1. Nursing Health Services Research Unit 1 Nursing Human Resources: A Contribution to Health Andrea Baumann, RN PhD Mabel Hunsberger, RN PhD Mary Crea-Arsenio, MSc. Presented at 10th Conference of the Global Network of WHO Collaborating Centres for Nursing and Midwifery Coimbra, Portugal July 23-25, 2014

2. Nursing Health Services Research Unit Background to Policy Healthcare restructuring (1990s): –Increase in the casualization of the nursing workforce –Decreased supply of registered nurses (RNs) and registered practical nurses * (RPNs) Early evidence identified an increased trend of part-time and casual employment SARs outbreak highlighted issues associated with casualized nursing workforce 2

3. Nursing Health Services Research Unit Total RN Workforce 1994-2013 (Source: CNO, 2013) Date of renewal counts reflects members who renewed at the end of the previous calendar year (e.g. 2012 data represents members who renewed at the end of 2011 for the 2012 practice year). Source: College of Nurses of Ontario (CNO), 2013. 3 83% of RNs are employed in nursing

4. Nursing Health Services Research Unit Total RPN Workforce 1994-2013 (Source: CNO, 2013) Date of renewal counts reflects members who renewed at the end of the previous calendar year (e.g. 2013 data represents members who renewed at the end of 2012 for the 2013 practice year). Source: CNO, 2013. 4 80% of RPNs are employed in nursing

5. Nursing Health Services Research Unit Evidence for Policy 5 Source: MOHLTC 1999, 2004, 2006, 2007; Nursing Task Force, 1999; Naylor, 2004; Baumann et al., 2006. Nursing Enhancement Fund 70% Full-Time Commitment New Graduate Initiative Nursing Graduate Guarantee 1999200520072004-2006 Evidence Good Nursing Good Health Report (Nursing Task Force, 1999) Final Report on SARS (Walker, 2004) Educated and Underemployed (Baumann et al., 2006)

6. Nursing Health Services Research Unit NGG Sequence Six months of funding  Online employment portal (HFO * Jobs) facilitates matching between employers and new graduates  Employer provides a temporary supernumerary FT position with extended orientation/mentorship  Employer transitions new graduate into FT permanent position 6 *HFO = HealthForceOntario. Source: Ministry of Health and Long-Term Care (2011). Guidelines for participation in the Nursing Graduate Guarantee.

7. Nursing Health Services Research Unit Evaluation Study- Objective The objective of this study was to evaluate the impact of a targeted government initiative created to increase full-time employment of new graduate nurses. 7

8. Nursing Health Services Research Unit Supply of Ontario New Graduate Nurses (Source: MTCU, 2013) 8 Source: Baumann et al., 2013; MTCU, 2013.

9. Nursing Health Services Research Unit 9 Source: MOHLTC, unpublished NGG program data, 2012. New Graduate NGG Participation (RN and RPN) Over six years, a total of 14,395 new graduate nurses obtained an NGG position (11,132 RNs and 3263 RPNs).

10. Nursing Health Services Research Unit Labour Demand: Profile of Ontario Healthcare Employers 10 *The total number of employers is an approximate number based on healthcare employers who have registered on the HealthForceOntario Jobs website. This number may include organizations that do not employ nurses. Source: MOHLTC, 2012.

11. Nursing Health Services Research Unit 11 Employer NGG Participants by Sector Source: : MOHLTC, unpublished NGG program data, 2013. Sector Fiscal Year of NGG 2007/082008/092009/102010/112011/122012/13 Hospital979110610496103 Long-Term Care876486999482 Community and Other 382032272229 Total222175224230212214* *On average, 18% of all employers participate in the NGG each year

12. Nursing Health Services Research Unit RN New Member Working Status 2005-2013 (Source: CNO) 12 Source: CNO, 2013.

13. Nursing Health Services Research Unit RPN New Member Working Status 2005-2013 (Source: CNO) 13 Source: CNO, 2013.

14. Nursing Health Services Research Unit Changing Employment Practices Stakeholder Analysis 14

15. Nursing Health Services Research Unit Findings 1.HHR Planning: Employers use the NGG funding to integrate new graduate nurses into their annual human resource planning. 2. Employment Portal: Portal was designed as a centralized online system where employers can recruit new graduates to meet their specific HR needs. 15

16. Nursing Health Services Research Unit Findings 3. Full-time Employment: Six month subsidy gives employers time to integrate new graduates into their organization and fulfill their HR needs. For new graduates, the opportunity for six months FT employment is essential for them to gain the experience they need to practice independently. 4. Quality and safety: Six-months supernumerary allows new graduates time to build confidence, comfort and competence to practice safely. 16

17. Nursing Health Services Research Unit Conclusions Underemployment of new graduates leads to instability of the nursing workforce and consequences for the delivery of quality care globally. Incentive funding can impact employment patterns of new graduate nurses and employment practices of employers. 17

18. Nursing Health Services Research Unit Contact Andrea Baumann, RN PhD Scientific Director Nursing Health Services Research Unit McMaster University Michael DeGroote Centre for Learning MDCL 3500 (905) 525-9140 ext. 22581 baumanna@mcmaster.ca 18