October 30 2021 COVID-19 report


Dear Colleagues: Welcome to our Saturday, October 30 report during this twenty first 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 policy updates and action alerts, as well as RNAO’s upcoming webinars.

Join the rally for climate emergency action: On Saturday, November 6th, to coincide with the arrival of global leaders at COP26, RNAO will be attending the Toronto Global Day of Action for Climate Justice from 1pm to 3pm on the south lawn of Queen’s Park. Come join me under the RNAO banner. We will be raising our voices together pushing the Canadian government and world leaders to stop stonewalling and take real action now for climate justice. Our rally will include Indigenous land defenders, climate justice, social justice and labour activists, Indigenous drummers, dancers and actions that all those in attendance can participate in. Our demands are: respect Indigenous sovereignty; phase out fossil fuels; a just transition for communities and workers, and global justice. Check details here. See below the call from The Lancet and health professionals around the world for leaders to take action.

Save the date: Sunday, November 14, 2021, noon at Nathan Phillips Square, Toronto. RNAO is joining the rally organized by @NurseWithSign bringing the public sector to call on Premier Ford to repeal Bill 124! Come and support the demand to immediately end wage suppression! I am proud to be one of the guest speakers at the rally and our awesome RNAO president Morgan Hoffarth will be leading the RNAO contingency – look for the RNAO banner!  We hope you can come and invite your colleagues, family and friends. We will use masks, maintain physical distancing and abide by all public health measures.

Update: The Canadian government is appealing a Federal Court ruling that upheld a landmark Canadian Human Rights Tribunal ruling on Indigenous child welfare compensation — but Ottawa says it's also working with Indigenous groups to reach a compensation agreement by the end of the year. "While we are disappointed that Canada continues to pursue an appeal, we are encouraged that a deadline will be set to negotiate a settlement of this matter," said RoseAnne Archibald, national chief of the Assembly of First Nations. Here is the RNAO Action Alert and RT here.

This week we share: (1) Hospitals ‘bleeding out’ as nursing shortage intensifies; and (2) The Lancet calls for emergency action to limit global temperature increases, restore biodiversity, and protect health.

Hospitals ‘bleeding out’ as nursing shortage intensifies

This is an Oct 28, 2021 article by Mary-Kay Whittaker. This article is republished from HealthyDebate. The original article can be found here.

As Ontario’s nursing workforce staggers under the strain of COVID-19, nursing organizations say little effort has been made to retain the province’s nurses. The focus on recruitment rather than retention and wage-restraint legislation are major factors driving overworked and stressed nurses away.

“The nursing shortage is horrific,” says a clinical program director in a large hospital in the Greater Toronto Area, who asked not to be identified because she did not have approval to speak publicly. “Anyone can have the best nursing recruitment strategies, but all hospitals are bleeding out. We are all vying for the same people.”

The nursing shortage has long been predicted by the Canadian Nurses Association as a result of changing health-care needs and an aging population. The pandemic has exacerbated the shortage, leading to understaffing and hospital unit closings. It has taken a significant mental-health toll on nurses and resulted in some quitting their jobs.

The nurse-per-capita ratio has been in steady decline in Ontario since 2014 as population growth outpaced the number of employed nurses. In 2020, Ontario had the lowest nurse-per-capita ratio in Canada, with 665 registered nurses (RNs) for every 100,000 people. The Canadian average is 814; Ontario would require 22,003 more working RNs just to reach the national average.

Ontario government investments this year are expected to add up to 2,000 new nursing school positions and allow hospitals to employ more than 4,000 health “externs,” nursing students supervised by nurses who work as unregulated care providers as part of health-care teams. While recruitment strategies are viewed as positive by many in the nursing profession, they say the strategies miss the mark.

The Ontario government has “been doing some things around recruitment, and that’s all well and fine, but they aren’t doing anything in regard to trying to retain the nurses they have,” says Vicki McKenna, president of the Ontario Nurses Association (ONA). McKenna estimates that thousands of nursing vacancies exist in Ontario, though no one can say exactly how many.

“Recruitment is cheaper than retention,” says a critical-care nurse with more than 30 years’ experience who asked not to be identified for fear of appearing critical of her employer. She says that before the pandemic, hospitals were already getting by with the bare minimum staff. COVID has turned “a crack into a crevice … If employees are leaving at unprecedented rates, there’s a reason.”

The reason, say nursing representatives, is working conditions. “What a nurse will decide upon will be the quality of nursing, or the area of nursing they want to be in,” Linda Silas, president of the Canadian Federation of Nurses Unions, told the Toronto Star. “But the key (factor) is the workload.”

Among other issues noted by nurses were lack of control of their day-to-day lives, lack of respect from patients/hospital leadership, being overworked due to other co-workers calling in sick or being unable to staff their departments fully (with no fewer patients), and workplace violence.

Job vacancies for registered nurses and registered psychiatric nurses in Canada in the second quarter of 2021 were up 85.8 per cent compared to two years ago, the largest increase among all occupations in the country.

Nurses become exhausted and demoralized when they see patients getting deficient care, Doris Grinspun, CEO of the Registered Nurses Association of Ontario (RNAO), told CP24. Normally, nurses in intensive-care units (ICUs) care for only one or two patients at a time. Because hospitals are so short-staffed, ICU nurses are often now caring for three or more patients, which can negatively impact health outcomes, says Grinspun.

About 1,000 nurses have indicated in an ONA exit survey over the past four months that they are leaving, or planning to leave, their jobs because they are switching to a different profession, retiring or have been recruited elsewhere, including the United States, where some hospitals pay up to $40,000 in signing bonuses.

Quebec is among several provinces offering recruitment or retention bonuses. On Sept. 23, Quebec announced a $1-billion plan to fix the province’s nursing crisis. The funds will pay nurses bonuses of $12,000 to $18,000 to stay in full-time jobs, encourage part-timers to go full-time and attract 4,300 nurses back into the profession. However, some Quebec nurses say this money won’t fix the problem because their concerns are about the province’s forced overtime and poor working conditions

In Ontario, $10,000 recruitment bonuses are offered through the Community Commitment Program for Nurses. To be eligible, a nurse must not be employed in Ontario in the six months before being hired. That means the bonuses are going mainly to new graduates and to nurses returning to the field or from other provinces. For the mid- to late-career nurses who have stuck with it through the pandemic, no bonuses are available. ONA president McKenna says it isn’t good for morale when some nurses have received a bonus and are working side by side with others who have not.

McKenna says while Quebec is acknowledging all nurses’ efforts and the bonuses could help stem some of the flow, Ontario has not done the same. “At this point, (it has) refused to acknowledge or do anything other than to call nurses ‘heroes.’ I can tell you that that’s the last thing that nurses want to hear (from government). It’s not anything they want to write down and put on a bumper sticker.”

What nurses want is respect, say both McKenna and Grinspun. Nurses’ wages are currently constrained by Bill 124, passed into law in 2019, which ensures that increases in pay for public-sector employees reflect the fiscal situation of the province. Under this law, pay and other compensation increases are limited to a maximum of one per cent a year for a period of three years.

“Nurses are angry,” says McKenna. “We’re under this Bill 124 wage restraint … and other groups, primarily male-dominated professions such as police and fire, were exempt … This further just demoralizes what is predominantly a female workforce.”

At this point, Bill 124 should be repealed for symbolic reasons – Grinspun would like the premier to say to nurses, “I respect you for real, that bill is gone” – and the government should permit immediate wage increases for nurses. Repealing Bill 124 would also allow another key nurse-retention strategy – badly needed mental-health support improvements for nurses and other health-care professionals.

A recent arbitration decision that upheld Bill 124 enraged the ONA because of its “insulting one-per-cent total wage and compensation increase for the next year.” The ONA says it could not negotiate improved mental-health benefits because the costs are more than allowable under the legislation.

The Ontario COVID-19 Science Advisory Table’s recent report Burnout in Hospital-Based Healthcare Workers during COVID-19 says that more than 60 per cent of health-care workers surveyed in multiple Canadian studies have experienced severe emotional exhaustion. During the pandemic, nurses were consistently reported as having higher levels of burnout than other hospital-based health-care professionals, in Canada and internationally. The report says that elevated burnout and other indicators of stress will persist long after the pandemic.

“The pandemic has meant countless hours of overtime for nurses, back-to-back 12-hour shifts, and cancelled time off,” says Silas. “To top things off, many provinces are balancing their budgets on the backs of nurses through wage freezes, cutbacks and layoffs. We are done asking for the basics; we demand (government) action to fix the nursing crisis.”

McKenna says actions needed in Ontario include a human resource plan that addresses nursing needs now and in the future; secure employment for nurses that provides committed, full-time hours; competitive salaries and benefits; and the ability for nurses to care for patients according to the standard of care for which they are trained.

“We have to hold on to every nurse we can,” she says, “and that is about listening to the concerns they have about their ability to care for people and taking their concerns seriously.”

The Lancet calls for emergency action to limit global temperature increases, restore biodiversity, and protect health

Health professionals around the world are calling on global leaders congregating in Glasgow, Scotland for the climate change conference starting this Sunday, October 31, to address the emergency aggressively and in unison.

The following is a climate emergency editorial issued on September 4 by The Lancet, the prestigious family of health journals, urging leaders, including Prime Minister Trudeau, to meet the most important challenge of their generation. The Lancet’s editorial was published simultaneously around the world in dozens of journals in the BMJ website. For ease of reading, the citations have been removed. The full article with citations can be read here.

The UN General Assembly in September, 2021, will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the UN Climate Change Conference of the Parties (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1·5°C, halt the destruction of nature, and protect health.

Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades. The science is unequivocal; a global increase of 1·5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse. Despite the world's necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions.

Reflecting the severity of the moment, this Comment appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.

The risks to health of increases above 1·5°C are now well established. Indeed, no temperature rise is “safe”. In the past 20 years, heat-related mortality among people older than 65 years has increased by more than 50%. Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality. Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.

Global heating is also contributing to the decline in global yield potential for major crops, falling by 1·8–5·6% since 1981; this, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition. Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of pandemics.

The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no country, no matter how wealthy, can shield itself from these impacts. Allowing the consequences to fall disproportionately on the most vulnerable will breed more conflict, food insecurity, forced displacement, and zoonotic disease—with severe implications for all countries and communities. As with the COVID-19 pandemic, we are globally as strong as our weakest member.

Rises above 1·5°C increase the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state. This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.

Encouragingly, many governments, financial institutions, and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of renewable energy is dropping rapidly. Many countries are aiming to protect at least 30% of the world's land and oceans by 2030.

These promises are not enough. Targets are easy to set and hard to achieve. They are yet to be matched with credible short-term and longer-term plans to accelerate cleaner technologies and transform societies. Emissions reduction plans do not adequately incorporate health considerations. Concern is growing that temperature rises above 1·5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community. Relatedly, current strategies for reducing emissions to net zero by the middle of the 21st century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.

This insufficient action means that temperature increases are likely to be well in excess of 2°C, a catastrophic outcome for health and environmental stability. Crucially, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed. This is an overall environmental crisis.

Health professionals are united with environmental scientists, businesses, and many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the immediate years that follow. We join health professionals worldwide who have already supported calls for rapid action.

Equity must be at the centre of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond. Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity loss and the wider destruction of the natural world.

To achieve these targets, governments must make fundamental changes to how our societies and economies are organised and how we live. The current strategy of encouraging markets to swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and much more. Global coordination is needed to ensure that the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.

Many governments met the threat of the COVID-19 pandemic with unprecedented funding. The environmental crisis demands a similar emergency response. Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes. These include high quality jobs, reduced air pollution, increased physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions.

These measures will also improve the social and economic determinants of health, the poor state of which may have made populations more vulnerable to the COVID-19 pandemic.

But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.

In particular, countries that have disproportionately created the environmental crisis must do more to support low-income and middle-income countries to build cleaner, healthier, and more resilient societies. High-income countries must meet and go beyond their outstanding commitment to provide US$100 billion a year, making up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.

Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low-income countries. Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of the environmental crisis.

As health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient, and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis. We must hold global leaders to account and continue to educate others about the health risks of the crisis. We must join in the work to achieve environmentally sustainable health systems before 2040, recognising that this will mean changing clinical practice. Health institutions have already divested more than $42 billion of assets from fossil fuels; others should join them.

The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1·5°C and to restore nature. Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.


Addressing Substance Use Level 2 Virtual Workshop - Session 1

Nov 4, 2021, 10:00am - 12:00pm

*Please note, this registration is only for Session 1 of the two-part Addressing Substance Use Level 2 Virtual Workshop. Please register for Session 2 at RNAO.ca/events

The RNAO Addressing Substance Use Level 2 Virtual Workshop is for nurses and health professionals with experience working with clients who use substances and who would like to advance their knowledge of this group.

This workshop consists of two sessions, each being two hours in length use the Zoom platform; these live sessions must be completed in sequential order by March 20, 2021, in order for you to become a Mental Health Champion and receive your Champion's certificate.  

Workshop prerequisite: Completion of a Mental Health and Addiction Level 1 workshop or completion of the Engaging Clients Who Use Substances e-learning (Under Addiction and Mental Health). 

This online workshop will focus on appropriate evidence-based assessment tool to identify people with substance use disorders, therapeutic interventions and techniques to treat clients with substance use disorders and approaches to integrate best practices in clinical care and organizational processes.


COVID-19 Webinar Series

Nov 8, 2021, 2:00pm - 4:00pm

When: Every second Monday of the month

RNAO's CEO Doris Grinspun will be hosting 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
  • calls to action

Health providers from Ontario, Canada, and anywhere in the world are welcome to join at no cost.

We are here with you in solidarity. Together, we will continue to tackle COVID-19 with the best tools at hand, including accurate information, calmness, determination and swift actions!

Upcoming webinars:

Nov. 8, 2021, 2 - 4 p.m. ET

Details coming soon.


Recordings and documents from earlier webinars can be found here.

NP Knowledge Exchange Virtual Symposium

Nov 23, 2021, 9:00am - 4:00pm (virtual VIA Zoom)

On Nov. 23, 2021, RNAO is holding its eighth invitational Nurse Practitioner (NP) Knowledge Exchange Virtual Symposium, titled "Powered by Change." This annual event offers RNAO's NP members a unique opportunity to discuss matters important to their critical role in Ontario’s health system.

The NP Knowledge Exchange Symposium's objectives are to:

  • update knowledge about the NP Task Force's Vision for Tomorrow: recommendations, action and outcomes;
  • share and discuss how the clinical, policy and governance roles of NPs during COVID-19 are impacting the system and can power health transformation;
  • embrace the collaborative efforts and relationships between RNAO and its NP interest group (NPIG);
  • mobilize Ontario’s health transformation agenda incorporating opportunities and strategies to advance full NP supply, utilization and scope expansion;
  • galvanize NP engagement on global and local initiatives impacting health transformation and the role of the NP; and
  • showcase a vibrant public education campaign spotlighting the role and capacity of NPs.

View the 2021 NP Virtual Knowledge Exchange Symposium Agenda.


Related Documents:   NP Virtual Knowledge Exchange Symposium Agenda 2021

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 detailed Ontario epidemiological summary from Public Health Ontario, you can go here.

According to the latest Situation Report #544 for October 29, the case count was as follows: 599,259 total, +419 change from yesterday; 9,865 deaths, +0 change from yesterday.

No updates for today.

Staying in touch          

Keeping in touch remains important as ever. Feeling that we are part of a community and that we have each other’s backs helps us get through challenging times, becoming better people in the process. We are eager to hear how we, at RNAO, can best support you. Send us your questions, comments, and challenges. Recommend ideas for articles and webinars. Write to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten at pgbatten@rnao.ca. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

We thanks you again and again for being there for your community – everywhere and in all roles! Together, in solidarity, we are stronger. Please keep encouraging your colleagues, their loved ones and your communities to be fully vaccinated. We must not forget, however, about our privilege. Canada has purchased more vaccines than what it needs, while the majority of the world’s population has almost nothing. Like with other challenges we face – systemic discrimination and climate change – we are not safe until everyone is safe. Vaccines for all – literally for all, across the world – must guide policy in the upcoming months. Let’s learn from the 20-month pandemic and take real action to build a better world.

To everyone – THANK YOU! Please take care of yourself and know that RNAO always stands by you!

Here’s one constant throughout the pandemic. The silver lining of COVID-19 has been to come together and work as one people for the good of all. Let’s join efforts to demand that political leaders protect patients, students, and workers – and secure #Vaccines4All.

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


24 Oct - Big tech has a vaccine misinformation problem – go here.

24 Oct - RNAO is deeply disappointed with government’s reopening plan – go here.

24 Oct- Misinformation is an urgent threat that prolongs the pandemic and puts people at risk – go here.

17 Oct - Health organizations around the world: Urgent climate action required – go here.

17 Oct - Climate change the new public health emergency – go here.

17 Oct - A crucial moment for global public health: The Glasgow climate conference – go here.

10 Oct - RNAO launches new, evidence-based online implementation toolkit – go here.

10 Oct - Media release: Mandate vaccinations and establish safe zones – go here.

10 Oct - A renewed call: Prime minister, stop the court battle with First Nations children! – go here.

10 Oct - The inherent racism of anti-vaxx movements – go here.

3 Oct - RNAO’s continuing media profile: The September 2021 report – go here.

3 Oct - RNAO commends move to mandate vaccination for long-term care staff; urges for more – go here.

3 Oct - Action Alert – Stop fighting First Nation children in court: Concrete action on Truth & Reconciliation – go here.

25 Sept - Accelerating knowledge uptake and sustainability – learning from the Leading Change Toolkit – go here.

25 Sept - Connecting the dots – far right extremism as a serious health threat – go here.

25 Sept - How anti-vaxxers, conspiracy theorists, and the far-right came together over COVID – go here.

25 Sept - The anti-vax movement is being radicalized by far-right political extremism – go here.

19 Sept - Nurses urge Canadians to vote – go here.

19 Sept - Keeping schools open and safe – learning from Spain’s exceptional experience – go here.

11 Sept - Vote in the federal election! Nurses vote for a healthy recovery for all Canadians – go here.

11 Sept - Federal election: Which party has the best climate plan? Here’s where they stand – go here.

11 Sept - Where the parties stand on gun control in the 2021 federal election – go here.

4 Sept - RNAO condemns protests outside health organizations – go here.

4 Sept - RNAO’s continuing media profile: The August 2021 report – go here.

4 Sept - RNAO welcomes important steps to implement vaccine certificates – go here.

28 Aug - Mandatory vaccination in process; vaccine certificates coming to Ontario – go here.

28 Aug – MSF on boosting global vaccine supply – go here.

21 Aug - Nurses call on voters to vote for a healthy recovery for all – go here.

21 Aug – RNAO calls for a stronger vaccine mandate and action on vaccine certificates – go here.

21 Aug - WHO condemns rush by wealthy nations to give Covid vaccine booster – go here.

21 Aug - Calling on Canada to back WHO Moratorium on Booster Shots and Donate Vaccines – go here.

15 Aug - Why is Delta such a worry? – go here.

15 Aug - This is what we know about the Delta variant and kids – go here.

15 Aug - RNAO welcomes mandated vaccination for health care workers – go here.

8 Aug - COVID-19 vaccine boosters: is a third dose really needed? – go here.

8 Aug - RNAO calls to implement vaccine passports to help reopen Canada – go here.

8 Aug – School reopening plan: additional measures needed to stave off worst effects of fourth wave – go here.

1 Aug - RNAO’s continuing media profile: The July 2021 report – go here.

1 Aug - Preparing for the fourth wave – go here.

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