April 24 2021 COVID-19 report


Dear Colleagues: Welcome to our Saturday, April 24 report during this fifteenth month of COVID-19 in Ontario. You can find earlier update reports here, including thematic pieces in Doris’ COVID-19 Blog. And, for the many resources RNAO offers on COVID-19, please visit the COVID-19 Portal where you will also find RNAO media hits and releases on the pandemic here. Daily Situational Reports from Ontario's MOH EOC can be found here. As always, feel free to share this report and links with anyone interested. Scroll down for information on several webinars in the next few weeks.

In today’s report we share the following: (1) a new emergency regulation on scope of practice; (2) a big thank you to the 429 critical care RNs that have already registered with VIANurse and call on any additional available critical care nurses to consider joining the matching portal; (3) urgent call for paid sick time and for the premier of Ontario to do the right thing; (4) reaction to the federal fiscal budget through a media release; and (5) invitation to visit and provide feedback on RNAO’s new policy website.  


New emergency regulation regarding scope of practice

The Ontario government issued on April 21 an emergency order addressing regulated health professions in hospitals (here). The College of Nurses (CNO) has provided a message here and and update here. Under this new government order, health professionals from Ontario or other Canadian jurisdictions – including nurses – are authorized to engage outside of their regular scope of practice provided that doing so is necessary in order for the health care professional to respond to, prevent, or alleviate the effects of the COVID-19 outbreak. This new order applies only to health professionals working in hospitals.

The changes enacted by the nurses’ regulatory body (CNO) means that an RPN, RN, NP or other health professional in a hospital can be asked to perform tasks outside their scope of practice. While RNAO understands the direness of the situation, we are concerned about the safety of patients and the impact it will have on the nursing profession. RNAO is cautioning that this emergency order should not be used to push forward permanent changes to scope of practice after the pandemic crisis passes. Government and the CNO have tried to address the long standing crisis of care in Ontario due to its lowest RN per population in Canada by promoting deskilling of nursing work.

There is also the issue of disciplinary action against a nurse for errors while performing outside their scope of practice. The government regulation stipulates that “a member of a College continues to be subject to the jurisdiction of the College for incompetence” in that situation. The College says that “CNO always considers the context in which you must provide care when we are assessing concerns that we may receive.”  


COVID-19 VIANurse – Critical care nurses

RNAO continues to act swiftly on our commitment to Ontarians and our health system during the COVID-19 pandemic. With the record-high daily COVID-19 cases surpassing 4,000, RNAO activated VIANurse to augment nursing HR in critical care.

A survey was sent out starting on April 14, 2021 to RNAO’s RNs and NPs. As of April 23, 429 RNs and NPs have indicated their availability to help in critical care.

As of April 23, 27 hospitals have requested critical care RNs/NPs from VIANurse to augment their HR. All 27 facilities have been responded to within a day. A second call was also sent out for 10 facilities as more RNs/NPs filled out the survey. Other than for 3 hospitals where we are not aware of applications from survey respondents, all others have received applications. We are aware that 68 RNs/NPs have applied to the postings sent to them. About half of the hospitals have hired or are in the process of hiring these nurses.

Huge thanks to our RN and NP colleagues coming forward. Also thank you to the inspiring CEOs, CNE and HR personal for your kind messages of thanks. We salute you for your unwavering commitment, expertise and resilience to care for very ill patients in the most challenging conditions. As RNAO has said before and will continue to say: It didn’t need to be this way had the government followed the science table recommendations. Health organizations and us all must continue to be focused and resilient to help front line staff and through them Ontarians in dire need.

With the provincial government’s expansion of ICU beds across Ontario, there is an urgent need for additional RNs and NPs to provide care to more and more patients. Thus, we are asking again those of you with experience and competency in the provision of critical care health services, who are not currently working in these settings, or who can increase their hours, to support the increased demand. The need is immense across the province and we urge you to step forward, if you can.

Critical Care Nurses: Please CLICK HERE to complete our critical care survey if you are:

  • available, and
  • registered in a practicing class with the College of Nurses of Ontario (CNO) as an RN or NP in good standing, or
  • register with the College of Nurses of Ontario (CNO) through the Emergency Assignment Class which was opened on April 19, 2021. There is no fee to register in this class. Also included is the link to Reinstatement.

How does it work? When employers in your area need critical care nurses we will let you know. You will discuss directly with the employer regarding application, hours of work, compensation, etc.

Employers: Employers who need critical care nurses can fill out this FORM. RNs and NPs in your geographical area will be connected to your hiring personnel via email for you to take it from there regarding application, hours of work and compensation etc.

Please note that VIANurse is only focused on critical care. For other staffing needs, nurses and employers should access RNCareers.ca, RNAO’s job board since 2005. If there are questions, please contact Daniel Lau, Director of Membership & Service at dlau@rnao.ca.


RNAO statement on paid sick days - Do what must be done, premier!


Media release, April 20, 2021


With the musings in the media a few days ago that the Ford government was discussing paid sick days, we at the Registered Nurses' Association of Ontario (RNAO) issued a statement urging the provincial government to move immediately with paid sick days and disclose the details. "This is a critical public health measure that RNAO and many others have been advocating for since the beginning of this pandemic. At this time of dire crisis any delay is causing undue hardship and costing more lives," says RNAO's CEO Dr. Doris Grinspun.

RNAO will continue to urge Premier Ford's government to:

  1. Close down all non-essential workplaces. Non-essential workers need to be financially supported through this crisis and essential workers need paid sick leave.
  2. Lock the province down and prohibit movement from one region to another.
  3. Deploy nurses, physicians, pharmacists, dentists, paramedics, and every other health-care worker willing and able to vaccinate. Mobile units – including home care nurses – should be urgently deployed to essential workplaces and hot spot communities. And everyone 16 and up should be deemed eligible for vaccination.

"The response to the tidal wave of COVID-19 transmission needs to be simple and done with speed. There is no time left for logistical logjams and delays. Every delay puts more lives at risk and threatens the collapse of our intensive care units (ICU)," adds Grinspun. It has been many days since the Ford government, including the premier, have been announcing a paid sick day program. Yet, nothing has happened and precious lives continue to be lost – 189 Ontarians succumbed to COVID19 during the last week with NO action from the government. Promises do not save lives – actions do. Please RT urgently this tweet. We also urge you all – nurses, other health-care workers and members of the public – to sign our Action Alert. Tell the premier to do what must be done! Please sign right away here.


RNAO applauds Ottawa’s pandemic role and child care proposal, wants faster action on national standards for long-term care and new funding for pharmacare

In the wake of the federal fiscal budget, RNAO issued its response through a media release on April 21.

The federal government's budget contains progressive measures that address social determinants of health such as child care, affordable housing, infrastructure funding for Indigenous communities and a $15 minimum wage. It also pledges to continue programs that have lessened the socio-economic impacts resulting from the pandemic, especially on those most vulnerable. It does not move fast enough on national standards for long-term care (LTC) and offers no progress for a national pharmacare program.

The Registered Nurses' Association of Ontario (RNAO) says promises outlined by Finance Minister Chrystia Freeland are welcome and, if realized, will help individuals and families, especially those who have experienced the cracks of inequity aggravated by the COVID-19 pandemic.

"A $15 minimum wage – championed by nurses in Ontario – sends a strong message and creates pressure for the provinces to do the same. Of major importance is the commitment to affordable and accessible child care. Nurses are among those who know the challenges of finding reliable care for their families," says RNAO CEO Dr. Doris Grinspun. "We know how the economy has been impacted by the virus and that is precisely why those affected by the downturn need help the most," adds Grinspun, acknowledging the ongoing need for federal pandemic subsidy programs for wages and rent.

RNAO praised Ottawa's $6 billion five-year commitment to Indigenous communities for infrastructure projects for clean water, housing and other projects. Access to safe drinking water is a basic human necessity, and it is shameful there are still children in our country that have never been able to drink water from their taps," Grinspun says. 

Improvements in long-term care (LTC) are critically important. RNAO is pleased to see $3 billion dedicated to improving the lives of residents, over five years, starting in 2022-23 – although the hope was for immediate investment. "This promise came after the first wave of COVID-19 and the urgency for residents has only grown. What message are we sending to the families of more than 15,000 LTC residents who died of COVID-19 across Canada – including 4,409 in Ontario," asks Grinspun. She says RNAO will "actively contribute to the Health Standards Organization and Canadian Standards Association on development of national standards to improve the quality of life in LTC." RNAO's expert work on evidence-based clinical guidelines for nurses and other health-care workers will help advance national standards. So will the association's Nursing Home Basic Care Guarantee, which models a minimum of four worked hours of direct nursing and personal care for each resident per day.

RNAO is disappointed that the budget failed to outline next steps and new funding for the government's long promised national pharmacare program. "Access to medicine is a human right. Every developed country in the world with universal health-care coverage includes pharmacare. No one, especially in these precarious economic times, should have to make a choice between getting a prescription filled and putting food on the table or paying the rent," says RNAO President Morgan Hoffarth. "We can and must do better on advancing pharmacare."

The pandemic has also highlighted public policy failures involving all levels of government – the decade-old opioid overdose crisis and a crisis of even much longer duration, homelessness. The budget does little to respond to the devastating impacts of either crisis. In spite of a 74 per cent increase in opioid-related deaths last reported on September, 2020, the federal government continues to respond with helpful but insufficiently funded measures.

RNAO commends the investments in affordable housing but would have liked to see faster and higher amounts, for "Reaching Home," the federal government's homelessness strategy. "The pandemic has reinforced the importance of having a place to call home and respecting housing as a human right. Any recovery from the pandemic must be a recovery for all because housing is a fundamental determinant of health," says Hoffarth. She adds that across the country, more than 250,000 people have no place to call home – a reality that puts them at great risk of illness and disease.

RNAO says more attention must be made to the revenue side of the budget. While we welcome the budget's proposed luxury taxes, they are not sufficient to fund the important measures required to ensure greater health equity in Canada. RNAO calls on the federal government to implement an annual wealth tax and an inheritance tax, more resources to fight those who engage in tax avoidance and tax evasion, and other measures to ensure that there is a fairer distribution of the enormous wealth generated by the Canadian economy. This includes implementing the planned digital services tax sooner and at a higher rate than announced by Minister Freeland.


RNAO launches new policy webpages

RNAO’s Policy Department, under the direction of Matt Kellway, in partnership with our Communications and IT departments, is in the process of launching a brand-new policy website that will substantially enhance our outstanding policy work. Thanks to Matt for this update!

We’re not done. But we are well on our way to communicate RNAO’s policy work in a more accessible way on our website. Please take a look.

RNAO has a vision for our health system. The Association wants a publicly-funded/not-for-profit, integrated, accessible, equitable and person-centred health system to serve and support the health and well-being of all Ontarians. Our job in the policy department is to shape public policy towards that destination. We want our new webpages to set that vision out clearly, to explain where we are in relation to our destination, to show what we’re doing to reach that destination and, very importantly, to provide nurses and others with an opportunity to join us in our efforts to reach that destination.

Whether you’re using a desktop or your phone, when you come to RNAO’s policy pages here’s what we want you to see. Firstly, we want you to see what you can do to help us all get closer to the health system that we envision. Our pages are, first and foremost, about making action easy.

If you need to be convinced that the action that we’re encouraging is the right action or the necessary action, we want the support for that action to be close at hand. That begins with a scorecard. That scorecard is currently under construction as data sources struggle with data collection through the pandemic. When complete, however, RNAO’s scorecard – to appear on our policy landing page – will assign a grade to the performance of our health system corresponding to each of our five areas of (policy) focus or “policy buckets”: nursing policy; care delivery; social determinants of health; environmental determinants of health; and fiscal capacity.

Our scorecard will be informed – in large part but not exclusively – by dashboards containing key performance indicators corresponding to each of our five areas of policy focus. Those dashboards are nearing a state of completion though, at present, they are compromised by the COVID-related lags in data collection and publication. However, you can get a good feel for the finished product if you go here to our recently published fiscal capacity dashboard. The fiscal capacity dashboard puts Ontario spending – program spending, generally, and health, specifically - and revenues in the context of its historical trends and in the context of jurisdictions across the rest of Canada.

While the dashboards correspond to our five policy buckets, the issues we take on cut across areas of focus and are informed, inevitably, by more than a single dashboard of indicators. Our fiscal capacity dashboard tells us, in a nutshell, that the Ontario government has a revenue problem and not a spending problem. When you take a look at our nursing dashboard and see that Ontario continues to have the lowest RN per capita ratio in Canada, you can begin to see the evidence and rationale in support of RNAO’s call, year-after-year, for increasing RN and NP resources in our health system. Sadly, there is little surprise that we are short of nurses in ICU and other critical care areas, as these must all be RNs.

You can find the call for increased nursing resources in our fiscal capacity issues page.  It comes in the form of our provincial pre-budget submission. All issues for which we have ongoing advocacy, supported by policy work, will have a corresponding issues page. Visitors to our webpages will be able to identify in quick order what issues RNAO is tackling and championing, what’s keeping our board, assembly of leaders, and policy team busy and what actions members and others can take to advance these issues. At the moment, we have published six issues pages. In the very near future visitors will see new pages dealing with environmental determinants of health and anti-Black racism in the nursing profession, including the tremendous work of RNAO’s Black Nurses Task Force.

We invite you to visit our new webpages. We hope it will give you a deeper understanding of RNAO’s policy work -- what we do, how much we do and why we do what we do. We hope it will inspire you to take action and join us in our ongoing efforts to shape the health system as we keep pushing toward an Ontario that provides the conditions for the health and well-being of all Ontarians.  We would love to hear your feedback – please contact Matthew Kellway <mkellway@rnao.ca>.




Webinar: Continuing the Conversation - An Open Forum for Nurses

Apr 28, 2021, 2:30pm - 4:00pm

RNAO is aware nurses across Ontario – especially those working on the frontlines of COVID-19 – are experiencing tremendous levels of physical and emotional stress and burnout. We know this can affect your mental health and wellbeing at this challenging time and that you may have less time to devote to your own self care.

During these biweekly open forums, RNAO facilitates discussions and holds breakout sessions for participants to discuss themes identified in the previous forums, such as dealing with multiple losses, taking care of yourself, burnout and more.

All RNs, NPs, RPNs and nursing students – in all roles and sectors – are invited to participate. You may wish to share how things are going for you or you can simply join and listen in.

Visit our COVID-19 Portal for additional resources and information on psychosocial support.

Next session: April 28, 2021. Stay tuned for details.



Webinar: COVID-19 Webinar Series

May 10, 2021, 2:00pm - 4:00pm

RNAO's CEO Doris Grinspun hosts the COVID-19 webinars for health providers.

Topics include:

  • updates on COVID-19 and the health system: latest news and pressing issues;
  • guest speakers (as available);
  • questions and answers; and
  • calls to action.

Health providers from Ontario, Canada, and anywhere in the world are welcome to join.

Upcoming webinars:

May 10, 2021, 2 - 4 p.m. ET
Register now

June 14, 2021, 2 - 4 p.m. ET
Register now

July 12, 2021, 2 - 4 p.m. ET
Register now

You can watch our April 12, 2021 webinar on Wave three: Update, advocacy and what's next?:

Ontario is now in the third wave of the COVID-19 pandemic. During this webinar, Dr. Doris. Grinspun, RNAO's CEO, and colleagues provided an update on how the third wave is affecting nurses and Ontarians. Hear how RNAO, together with members and allies, are advocating for immediate actions to save lives, and long-term actions to right wrongs and establish justice for all. Learn about the next steps and how you can help shape the trajectory of this devastating virus and its variants.

Watch the webinar here.

Watch earlier webinars here.



Webinar: Let’s Talk about Anti-Black Racism and Discrimination in Nursing

May 17, 2021, 2:30 - 4 p.m. ET

Topic: An intergenerational conversation: Addressing anti-Black racism


  • provide a deeper awareness of anti-Black racism's impact in the 21st century;
  • begin to bridge the generational gap within nursing through social justice; and
  • identify practical action steps for measurable and transformational outcomes using a millennial lens.


  • Nadia Prendergast, RN, LCCE, PhD, Assistant Professor at York University and Childbirth Educator at Mount Sinai Hospital
  • Leanne Prendergast, MSc, President and Co-Founder of Love our Lives

This is a monthly webinar series designed for nurses interested in receiving updates on RNAO’s Black Nurses Task Force and to engage them in meaningful conversations that will inform the work of the Task Force. The Black Nurses Task Force has a mandate to tackle anti-Black racism and discrimination within the nursing profession. Read more here.

Register for the May 17 webinar here.

You can watch the April 19, 2021 webinar on Recruiting, retaining and advancing Black nurses.

The objectives:

  • generate awareness on the underrepresentation of Black nurses in leadership and executive roles in health care;
  • describe strategies to incorporate equity, diversity and inclusion in hiring processes;
  • explore best practices and effective strategies for recruitment, retention and advancement of Black nurses; and
  • identify the meaning of sponsorship and its value in the progression of Black nurses.


  • Ingrid Wilson, CHRL, CMS, GridFern Strategic HR
  • Josephine Etowa, PhD, RN, RM, FWACN, FAAN, Professor, OHTN Chair in Black Women’s HIV Prevention and Care in Health Sciences, University of Ottawa
  • Suzanne Charles Watson, Program Manager, Equity, Diversity and Inclusion, SickKids Research Institute

Watch on YouTube here

RNAO's slides for April 19 webinar
Ingrid Wilson's slides 
Josephine Etowa's slides
Suzanne Charles Watson's slides     



Mark your calendar: 96th Annual General Meeting (AGM)

Jun 24, 2021, 2:00pm - Jun 26, 2021, 1:00pm

RNAO’s 96th AGM will be held virtually on June 24 - 26, 2021. Details on how to join the live streamed events will be posted in early June.

View the schedule of events and register now!

For a recap on last year's virtual AGM, please visit our AGM portal.  



MOH EOC Situational Report

We are posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you can access the Ministry’s guidance at any time.

For a more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.

Here is a segment from the Situation Report #415 for April 23 (no report on April 24):


Case count as of April 23, 2021 / Nombre de cas le 23 avril 2021

Area / Région

Area / Région

Change from yesterday / Changement par rapport à hier

Deaths / Décès

Change from yesterday / Changement par rapport à hier


1 155 834

+ 8 371

23 822

+  59


437 310

+ 4 505

7 863

+  34



  • A guidance document to accompany CMOH Directive #2 issued April 19, 2021 is here and here to provide clarification on the intent and purpose of the directive.
  • Directive #3 for Long – Term Care Homes under the Long – Term Care Homes Act, 2007 has been updated and is here. It will be available shortly in French and English on the Ministry’s website.
  • Ontario Confirms First Case of Rare AstraZeneca-linked Blood Clotting. Today, Dr. David Williams, Ontario's Chief Medical Officer of Health, issued the following statement on the province's first confirmed case of vaccine-induced immune thrombotic thrombocytopenia (VITT) in a patient after receiving the AstraZeneca/COVISHIELD vaccine: "We have confirmed the first case of the rare blood clotting condition known as vaccine-induced immune thrombotic thrombocytopenia (VITT) in Ontario. The patient is a male in his 60s who had received his first dose of the AstraZeneca/COVISHIELD vaccine. The patient has received treatment and is recovering at home. Additional details will not be publicly released to protect the patient's privacy.”


Staying in touch        

Keeping in touch is now more important than ever. Feeling that you are part of a community and that we have your back will help you get through this challenging time. We are also eager to hear from you how we can best support you. Send to us your questions, comments, and challenges. Feel free to also recommend ideas for future webinars. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten email: pgbatten@rnao.ca. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you all for being there for our communities – everywhere and in all roles! Together, in solidarity, we are stronger and more resilient. These continue to be tough times and we have to reach out to one another in solidarity! Our government, the public and indeed all health professionals – must keep focused. There is hope at the end of this long tunnel. Vaccines are being delivered in large quantities and now we need to fasten the rollout! Hugely important is to continue fighting the spread of the virus to preserve lives. To everyone and most especially our colleagues working in the front lines here at home and in countries around the world hit hard by evil COVID-19 – THANK YOU, and please take care of yourselves and know that RNAO always stands by you!

As we have said before, the silver lining of COVID-19:  Coming together and working as one people – for the good of all!

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, FCAN, O.ONT
Chief Executive Officer, RNAO



17 April - Vaccine engagement as a tool to address marginalization and exclusion – go here.

17 April - Here's how the COVID-19 pandemic could play out in 2021 and beyond – go here.

17 April - Reacting to the latest Ontario government public health measures – go here.

10 April - RNAO and NAN sign Relationship Accord to improve health across NAN Territory – go here.

10 April - RNAO media release on public health measures and vaccination rollout – go here.

10 April - 3 ways to vaccinate the world and make sure everyone benefits, rich and poor – go here.

3 April - Government’s “shutdown” announcement doesn’t go far enough – go here.

3 April - RNAO’s continuing media profile: The March reportgo here.

27 Mar - Provincial budget fails to deliver urgent nursing investments to care for Ontarians – go here.

27 Mar - Government's reopening plan threatens the health of Ontarians – go here.

20 Mar - Preliminary results of RNAO‘s Work and Wellbeing Survey – go here.

13 Mar - Getting it right – go here.

13 Mar - RNAO leads dozens of organizations in candlelight vigilgo here.

6 Mar - RNAO’s continuing media profile: The February report – go here.

6 Mar - Communication during a Pandemic: How we can endure the pandemic togethergo here.

6 Mar - Webinar: Understanding wellness in Indigenous wisdom traditions for caregivers – go here.

27 Feb - RNAO celebrates Black History Month 2021 – go here.

27 Feb - RNAO’s 21st annual Queen’s Park Day goes virtual – go here.

27 Feb - RNAO’s NP Task Force releases groundbreaking report – Vision for Tomorrow – go here.

20 Feb - Are you struggling with substance use and/or mental illness? – go here.

20 Feb - RNAO hears about COVID-19: A heart-to-heart dialogue for nurses – go here.

20 Feb - With new variants growing, concerns mount about the premature lifting of restrictions – go here.

18 Feb - Anti-Black racism and discrimination in nursing: The power of mentorship in nursing education – go here.

13 Feb - RNAO’s letter to the premier on the vaccine rollout and the current context – go here.

6 Feb - Use community care providers to ramp up vaccinations! – go here.

6 Feb - RNAO’s continuing media profile: The January report – go here.

30 Jan - The PrOTCT plan for nurses: Counseling vaccine hesitant patients & colleagues – go here.

30 Jan - Please sign action alert urging Premier Ford to suffocate COVID-19, NOW!go here.

23 Jan - Mitigating the spread in Toronto shelter settings – go here.

23 Jan - Home care nurses are #ReadyToVaccinate – go here.

23 Jan - Hurtful comments about law enforcement – go here.

15 Jan - The escalating catastrophe of the COVID-19 second wave in Ontario – go here.

15 Jan - Progress in vaccine distribution: Updates, issues and concerns – go here.

8 Jan - RNAO raises its voice in the media: Media coverage in December 2020 – go here.

8 Jan - A practicum experience at RNAOgo here.

8 Jan - RNCareers: Help during the holidays and help for next phases of this pandemic – go here.

We have posted earlier ones in my blog here. I invite you to look.


Information Resources

Public Health Ontario maintains an excellent resource site on COVID-19 materials. 

Ontario’s health provider website is updated regularly with useful resources.

Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.

Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.