialty orientation in the province. Although there were some suggestions for minor changes, the standards were generally seen as “very thorough and well-framed with inherent specific outcomes.” However, concerns were raised about the professional ownership of and ultimate accountability for consistent implementation across the province.

Collaborative evaluation of 24 critical care nursing education programs against the CCNS demonstrated great variation within and among college and hospital-based curricula in Ontario. Mean compliance with the standards varied from 25% to 75%. These outcomes underscored the need for a standardized core curriculum for beginning practitioners in the specialty. If basic preparation in the specialization is to be portable from one hospital to another, all beginning critical care nurses should receive the same educational preparation. Further to this, nurses have consistently identified the lack of formal recognition for the education required to begin work in their specialty area. If educational preparation for the beginning critical care nurse is based on a standardized core curriculum, there should be some consideration for formal credit, either towards a baccalaureate in nursing or a critical care nursing certificate. The standardized critical care nursing curriculum should be presented in partnership with educational institutions in the province. For this to be viable and have provincial impact, strong partnerships between the educational and hospital sector and structures such as the Local Health Integration Networks (LHINs) are required. Ongoing collaborative planning at the governmental, regional and local level will be essential in making this a reality.

Precedence has been set at both the undergraduate and postgraduate level with nursing specializations such as oncology, neonatology and primary health care. These programs provide a standard approach that can be adopted across educational institutions. It may be timely to consider such an approach with critical care nurse specialization.

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Registered Practical Nurses: An Overview of Education and Practice A Report to the Implementation Task Force Ontario Ministry of Health and Long -Term Care

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Authors: Andrea Baumann, Jennifer Blythe, Pam Baxter, Kim Alvarado, & Dianne Martin

Executive Summary:Professional practical nurses are designated as Registered Practical Nurses (RPNs) in Ontario and Licensed Practical Nurses (LPNs) in other provinces. This report presents an overview of RPN education and practice in Ontario. It provides the background to a much-anticipated study that will examine more fully the fit between how RPNs are educated and what roles they perform in the workplace. This report will review the evolution of RPN education and its effect on practice. It begins with an overview of the development of RPN education and scope of practice since the inception of the profession. The nature of the RPN role is further explored through tracking the development of RPN education and an analysis of an RPN curriculum from a major Ontario college. Trends in RPN demography during the past two decades are summarized and a current workforce profile of RPNs in Ontario is presented. The report concludes with a review of the literature on issues relevant to the role of practical nurses in the contemporary workforce, particularly their relations with Registered Nurses (RNs) in the nursing team.

 

Practical Nurse Education in Ontario

Pringle, Green and Johnson (2004) trace the education for practical nurses in Canada through three phases: the establishment of educational programs (1939-1959), the evolution of educational programs (1960-1990) and the subsequent expansion of scope of practice.

The first RPN courses were offered by non-academic private companies in 1938 and were six months in length (Registered Practical Nurses Association of Ontario [RPNAO], n.d.a). In 1946, training centres for nursing assistants were established, providing ninemonth courses. Education was later extended to a one-year certificate course taken at either a college or high school (RPNAO, n.d.a).

Over the years, the trend in education has been towards increased length of preparation, with the exception of 1967 when educational programs were reduced to 35 weeks. Other notable amendments include changes to nomenclature. The title Registered Practical Nurse has not always been used in relation to this health care profession. In 1963, Certified Nursing Assistant was used; this was subsequently changed to Registered Nursing Assistant (RNA). In 1993, RNAs were given the right to use the title nurse and to adopt the designation of Registered Practical Nurse (RPNAO, n.d.b.). Additional milestones in the development of the profession are described on the RPNAO website (http://www.rpnao.org/about/whatisanrpn.asp) and summarized in Appendix A. Registered Practical Nurses: An Overview of Education and Practice 4

Recent Developments

In the early 2000s, changes were made to the educational criteria for RNs and RPNs in Ontario. In December 2001, the CNO recommended that all new RPNs would require a two-year diploma from a Community College of Applied Arts and Technology as the basic educational requirement, effective January 1, 2005 (CNO, 2004). In 2002, two-year diplomas were offered and approved by the Ministry of Training Colleges and Universities (MTCU). These diplomas were in compliance with the CNO’s entry to practice competencies, professional standards and guidelines (CNO, 2004, CNO 2009a).

In 2005, a baccalaureate degree in nursing became mandatory for RNs to enter into practice and diploma programs were discontinued. The MTCU facilitated transition to the new educational standards via financial support for increased enrolment in collaborative college and university degree programs, as well as providing funding for compressed degree programs in universities and the final intake of diploma students to the colleges. The intention was to boost the number of nursing graduates in 2003-2004, the year in which reduced numbers were anticipated due to the elimination of the three-year college diploma. These changes and the existing shortage affected the supply of RNs.

In the new RPN programs, the minimum admission requirement remains an Ontario Secondary School Diploma. Currently, 24 Ontario colleges provide educational programs for RPN diplomas. There is at least one program in each Local Health Integrated Network (LHIN), with the exception of Central West (CNO, 2007) (see Appendix B). To encourage high enrolment, caps on RPN numbers in college programs were removed effective January 2001. Greater numbers of RPNs, many of which are employed in longterm care, would be needed to care for the aging population. Given the general shortage of nurses, higher numbers of RPN graduates might, in the short run, help offset the lower numbers of RNs graduating during the transition to baccalaureate degrees.

The rationale for creating the RPN diploma program was that advancing technology, increased demands in community care and changing skill mix required an expansion of RPN practice. The CNO also argued that the limited mentoring and orientation available in the workplace meant that students needed to be better prepared for immediate responsibilities. In the past, RPNs required an order to carry out certain medical procedures that were previously only permissible for RNs and RNs with extended class designation to perform. An important reason for the modification of the curriculum was to ensure that graduates had the knowledge and skills to practice according to the Regulated Health Provisions Act, 1991 and the Nursing Act, 1991. However, in 2005, amendments were made to regulations under the Nursing Act, 1991. Thus permitting RPNs to initiate controlled act procedures, such as dressing and cleansing wounds, and assisting an individual with the insertion of a catheter (Ministry of Health and Long-Term Care [MOHLTC], 2007). Registered Practical Nurses: An Overview of Education and Practice 5

The new diploma program is one term longer than the previous three-semester certificate program. Qualifications for entry to the RPN programs have not changed significantly, except that a requirement for grade 11 math has been added. Similarly, some core components of the program (theoretical knowledge, human biology and practical skills) have remained the same. However, course content has been updated in response to the expanded knowledge base and skill set required to meet the range of competences now required.

To gain a preliminary appreciation of the new curriculum, a comparison was made between the certificate and diploma programs in one institution (see Appendix C). The diploma differs from the certificate program in the addition of four courses in professional development held in the first, third and fourth semesters. Non-nursing courses in both programs include psychology, developmental psychology and sociology. The diploma program had added a second sociology course and a course in active citizenship to requirements already present for the certificate. Most importantly, diploma students spend a considerably longer amount of time in their nursing practicum, which allows for more opportunities to acquire the knowledge and skills required in the workplace.

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National Community Health Nursing Study: Comparison of Enablers and Barriers for Nurses Working in the Community

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Research Team: J. Underwood, A. Baumann, N. Akhar-Danesh, S. MacDonald-Rencz, M.MacDonald, S. Matthews, R. Goodyear, BN, MSA, CCHN(c)
D. Mowat, J. Blythe, A. Dragan, R. Gannan, & D. Ciliska

Executive Summary:

SARS, 9/11, continuing infectious outbreaks and increased evidence about social determinants of health have heightened the focus of governments and health policy analysts on public health capacity. Similarly, the rising costs associated with hospital and long-term care beds has increased awareness of the need to improve home care, primary healthcare and other community care services.

Effective human resource planning requires service delivery strategies that ensure the community health workforce is used to its full potential. In 2006, 50,577 (16 %) of the 320,248 nurses in Canada were Community Health Nurses (CHNs). However, there is little research about the CHN workforce and how it can contribute to improving health system capacity. This report provides an analysis of CHNs’ perceptions regarding enablers and barriers to practice their full scope of competencies (knowledge, skills and attitudes).

The Nursing Health Services Research Unit (NHSRU) CHN Questionnaire©1 was administered in 2005-2007 to a random sample of Community Health Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) stratified across all provinces and territories. Most CHNs were contacted through their provincial regulatory bodies, but this was not possible for Registered Psychiatric Nurses or for RNs in Prince Edward Island.

The response rate was 57%; 6,667 questionnaires were analyzed. The respondents’ demographic profile approximated the Canadian Institute of Health Information (CIHI) profile of the national cohort of CHNs. Work environment was found to be the most important enabler to support CHNs to work to the full scope of their competencies. This finding was underscored by the lack of statistically significant differences in responses by age, education, employment status or experience. Respondents revealed strong relationships among CHNs and with most other disciplines. However, there were indications that physician/nurse collaboration could be improved, especially in the public health sub sector.

Although respondents expressed confidence in their own professional abilities, continuously evolving scientific evidence and changing needs in the community require ongoing opportunities for updating skills and knowledge. Almost 20% of respondents did not agree that they received updates on changing government policies. Less than half agreed that they had adequate time/money/access to learning resources. This problem was most pronounced for CHNs in Quebec and for Outpost Nurses.

About three-quarters of the respondents agreed that there are nurses in key leadership positions, and more than 80% felt that employers upheld their professional Standards of Practice. However, employers could become more supportive by providing additional debriefing opportunities and better demonstrate their trust by encouraging the flexibility of CHNs to vary care plans and time spent, based on client need. Employers could also be more supportive of CHNs’ efforts to address population health needs.

Canadian communities are the context for CHN practice. Only half of RN CHN respondents agreed that provincially-mandated policy supports them to work effectively. Collectively, organizations within communities must assure timely access to good quality resources for their citizens. If the resources are available, CHNs could ensure that they are well-used by the people who need them. In order to do this, community groups and workers need to understand each other’s roles and abilities.

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Building Canadian Public Health Nursing Capacity: Implications for Action

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Research Team: D. Meagher-Stewart, J. Underwood, B. Schoenfeld,  M. Lavoie-Tremblay, J. Blythe, M.MacDonald, A. Ehrlich, K. Knibbs, V. Munroe

Executive Summary:

The purpose of this research was to assist public health policy makers/managers in developing policies to enhance the effectiveness of public health nursing services. Previous research has shown that strong organizational support contributes to optimal performance of Public Health Nurse (PHN) competencies (skills, knowledge, and attitudes).1 Better utilization of PHNs would enhance efficiency of health care dollars by increasing job satisfaction amongst nurses, improving upstream prevention of illness and promoting population health.

The research question was, “What organizational attributes support PHNs to practice their full scope of competencies?” An appreciative inquiry process was utilized to conduct 23 focus groups, which included frontline PHN groups (urban and rural/remote) and associated policy maker/managers, from six Canadian geographic regions (British Columbia, Prairies, Northern Canada, Ontario, Quebec and Atlantic Canada).

The organizational attributes that support PHNs working to their full scope of competencies were identified in three thematic areas based on the study findings:

1. Government and other system attributes;
2. Local organizational culture – values and leadership characteristics; and
3. Frontline management practices, which was the strongest area of participant emphasis.

These findings support a growing recognition that changes to health care systems and organizations require integrated action, with each system area incrementally reinforcing and developing other interdependent areas. The results of this study highlight areas for public health organizational development and offer recommendations for supporting effective public health nursing practice. It was evident throughout the investigation that there are passionate and committed front line staff and policy maker/managers who have the capacity to pursue these recommendations with common purpose.

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Integrating Internationally Educated Health Care Professionals into the Ontario Workforce

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Authors: A. Baumann & J. Blythe

Executive Summary:

IntroductionA shortage of health care professionals is forecast for Ontario. An aging workforce and insufficient recruitment and production in the past decades mean that the province must make full use of all health human resources. The purpose of this report is to provide background information to support the development of guidelines for the integration of internationally educated health professionals (IEHPs) into the workplace. Challenges and barriers to hiring IEHPs and mechanisms for addressing them are outlined. The report also focuses on the extent to which the recruitment and retention of IEHPs is a priority. It identifies professions that are encouraging the recruitment of IEHPs and the strategies and resources required to reduce barriers and improve IEHP recruitment and retention. Multiple methods were used to gather information on IEHP integration into the Ontario health care system, including a review of published literature, an investigation of relevant web sites and interviews with various stakeholders. Individuals from government, education and health care organizations were interviewed. The community sector, acute care hospitals and rural, urban and mid-sized communities were represented.

Identifying Internationally Educated Health Professionals

It is impossible to determine accurately how many IEHPs reside in Canada or individual provinces (Torgerson, Wortsman, & McIntosh, 2006). Most health professionals enter the country before passing registration examinations or contacting regulatory bodies, and many remain unregistered for several years or indefinitely (Baumann, Blythe, Rheaume, & McIntosh, 2006). Data is available for IEHPs who have completed registration, but it varies in quality among professions. The Ministry of Health and Long-Term Care (MOHLTC) is currently working with health regulatory colleges in Ontario to create an Allied Health Human Resources Database (HealthForceOntario [HFO], 2009e). This will improve our knowledge of IEHPs in the workforce.

Migration and Settlement

Internationally educated health professionals encounter challenges in obtaining complete and timely information about re-entering their profession after migration. Early acquisition of this information facilitates their professional transition. Citizenship and Immigration Canada is becoming more proactive in supplying potential immigrants to Canada with relevant information and referral services.

Information dissemination and support for IEHPs who have settled or plan to settle in Ontario have improved. This includes government and professional organization web sites such as the Ontario Ministry of Citizenship and Immigration and Global Experience Ontario (Ontario Immigration, 2005a). A major investment by HealthForceOntario (HFO) is the Access Centre for Internationally Educated Health Professionals, which provides information, advice, support and Integrating Internationally Educated Health Professionals Into the Ontario Workforce 9 programs to IEHPs pursuing registration in regulated health professions (HFO, 2009a). One organization that serves a specific region of Ontario is the Access Centre for Regulated Employment, which provides information and assistance to IEHPs seeking licensure and employment in Southwest Ontario.

Registration: Processes and Challenges

Challenges for IEHPs in meeting registration criteria include supplying and validating credentials, satisfying educational/practice requirements, achieving language fluency, gaining clinical experience and passing the professional examination.

In 2008, the Canadian government signed labour market agreements with the provinces and territories. On January 16, 2009, an agreement was made to develop a common pan-Canadian Qualification Recognition Framework and Implementation Plan for better integration of immigrants into the Canadian labour force (White, 2009). Proposed legislation (i.e., the Labour Mobility Act) would ensure that a worker certified to practice in one province or territory would be entitled to certification in that occupation in Ontario, without having to complete additional material training, experience, examinations or assessments (Province of Ontario, 2009).

Human Resources and Skills Development Canada funds the Foreign Credentials Recognition Program, which supports projects initiated by provincial and territorial governments and other stakeholders.

In Ontario, the Centre for the Evaluation of Health Professionals Educated Abroad is part of an MOHLTC strategy to enhance services to IEHPs. Bridging programs help IEHPs satisfy registration criteria, and ways of recognizing prior learning experience are being developed. Regulatory bodies and the Centre for Canadian Language Benchmarks have undertaken projects to improve language testing and acquisition. Bridging and adaptation programs find clinical placements and job shadowing opportunities for IEHPs. Regulatory bodies and educational institutions have developed courses and tools to help IEHPs prepare for registration examinations.

Entering the Workforce

Given the current shortages, unemployment rates are low for IEHPs. Nevertheless, they face challenges due to uninformed employers, bias and their potential need for extended orientation. HealthForceOntario was created to oversee a number of health human resources strategies “designed to make the province ‘the employer of choice’ in health care” (HFO, 2008a). Marketing and recruitment activities include maintenance of a job posting web site, working with employers and communities to satisfy health human resource needs, acting as a clearing house of information about marketing and promoting Ontario though various media (e.g., career fairs). Integrating Internationally Educated Health Professionals Into the Ontario Workforce 10 Integration Into the Workforce Although the retention rate of IEHPs is reported to be high, they may face adaptation problems. Ultimately, the success of IEHPs in re-establishing themselves in their profession and contributing fully to their workplace depends on their efforts to integrate and on whether their practice environment is welcoming and adaptive. The literature makes it clear that diversity must be accepted into corporate culture (Kukushkin, 2009). It would be beneficial to identify exemplars or establish a gold standard to encourage successful diversity management. Among individual organizations, St. Michael’s Hospital, University Health Network, the Ottawa Hospital and Hamilton Health Sciences have all initiated programs to assist IEHP integration.

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How Government Invests in Research to Advance Policy: Evolution of Evidence

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Authors: A. Baumann, J. Blythe, M. Hunsberger, A. Fisher, & J. Underwood

Executive Summary:

The Nursing Health Services Research Unit (NHSRU) has helped aid nursing policy for Ontarians for the past 20 years. The NHSRU is comprised of two sites, one at McMaster University in Hamilton and the other at the University of Toronto. The McMaster site is headed by Dr. Andrea Baumann. Funded primarily by the Nursing Secretariat and Research Unit of the Ministry of Health and Long-Term Care (MOHLTC), the unit began in 1990 and has held several names during the past two decades. As the most recentcontract with the MOHLTC ends in 2010, the NHSRU McMaster site has drafted policy-relevant research evidence spanning the past five years. From 2004 to 2009, 20 reports in the NHSRU McMaster University Site’s Health Human Resource Series were published, as well as many journal articles and fact sheets. The evidence from this research has been categorized into five themes below.

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A Made-in-LHIN Solution: Identifying Local Needs in 70% Full-Time Nurse Employment – Hamilton, Haldimand, Brant LHIN 4

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Authors: A. Baumann, M. Crea, D. Idriss, M. Hunsberger,  & J. Blythe
Summary:

Since the economic downturn of the 1990s, when the province lost over 2,000 full-time nurses, the stability of nursing employment has been a priority healthcare issue. In 1990s, the percentage of nurses employed part-time increased dramatically, exceeding 60% in some hospitals, and overtime hours became a major strategy to achieve adequate patient care coverage. Since 2000, the Ontario government has introduced a series of focused strategies to improve recruitment and retention of nurses, with the intent to attain a higher ratio of full-time nurse employment. Specifically, a 70:30 full-time to part-time ratio was identified as the goal to be achieved in as many organizations as possible. This report examines the Ministry of Health and Long-Term Care’s (MOHLTC) priority theme of “a 70% Full-Time Commitment” via an analysis of nurse employment in four collaborating Local Health Integration Networks (LHINs) in Ontario. Information in this report was obtained through a number of sources, including qualitative interviews, survey data, MOHLTC Health Data Branch statistics, and College of Nurses of Ontario (CNO) statistics. Percentages presented will vary according to source and are based on differences in data collection methods. The data presented is not for comparative purposes; rather, it is used as descriptive information to provide a picture of nurse employment across the participating LHINs.

Highlights:

Geographical Context

HNHB is the second largest LHIN in the province with a population of 1.4 million
Located in the Golden Horseshoe,
HNHB includes Brant, Burlington, Haldimand, Hamilton, Niagara and most of Norfolk.
 Made up of urban and rural communities rich in ethnocultural and linguistic diversity
 Home to two Aboriginal reserves (Six Nations of the Grand River Territory and Mississaugas of the New Credit)

Healthcare Organizations

 10 hospital corporations (operating on 24 sites),
 more than 105 community support service organizations,
 more than 50 community mental health and substance abuse services,
 six community health centres and
 the HNHB Community Care Access Centre

Nurse Employment

 11% of all RNs and 12% of all RPNs working in Ontario are employed in HNHB LHIN 4
 RNs: 62.7% were employed FT, 30.3% PT and 7.0% Casual (CNO, 2008)
 RPNs: 58.6% were employed FT, 31.7% PT and 9.7% Casual (CNO, 2008)

By sector

 64.6% of RNs were employed in hospitals, 18.9% in community settings and 9.5% in long-term care facilities
 47.9% of RPNs were employed in hospitals, 35.5% in long-term care facilities and 11.8% in community settings

Nurse Vacancies

 Acute care organizations: most recruitment for RNs and RPNs is occurring in the acute care organizations for both full-time and part-time positions.
 LTC: no reported vacancies for RN and RPN full-time and part-time positions.
 Community: few reported vacancies for full-time employment for RNs and RPNs; highest rate of available part-time positions for RNs, and few part-time positions for RPNs.

Achieving 70:30

 For RNs: 43% of employer survey respondents across all sectors (acute, LTC and community) indicated they had achieved 70% FT target
 For RPNs: 30% of employer survey respondents indicated that they had achieved the 70% target.
 Average reported FT:PT mix across all sectors: o RNs: 69:31 o RPNs: 63:37


Key Strategies for Achieving 70%

1. Converting part-time to full-time positions
2. Creating clinical float team
3. Offering educational incentives to all nurses (RNs and RPNs)
4. Multi-site positions in areas of clinical specialty
5. Building strong relationships with academic partners and increasing clinical student placements
6. Changing RN/RPN mix in some clinical areas to create more full-time positions.

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A Made-in-LHIN Solution: Identifying Local Needs in 70% Full-Time Nurse Employment – Central West LHIN 5

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Authors: A. Baumann, M. Crea, D. Idriss, M. Hunsberger,  & J. Blythe,

Summary:

Since the economic downturn of the 1990s, when the province lost over 2,000 full-time nurses, the stability of nursing employment has been a priority healthcare issue. In 1990s, the percentage of nurses employed part-time increased dramatically, exceeding 60% in some hospitals, and overtime hours became a major strategy to achieve adequate patient care coverage. Since 2000, the Ontario government has introduced a series of focused strategies to improve recruitment and retention of nurses, with the intent to attain a higher ratio of full-time nurse employment. Specifically, a 70:30 full-time to part-time ratio was identified as the goal to be achieved in as many organizations as possible.

This report examines the Ministry of Health and Long-Term Care’s (MOHLTC) priority theme of a “70% Full-Time Commitment” via an analysis of nurse employment in four collaborating Local Health Integration Networks (LHINs) in Ontario. Information in this report was obtained through a number of sources, including qualitative interviews, survey data, MOHLTC Health Data Branch statistics, and College of Nurses of Ontario (CNO) statistics. Percentages presented will vary according to source and are based on differences in data collection methods. The data presented is not for comparative purposes; rather, it is used as descriptive information to provide a picture of nurse employment across the participating LHINs.

Highlights:

Geographical Context

 Representing 6.25% of Ontario’s population, 800, 144 people reside in Central West LHIN
 Communities include the City of Brampton, Dufferin County, the Hills of Headwaters, the Village of Woodbridge, and the towns of Caledon, Mono, Orangeville and Shelburne.
 Over 50% of residents are considered visible minorities. Healthcare Organizations
 49 service providers across the health care continuum including: o 2 hospitals (across 4 sites), o 23 long-term care facilities, o 13 community support services, o 8 mental health and addiction programs, o 2 community health centres and o 1 Community Care Access Centre Nurse Employment
 2.9% of RNs and 2.6% of RPNs working in Ontario were employed in the Central West LHIN
 RNs: 68.1% were employed full-time, 24.3% were employed part-time and 7.7% were employed on a casual basis
 RPNs: 55.4% were employed full-time, 36.8% were employed part-time and 7.7% were employed on a casual basis (CNO, 2008). By sector
 59% of RNs were employed in hospitals, 20.2% worked in community-based settings and 10.3% were employed in long-term care facilities 6 | Identifying Local Needs in 70% Full-Time Nursing Employment – Central West LHIN (5), October 2009
 42.8% of RPNs were employed in hospitals, 42.2% worked in long-term care facilities and 9% worked in community-based settings (CNO, 2008). Nurse Vacancies
 Acute care: most recruitment for RNs, and RPNs is occurring in acute care organizations for both full-time and part-time positions.
 LTC: no reported vacancies for RN and RPN full-time positions and few for RN and RPN part-time positions.
 Community: no data available Achieving 70:30
 For RNs: 55% of employer survey respondents indicated that they had achieved the 70% target.
 For RPNs: 60% of employer respondents indicated that they had achieved the 70% target.
 Average reported FT:PT mix across all sectors: o RNs: 62:38 o RPNs: 52:48 Key Strategies for Achieving 70% 1. Converting part-time to full-time positions 2. Converting FTEs to full-time positions 3. Clinical Nurse Float team 4. Job sharing 5. Creation of 0.8FTE for Late Career Nurse

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A Made-in-LHIN Solution: Identifying Local Needs in 70% Full-Time Nurse Employment – Southwest LHIN 2

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Authors: A. Baumann, M. Crea, D. Idriss, M. Hunsberger, J. Blythe,

Summary:

Since the economic downturn of the 1990s, when the province lost over 2,000 full-time nurses, the stability of nursing employment has been a priority healthcare issue. In 1990s, the percentage of nurses employed part-time increased dramatically, exceeding 60% in some hospitals, and overtime hours became a major strategy to achieve adequate patient care coverage. Since 2000, the Ontario government has introduced a series of focused strategies to improve recruitment and retention of nurses, with the intent to attain a higher ratio of full-time nurse employment. Specifically, a 70:30 full-time to part-time ratio was identified as the goal to be achieved in as many organizations as possible. This report examines the Ministry of Health and Long-Term Care’s (MOHLTC) priority theme of a 70% full-time commitment via an analysis of nurse employment in four collaborating Local Health Integration Networks (LHINs) in Ontario. Information in this report was obtained through a number of sources, including qualitative interviews, survey data, MOHLTC Health Data Branch statistics, and College of Nurses of Ontario (CNO) statistics. Percentages presented will vary according to source and are based on differences in data collection methods. The data presented is not for comparative purposes; rather, it is used as descriptive information to provide a picture of nurse employment across the participating LHINs.

Highlights:

Geographical Context

 South West population is just under one million people, representing 7.5% of the population of Ontario.
 Almost one-third of the population of the South West LHIN lives in a rural setting; it also contains a significant urban population in the City of London.
 It includes Bruce, Elgin, Grey, Huron, Middlesex, Norfolk, Oxford and Perth counties Healthcare Organizations
 More than 150 health service providers including o 20 hospital corporations (30 sites) o 72 long-term care homes (6,636 beds) o 52 community support services o 33 mental health and addiction agencies o 2 community health centres (with 3 in development). o 1 community care access centre (South West CCAC) Nurse Employment
 9.4% of RNs and 10.2% of RPNs working in Ontario were employed in the South West LHIN
 RNs: 61.6% were employed full-time, 28.1% were employed part-time and 10.3% were employed on a casual basis.  RPNs: 54.3% were employed full-time, 35.9% were employed part-time and 9.8% were employed on a casual basis.

By sector
 67.6% of RNs were employed in hospitals, 17.9% worked in community settings and 8.1% worked in long-term care facilities
 47.1% of RPNs worked in hospitals, 32.2% were employed in long-term care facilities and 16.3% worked in community settings (CNO, 2008) Nurse Vacancies in Central West 6 | Identifying Local Needs in 70% Full-Time Nursing Employment – South West LHIN 2, October 2009
 Acute care: most recruitment for RNs, and RPNs is occurring in acute care organizations for both full-time and part-time positions.
 LTC: few reported vacancies for RN and RPN full-time positions and few for RN and RPN part-time positions.
 Community: no data available Achieving 70:30
 For RNs: 53% of employer survey respondents indicated that they had achieved the 70% target.
 For RPNs: only 13% of employer respondents indicated that they had achieved the 70% target.
 Average reported FT:PT mix across all sectors: o RNs: 72:28 o RPNs: 57:43 Key Strategies for Achieving 70% 1. Late career initiatives 2. Job shares 3. Combined part-time positions to full-time positions (i.e. created composite positions where part-time hours were amalgamated from more than one unit to create a full-time position; consolidating casual hours into FT positions) 4. Cross-training nurses 5. Reduced full-time hours to create more full-time positions 6. Offered flexible/individualized scheduling 7. Creation of the Nursing Reserve Unit – a centralized pool of full time nurses.

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Casualization and SARS (Severe Acute Respiratory Syndrome): Implications for Human Resource Policies

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Authors: Havenaar, J., & Blythe, J.

This summary defines casualization and examines the management of labour during the SARS crisis.

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