Introduction

Over the last few years, there has been a marked shift in the duration of stay for practitioners in the nursing profession in Canada – more so in Ontario. As a profession premised on among other responsibilities, the care for the ill and the advancement of health in the community, the high rates of nurses’ turnover are worrying not just for Ontario residents but also for Canada as a nation. In this assignment, the focus is on the causes of the high rates of turnover in the nursing profession in Ontario, and why the issue is difficult to resolve. Additionally, the paper proposes some possible ways through which the issue can be addressed and resolved.

The High Rate of Turnover in the Nursing Profession

Alameddine, Baumann, Laporte, Mourad, Onate and Deber (2014) point out that the Canadian province of Ontario has been lagging behind other jurisdictions regarding the number of nurses employed. To pile on to these low numbers in the high rate of turnover in the profession. While the rate of nurses’ turnover in Canada as a whole stands at 19.9%, as Winsa (2013) notes, Ontario records far higher figures on the same metric – as high as 25% or higher. Already with the lowest number of nurses per capita in the entire nation, Ontario has just 703 registered nurses for every a hundred thousand citizens while the national average is 839 registered nurses (RNs) for every 100,000 people, the Registered Nurses Association of Ontario (2017) points out. The number of practical nurses (PNs) in the region, which stands at 235 for every 100, 000 residents, also lags behind the national average, despite a slight increase in their numbers over the first half of the decade, indicates Registered Nurses Association of Ontario (2017). To further compound the problem, the number of the health professionals has been reducing year on year, with a decline of slightly more than 1.125% in the year between 2015 and 2016 in the number of RNs in the region (Registered Nurses’ Association of Ontario, 2017). Costing the Canadian healthcare system as much as $25,000 for every nurse (in the direct and indirect labor costs incurred as a result – according to Chiu, Chung, Wu & Ho, 2009), the high rates of turnover need to be addressed, With the possibility of compromising patient care, there is an urgent need for the Canadian national government, in collaboration with the authorities in Ontario to address the issue, considering that the population of the province (and by extension the nation) is aging, and thus the need for nurses shall increase (Winsa, 2013).

Causes of the High Turnover of Nurses in Ontario

Many reasons can be advanced for the high rate of turnover in the nursing profession in Ontario.

Social & Cultural Reasons

Among the reasons for the high turnover of nurses in Ontario are social and cultural reasons. In this regard, there are factors such as the relationship between nurses and their supervisors. Considering as Warren (2018) notes, that nurses are often placed under the supervision of technocrats who specialise in management rather than healthcare, the relationship between the two cadres of employees may be strained and thus lead to higher rates of turnover. Further, the relationship between the nurses themselves may also lead to higher rates of turnover in the profession, particularly if such relationship is strained. In Ontario, this factor is most likely a reason for the high rate of nurse turnover, drawing from the position of Cicolini, Comparcini and Simonetti (2014), due to the strain and the workload that each nurse has to bear because of the severer shortage of nurses in the region than in the rest of Canada.

Lack of proper social support for the nurses, as Boamah & Laschinger (2015) advance, may also be a factor that contributes to the high turnover of nurses in the Ontario region of Canada. To this end, nurses in fulfilling their roles, need the support of the communities in which they work to effectively perform their duties and post greater satisfaction with their jobs. In the absence of such social support, they are likely to consider leaving their jobs, Chiu, Chung, Wu & Ho (2009) so posit. In Ontario, due to the little social support they receive in terms of community health initiatives and social betterment programs, the nurses tend to witness lower levels of job satisfaction; a fact that then results in higher turnover rates among nurses in the province, Baumann, Hunsberger, Crea-Arsenio, Akhtar-Danesh and Alameddine (2018) allude.

Political Reasons

Healthcare is a function of the government and thus is influenced by political policies, Daniels, Laporte, Lemieux-Charles, Baumann, Onate and Deber (2012) confirm. In Ontario, the high rate of nurse turnover can, therefore, be linked to some political reasons. For one, the failure of the regional government of Ontario to enact policies and legislation that are aimed at improving the healthcare system – such as those that can help retain nurses, enhance the welfare of such nurses and provide better working conditions for them – can be cited as a contributor to the high rate of nurse turnover, agree Daniels, Laporte, Lemieux-Charles, Baumann, Onate and Deber (2012). This is because, in the absence of such frameworks, the nurses are overburdened with the responsibilities of work and hence opt to seek greener pastures elsewhere in Canada or even beyond. Secondly, the lack of commitment to the welfare of the nurses (as expressed in the failure to hire more nurses and hence reduce the overall workload for each) can be fronted as a reason for the high nurse turnover in Ontario. In such regard, Registered Nurses’ Association of Ontario (2017) points out that Ontario has 19.5% less nurses than the entire nation – a problem that should, and can only, be solved through political action.

Economic Reasons

Healthcare costs across Canada, just like elsewhere in the world, are increasing due to a myriad of factors. With this rise in the cost of healthcare, there continues to be the need for the managers of healthcare institutions to cut costs where possible, as Baumann, Hunsberger, Crea-Arsenio, Akhtar-Danesh and Alameddine (2018) assert. For this reason, therefore, there has been a slowdown in the hiring of the different classes of nurses in Ontario, mainly registered nurses. This is because as Winsa (2013) highlights, while Registered Nurses (RNs) tend to earn upwards of $30 per hour, Registered Practical Nurses (RPNs) earn lower than $25 per hour. Even the RPNs are not hired as based on demand – considering the ageing population of Canada – but based on economic considerations. This has resulted in a more significant workload for the nurses in Ontario hence the higher rates of turnover in the nursing profession in the province, Baumann, Hunsberger, Crea-Arsenio, Akhtar-Danesh and Alameddine (2018) posit.

Barriers to Resolution of the Problem

As an issue that affects the healthcare providers in the Ontario region, the high rate of nurses’ turnover needs immediate attention and quick resolution. Such is however difficult to resolve for some reasons. First, the arduous nature of politics – especially those revolving around healthcare – complicate the passage of legislation to improve working conditions for the nurse in the region, Baumann, Hunsberger, Crea-Arsenio, Akhtar-Danesh and Alameddine (2018) write. Secondly, the comparatively better working conditions for nurses in other regions contribute to the problem as more nurses prefer to work in the facilities that have comparatively better working conditions, Daniels, Laporte, Lemieux-Charles, Baumann, Onate and Deber (2012) write. This, therefore, means that more nurses only work in the Ontario healthcare system to gain the requisite experience, as Boamah & Laschinger (2015) reason, before seeking better conditions in other regions of Canada and even beyond. Finally, the budgetary constraints in Ontario compound the difficulties of the Ontario health care system to embrace community health initiatives that improve overall health indicators, Winsa (2013).

Strategies for Resolution

High rates of nurse turnover in Ontario could be addressed through various strategies. For one, the improvement of working conditions for the nurses, as Cicolini, Comparcini and Simonetti (2014) advice, would go a long way in helping improve the retention of the professionals within the Ontario healthcare system. It would offer them an incentive to stay in the region’s hospitals and healthcare facilities. Second, going by the advice of Boamah & Laschinger (2015), increasing the budgetary allocations to the healthcare sector in Ontario would help address a number of the staffing problems witnessed (which also contribute to the high nurse turnover rates.  Third, through the enactment of policies and legislation aimed at improving preventive health initiatives and community health improvement undertakings, the problem of high nurse turnover would be solved, as the workload of such nurses would be reduced, Daniels, Laporte, Lemieux-Charles, Baumann, Onate and Deber (2012) write. Still on that note, the hiring of more nurses to help plug the deficit, would also be helpful in reducing the turnover rates of nurses in Ontario by lightening the workload that each nurse has to bear thus increasing retention rates in the profession, Alameddine, Baumann, Laporte, Mourad, Onate and Deber (2014) suppose. Finally, improving the management of hospitals in the Ontario region by employing trained healthcare professionals as managers and supervisors may also go a long way in helping improve the working conditions for nurses (by improving the management – workforce relationship), as Cicolini, Comparcini and Simonetti (2014) claim, and thus reduce the high rates of turnover.

Conclusion

With the worst rates of nurse turnover in Canada, Ontario’s healthcare system needs immediate remedial action if it is to function correctly. Barriers to the resolution of the problem, including economical considerations, the inadequacy of political goodwill and the budgetary constraints all need to be addressed to help save the Ontario healthcare system – which like all other healthcare systems, is much dependent on the nursing profession. Strategies such as increasing the budgetary allocations to the healthcare sector, improving the working conditions for the nurses, hiring more nurses, and employing nursing professionals as supervisors could help reduce the high rates of turnover in the profession in Ontario Province.