PART I:
Nurses flee poor pay, unhealthy jobs.
PART II: U.S. hospitals draw
Canadian nurses south.
PART III: Job fair in Texas tries to
lure nurses back to Canada.
A comparison of the
nursing industry in Canada and the United States
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The Globe and Mail, Saturday, February 24, 2001
Poor conditions stressing out nurses. Lack of secure jobs, heavy
workloads are driving droves out of the profession.
By André Picard
Doris Grinspun is leafing through a stack of papers and shaking her head in
disgust.
The Registered Nurses Association of Ontario has surveyed nurses who are
working in the U.S. to find out why they left and the responses drip with
irony. At a time when the healthcare system is hobbled by the worst nursing
shortage in its history, 70 per cent of respondents say they left because of
lack of job opportunities. And another 25 per cent cite family reasons,
often related to shift work and the unbearable workload.
~This is crazy," Ms. Grinspun, the RNAO executive director said, pushing
away the pile disgustedly. ~We have to do something to bring them home."
On Monday, the RNAO will take action. It is hosting a job fair in Texas, the
state that has lured away the most Canadian nurses. There, 35 employers will
make their pitch.
The bold manoeuvre may woo some nurses back, but much more remains to be
done to retain and recruit nurses in Canada at a time the profession is on
the brink of a massive exodus.
According to the Canadian Nurses Association, within a decade, Canada could
be short as many as 113,000 nurses -- the equivalent of half the country's
entire nursing workforce today. The RNAO has an even bleaker outlook,
predicting that the shortfall could reach 90,000 in Ontario alone.
There are a number of demographic, social and economic reasons that help
explain the dire shortages, but nurses on the front lines say there is one
overwhelming issue driving them from the profession in droves: Poor work
conditions.
Just ask Maggie Milacek. On Tuesday morning, she arrived for work at
Vancouver's George Pearson Centre at 7 a.m. The nurse spent the day caring
for her patients, all of whom have severe disabilities, before heading home
in the late afternoon.
By the time she arrived, there was a message telling her to return to work
at 11 p.m. for the night shift and come morning, because no relief was
available, she began a third shift in 24 hours.
Ms. Milacek stresses that supervisors at her hospital are not to blame, that
like her, they are victims of a larger human resources crisis in the health
sector.
~The bottom line is there are no nurses," she said. ~And they say it's
going
to get worse."
As a result, Ms. Milacek is herself looking south. But if she does remain in
Canada, she will likely abandoning nursing -- at age 35.
~My husband looks at me when I come home from work and says: 'Is it worth
it?' And lots of days the answer is 'No,'" an exhausted Ms. Milacek said.
She works up to 10 overtime shifts a month in addition to her full-time job,
a pace that is damaging her family life and her health.
Kathleen Connors, president of the Canadian Federation of Nurses Unions,
said the nursing exodus -- to the U.S. and elsewhere -- has its roots in a
series of public policy blunders over the past decade.
When health budgets were slashed, nurses bore the brunt, suffering massive
layoffs and casualization -- the loss of full-time, permanent jobs with
benefits. The number of full-time jobs went from 75 per cent to 50 per cent
of the total workforce. And the casual employees -- generally the younger
nurses eager for full-time work -- have to juggle jobs in three or four
institutions, and their income is unstable.
In real terms, wages remain at 1985 levels. Yet, patient loads have steadily
increased, as has the acuity of patients.
Nurses also have the dubious distinction of being among the country's
unhealthiest workers, with an absenteeism rate three times the national
average and as many as 40 per cent of nurses suffering from chronic back
injuries. Stress levels are through the roof. At one Montreal hospital
alone, three nurses have committed suicide in the past year.
~Morale is low and recruitment is difficult because of low salaries, a
horrible work environment and widespread burnout," Ms. Connors said.
~Nurses today feel they cannot deliver anymore."
Already, some hospitals have had to close their doors for lack of staff,
emergency rooms have had to divert patients, specialty programs have closed,
and waiting lists for surgery have grown markedly, all due principally to an
insufficient number of nurses.
To date, Ms. Connors said, governments have responded to shortages not by
improving work conditions and increasing full-time positions, but by
imposing draconian measures.
An increasing number of nurses are facing mandatory overtime (double shifts
that, by law, they cannot refuse), mandatory on-call (up to 20 days a
month), being refused holidays, denied time for education and training, and
shifted to areas outside their specialty.
And when nurses have gone on strike for better pay and work conditions -- as
they have in Newfoundland, Saskatchewan and Quebec since 1999 -- they have
been legislated back to work. In Saskatchewan, it took only six hours; in
Quebec, the law including punishing fines.
~The anger and frustration of nurses has erupted, but there is still a
reluctance to respond to the legitimate grievances of nurses," Ms. Connors
said.
But the heat has just begun. Contracts for hospital nurses expire March 31
in B.C., Alberta and Ontario.
The B.C. Nurses' Union is looking to raise the salary of a senior,
front-line nurse to almost $79,000, from the current maximum of just under
$60,000, demands that are a harbinger of things to come across Canada.
Yet, as governments loosen the purse strings, there is a growing realization
that money alone will not resolve the shortage problem.
~The issue of workload is the number one concern in all our studies," said
Dr. Andrea Baumann, the associate dean of health sciences at McMaster
University in Hamilton.
Her research has shown that nurses are working, on average, at 94 per cent
of their productivity capacity -- yet, the ideal is 85 per cent. ~It's
impossible to work at this pace and not burn out," Dr. Baumann said.
And that is precisely what is happening in hospitals, community clinics and
homecare agencies around the country.
What nurses are looking for, Dr. Baumann found, is a reduced patient: nurse
ratio, full-time jobs, subsidized education programs, better pay, advocates
in the workplace, decent equipment and adequate supplies.
~Everybody knows the problems and almost everybody knows the solutions, but
few of us are doing anything about it but talking," she told delegates to a
recent nursing leadership conference.
~When solutions are proposed, they are one-off solutions. We are not seeing
a Gestalt of solution measures," Dr. Baumann said.
What is required is a combination of measures that will attract young people
to the nursing and to the full range of specialties that exist, help keep
qualified nurses on-the-job, and even attract experienced workers who have
left the profession.
But the reality on the ground is quite different. Despite shortages, nursing
schools are turning away two qualified applicants for every one accepted,
one-third of new nurses are lost to the profession within a year of
graduation, and experienced nurses are retiring younger than ever.
There are, in fact, almost as many nurses not working in nursing as there
are who are doing so. And the demographics are chilling: The average age of
a Canadian nurse is now 45 and rising, and the average retirement age 54 and
falling.
Cheryl Lenton, an emergency room nurse in Thompson, Manitoba understands why
many of her colleagues are bailing out. ~I don't regret making the decision
to be a nurse, but there are a lot of days now when you wonder why you
bother," she said.
With 29 years of full-time work under her belt, she has never had a break,
but sees the demands on her growing with each passing day. It is not unusual
for Ms. Lenton to be called in for an overtime shift three days a week.
At age 49, she wonders how long she can maintain this pace. But at Thompson
General Hospital there are 90 nursing positions, and 13 vacancies.
~I worry that there won't be younger nurses to take my place," Ms. Lenton
said.
It is a legitimate and current worry from coast-to-coast. In B.C.'s Pacific
Rim region, the three local hospitals -- Port Hardy, Port McNeil and Port
Alice -- have closed at least seven times in the past year for lack of
nurses. Similar problems exist, on a different scale in every province, city
and town, and they are escalating daily.
Ms. Grinspun of the RNAO said that there are clearly a number of measures
that have to be taken quickly and simultaneously but, above all, the work
environment has to improve dramatically so nurses have time to care properly
for their patients and feel valued again.
~Nursing needs to re-build its image as a professional career. Right now,
our image is that of casual burger-flippers because that's how governments
treat nurses today," Ms. Grinspun said.
A fast-food worker is exactly how Marnie Matthews of Terrace, B.C. feels
some days.
That is because the veteran operating room nurse at Mills Memorial Hospital
gets a meagre $1.25 an hour to be on-call. (Doctors get $40 an hour to be on
call.) She is on mandatory on-call -- carrying a beeper and being no more
than five minutes from work -- for up to 12 days a month in addition to her
full-time work. For her nursing has become a job that dictates where and how
she can live her life -- even walking her dog requires prior permission.
At age 49, Ms. Matthews suffers from chronic, job-related foot problems. She
is not looking to the U.S. but, pondering how much longer she will remain a
nurse, hopes that changes to the workplace will be made that appeal to
younger women and men.
~But my biggest worry is that there won't be relief. What's going to happen
when I need care?" Ms. Matthews wonders.
~It's a question everybody should ask themselves: What kind of care are they
going to get if there aren't enough nurses?"
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The Globe and Mail, Monday, February 26, 2001
Why our nurses head south for jobs. They say they won't return
until Canada improves opportunities, pay and conditions.
By André Picard
HOUSTON -- Julie Schmidt graduated at the top of her class at Queen's
University in Kingston in the spring of 1996. But the only work the newly
minted nurse could find was a short-term contract at a summer camp.
"I went personally to every hospital in Toronto with my résumé but I just
kept hearing: 'We're not hiring new grads,' " she said in an interview. So
Ms. Schmidt dropped in to a job fair her mother saw advertised in the paper,
and walked out with three firm job offers -- all in the U.S.
Expatriate nurses say that unless Canada gets serious about improving
opportunities and work conditions -- including better scheduling, higher
pay, paid education and more career options -- they will never come home,
and many talented health professionals will follow them south as U.S.
recruiters step up their efforts.
There are an estimated 20,000 Canadian nurses working in the U.S., and at
least 10 per cent of new graduates head south annually, plus hundreds more
experienced nurses. The migration rate for nurses is seven times that of new
graduates in other professions. This continuing brain drain hurts because
Canada is already short about 20,000 nurses and, barring a dramatic reversal
of fortunes, that shortfall is expected to reach 113,000 within a decade,
according to the Canadian Nurses Association.
Ms. Schmidt, 28, said her experience illustrates well why Canadian nurses
are discouraged and demoralized, and why they are easily lured to the U.S.
Although she was summarily dismissed as inexperienced in Canada, U.S.
employers focused on her potential. Instead of patching minor wounds at
summer camp, Ms. Schmidt opted to work at Ben Taub Trauma Center, one of the
busiest emergency rooms in the United States.
Four years after graduation, she is working as a nurse-educator at Memorial
Hermann Southwest Hospital, responsible for overseeing the training of
surgical nurses and support staff, while many of her classmates in Canada
are still looking for full-time jobs.
Julia Rock, a neurological rehabilitation nurse at M.D. Anderson Cancer
Center in Houston, states the problem in blunt terms: "In Canada, I had a
lot of work, but I didn't have a career."
"A lot of people in Canada think we just come here for the money. They
didn't throw all kinds of money at me, but they did offer me unlimited job
opportunities," she said.
Ms. Rock, 49, returned to nursing in 1990 after a lengthy hiatus operating a
small business. A diploma nurse, she decided to get a university degree. She
juggled studies and work -- in home care and occupational health -- but was
frustrated by an inability to find work in her chosen field, oncology. So,
when U.S. recruiters went to McMaster University in Hamilton in 1997, Ms.
Rock listened and liked what she heard.
Today, she works at the top-ranked cancer hospital in the U.S. and is
studying for a master's degree in nursing at the adjoining University of
Texas. Ms. Rock's employer not only adjusts her schedule to accommodate
classes, but pays the tuition. "Any nurse who is interested in upgrading
her
education would love it here. In Canada, you have to kill yourself to work
and study," Ms. Rock said.
The veteran nurse loves her job and the environment but, as a liberal
thinker and a lesbian, she does not like the political climate in Texas. For
now, though, the professional is overwhelming the personal, and conditions
would have to improve markedly before she would consider returning to
Canada.
"When I talk to other nurses from Canada, the No. 1 issue is instability.
Right now, they're making promises -- things like full-time jobs -- but
nurses don't believe them. Here in the U.S., they deliver on the promises,"
Ms. Rock said.
Shirlee Sharkey, president of the Registered Nurses Association of Ontario,
said that to win back the thousands of nurses it has lost, Canada "must
earn
their return."
"Having once been burned by stop-go funding for nurses, they want to see
some assurances before uprooting themselves and their families to come back
home. When we can provide enabling, healthy work environments and a
consistent commitment to stabilizing and improving career choices for
nurses, nurses will respond," she said.
In a survey conducted by the nurses association, 78 per cent of expatriate
nurses said they would consider returning. But the respondents made clear
that they are looking for stable, full-time work, decent wages, job security
and support for education. (Only a tiny fraction of those surveyed cited
lower U.S. taxes and warmer weather as important factors.)
Ranny Watson, a patient-care co-ordinator in the orthopedics division of the
Methodist Hospital in Houston, says nurses still do not get enough respect
and recognition in Canada.
"I was downsized, right-sized and capsized. That's why I'm down here in
Texas," he said. Mr. Watson worked seven years as an operating-room nurse
in
Toronto. During that time, he never had a raise and, in fact, had his wages
rolled back. He was laid off in the summer of 1996, when health budgets were
slashed.
"I couldn't see myself on UI or welfare, so I came here," Mr. Watson
said.
Finding a job was cinch. Browsing a newsstand in Toronto, he picked up a
Houston Chronicle because it had so many job ads for nurses. Every résumé he
sent translated into an immediate, full-time job offer, and he opted for
Methodist, an ultramodern, non-profit teaching hospital. For four years, Mr.
Watson has had regular raises every four months. He works a steady day job,
no overtime and, next year, he will begin his master's studies, fully paid
by his employer.
"I have a lot of friends in Canada and they phone me up and say, 'We're
hiring again.' And I say, 'So what? What are you offering that I don't
already have?' "
Mr. Watson, 37, estimates that he would have to be paid $70 an hour in
Canada to have the equivalent wage. The top rate in Ontario is $30.50. He
has had job offers at other Texas hospitals that have included signing
bonuses of up to $25,000. In Canada, few institutions offer bonuses of more
than $1,500.
Rosalinda Santos, an operating-room nurse at Methodist, came to Houston in
1997. With three decades of experience, her job in Canada was safe, but the
workload was too much.
"I have a lot less stress here, and less responsibility. And the pay's
better," she said. Ms. Santos works permanent evenings, from 3 to 11 p.m.,
with no overtime. She works strictly on day-surgery orthopedic cases, such
as the repairing of torn knee ligaments.
"At my age [52], I don't want to be in the operating room for 8-12 hours
for
a heart transplant or brain surgery," she said.
Ms. Santos said she would return home to Brampton if that flexibility
existed.
With three years to go before retirement, however, she said her choice
doesn't really matter. But, she added, Canadians should ponder what her
daughter Karen, a first-year nursing student at Ryerson Polytechnic
University, will do.
~With the shortages, she can write her own ticket," Ms. Santos said. ~If
they don't make nursing more attractive for people in her generation, Canada
won't have any nurses."
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The Globe and Mail, Tuesday, February 27, 2001
Nurses hear the siren song of Canada. But it will take more
than flag-waving to bring them home, recruiters acknowledge.
By André Picard
HOUSTON -- 'I'm definitely coming home," Kathy Lozano said with a broad
smile.
After seven years of working in Texas, the veteran pediatric emergency nurse
has decided the time has come to return to Canada. She will likely work at
the Hospital for Sick Children in Toronto, after leaving her impressive
résumé with recruiters.
While Ms. Lozano has been pondering the move for a while, she made up her
mind definitely yesterday afternoon after attending a job fair in Houston,
where 40 Canadian health-care institutions have come to lure nurses back
home.
Having left Canada because she could get only casual work, Ms. Lozano heard
that the severe nursing shortage is forcing employers to pull out all the
stops.
She heard promises not only of permanent, full-time work, but paid
education, a competitive salary with the U.S., better patient-nurse ratios
and even $5,000 for relocating expenses.
But the real reason Ms. Lozano is heading north again is lifestyle. As the
mother of two young children, she wants to benefit from Canada's public
health- care and education systems and live in a peaceful, gun-free
community.
"They preach about family values in the U.S., but there is no support for
the family," she said. "The taxes don't scare me at all in Canada. We
will
get good schools, good health care, parks, clean air and safe streets. There
are so many benefits of living in Canada that the taxes are worth every
penny."
Her husband, Jeff, a Texan, is equally keen. "You guys don't know how good
you have it in Canada. It's the kind of place I want to raise my kids," he
said.
The enthusiastic response from the hundreds of nurses who visited the job
fair yesterday left Doris Grinspun beaming. The executive director of the
Registered Nurses Association of Ontario, which dreamed up the job fair,
said the event is a confidence booster because it proves that Canadian
health-care institutions can compete head-on with their wealthy U.S.
counterparts and win back nurses.
"We will do everything possible to win you back and then keep you
home," she
told a rapt audience. But Ms. Grinspun stressed that job fairs are not the
solution, that the key to making nursing an attractive career in Canada is
improving working conditions.
There are more than 20,000 Canadian nurses working in the U.S., and Texas
has recruited more of them than any other state. According to a RNAO survey,
virtually all the nurses who migrated south did so because they were laid
off or reduced to casual work, often juggling jobs at several institutions.
"There's nothing I can say about the way you were treated except that it
was
shameful," Ms. Grinspun said. "But I'm here to tell you it will never
happen
again. Nurses will not allow it."
By way of apology, recruiters rolled out the red maple leaf carpet. The
ballroom of the Houston Marriott Hotel was festooned with Canadian flags,
and most employers, wearing maple leaf name tags, were doling out
sentimental reminders of home including maple syrup, Cadbury chocolates (not
available in the United States except in specialty stores), CD-ROMs and
picture books of Canadian scenery, and peppering their discussions with
sentences ending in "eh." The only authentic touch missing was a Tim
Hortons
doughnut.
The taste of home struck a chord with Tonya Whitby, a cardiovascular
intensive-care nurse at Spring Branch Medical Center in Houston.
"I've been here five years and I'm still homesick," she said.
Ms. Whitby, pushing her one-year-old daughter Megan in a stroller, said she
came to the job fair out of curiosity but was bowled over by what employers
were offering. "I knew there were jobs back home, but not that many."
But the real attraction of heading home for her is being able to hold down a
good job and raise a family simultaneously.
Texas, like most U.S. states, has no paid maternity leave. (In Canada,
working parents are entitled to one year of Employment Insurance benefits
and many health-care facilities top up EI payments to as high as 90 per cent
of salary.)
When Ms. Whitby gave birth to Megan, she took only 12 weeks off, all of it
unpaid, and used up all her accumulated holidays and overtime in the
process.
"I'm not going to quit my job today, but they've definitely planted a seed
in my head," she said.
Tracy Badour, a human-resources consultant at Lakeridge Heath Corp., a
five-site facility anchored by the former Oshawa General Hospital, said the
purpose of the job fair was to network, to give nurses options to ponder,
not to resolve Canada's shortage instantly.
The fact that Lakeridge alone has 150 vacancies for nurses is indicative of
the breadth of the problem, but Ms. Badour said she would be more than happy
if the hospital ultimately attracted five nurses as a result of the Houston
event.
She also described the job fair as educational for Canadian recruiters. The
steady patrol of nurses with strollers demonstrated just how important it is
to stress family-friendly policies and for Canada to highlight its
strengths.
"Our good maternity benefits are an attraction," Ms. Badour said.
"And
there's not a single hospital in Canada that has a 'Leave your guns at the
door' sign. That definitely appeals to families."
Maricar Laranang, a rehabilitation nurse at the Methodist Hospital, said
that while she has a superb job in Houston, her personal life is a bust.
"I'm afraid to go out at night, and I really miss my family, so I'm really
lonely," she said.
After a couple of hours at the job fair, Ms. Laranang was almost certain she
would return home to Toronto. Eager to pursue a master's degree in nursing,
she was looking for an employer who would sponsor her studies and was
surprised to find several.
Keen to leave the hospital setting, she was particularly attracted to the
Workplace Safety and Insurance Board. With paid education, competitive
salary (ranging from $49,146 to $61,432 annually) and good benefits, Ms.
Laranang said it sounds like a dream employer.
"I left Canada in 1997 because I got laid off and the only place I
could find a job was in an oral surgeon's office where I didn't even feel
like a nurse," she said. ~Suddenly, it looks like you can be a nurse in
Canada again."
Patricia Jappy-Loker, the nurse-recruiter at Halton Healthcare
Services Corp. in Oakville, said that nurses have to realize that, because
of shortages, ~everything is on the table, everything is negotiable."
And while getting new nurses in the door is a challenge, a bigger
one is retaining them.
"When the U.S. employers here about this job fair, they're going to
get out the chequebooks," she said. ~So even if we had a good day, if we
attracted some nurses back home, we can't be satisfied. We have to keep
improving the work environment for nurses."
Nursing America
A comparison of the nursing industry in Canada and the United States
NURSING: A CANADA-U.S. Comparison
| Number of Nurses | ||
| Year | CANADA | U.S. |
| 2000 | 228,450 | 2.7 million |
| 1994 | 234,393 | 2.5 million |
| per cent change | - 2.5 | + 5.4 |
| per 100,000 population - 2000 748 650 per 100,000 population -1994 764 642 |
||
| RNs employed in nursing |
89 per cent | 82 per cent |
| Average age - 2000 |
43 | 43 |
| Average age - 1994 |
41 | 42 |
| Per cent under age 35 |
22 | 18 |
| Per cent over age 50 |
27 | 31 |
| Average wage - 2000 |
n/a | $46,782 |
| Average wage - 1997 |
$36,876 | $42,071 |
| Average wage - 1988 |
$31,200 | $28,383 |
| Education of nurses | ||
| diploma | 76 per cent | 68 per cent |
| baccalaureate | 22 per cent | 29 per cent |
| Master's/PhD | 1.7 per cent | 3 per cent |
| Age at graduation |
32 | 30 |
| full-time - 2000 | 51 per cent | 72 per cent |
| full-time - 1996 | 55 per cent | 71 per cent |
| women |
96 per cent | 94 per cent |
| men | 4 per cent | 6 per cent |
| where nurses work | ||
| - hospitals | 62 per cent | 59 per cent |
| - community health | 15 per cent | 28 per cent |
| - nursing homes | 12 per cent | 7 per cent |
| - education | 2 per cent | 2 per cent |
| - other | 9 per cent | 4 per cent |
Sources: Canadian Institute for Health Information, Canadian Nurses
Association, U.S. Bureau of Health Professions, American Nurses Association
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