Preliminary results of RNAO‘s Work and Wellbeing Survey

On March 8, Matthew Kellway, RNAO’s director of nursing and health policy, Kim Jarvi, RNAO’s senior health economist, and I presented preliminary results from our Work and Wellbeing Survey at our biweekly COVID-19 webinar (watch webinar here and see the slides here).

We launched the survey at the end of January. We knew nurses were shocked by the news that an RN, Stefanie Van Nyugen, died by suicide. She was young – just a few years into her career. Throughout this brutal pandemic we have heard directly from many of you. You have also written to us about your challenges and struggles with COVID-19. Yet, given the shocking news of Stephanie, we felt compelled to formally check the pulse of nurses across all sectors and to more deeply understand how you are coping.

The survey was open for three weeks and we received more than 2,100 responses from RNAO members and non-members. The target population was RNs, NPs and nursing students. The reaction to the survey confirmed why it was so important. We learned about nurses’ working conditions, attitudes towards work, stress levels, how nurses were coping as well as their future in nursing. The results will inform RNAO’s ongoing policy and advocacy efforts, as well as our programs to support Ontario’s nursing community.

Who responded?

• 91% were RNs, 4% were NPs and 5% were nursing students. 
• 82% of those who responded were members of RNAO while 18% were non-members.
• Staff nurses accounted for almost 75% of respondents. 
• Just over 50% of respondents worked in the hospital sector.
• 15% worked in long-term care (LTC).
• The remaining worked in primary care, home care, community care and academia.
• The distribution of respondents was relatively even across age groups.
• 70% of respondents reported working full-time while 23% worked part-time.

Impact of the pandemic

We asked nurses how their work had been impacted by the pandemic. While this may be an obvious question, we didn’t want to pre-judge the outcome. In response, 96% reported yes while 4% said no. We asked how concerned nurses were about work-related risks to their personal health due to COVID-19, and 60% reported being moderately or extremely concerned. Early on, the lack of personal protective equipment was a key concern and weighed heavily on nurses, particularly those working in hospitals and long-term care homes.

Almost half of the respondents reported that their work-life balance was affected to a great extent. Some reported working seven days a week, working mandatory overtime and having to forgo days off and vacation. The never-ending length of the pandemic weighs heavily, now surpassing one year. We have lived through two waves already and have now entered wave three in Ontario.

In terms of stress, 60% of nurses reported high or very high levels, while 32% reported moderate levels. We asked how are they coping with the stress they experienced. More than half (56%) ranked their coping score a 6 out of 10, or higher. A key finding is that older nurses reported being better able to cope with stress than younger nurses who indicated they weren’t coping as well.

Pandemic responses

We asked nurses if they had taken time off to manage stress, anxiety or other mental health issues. In response, 74% reported no time off while 26% did take some time off. This is remarkable given the intensity and the length of the pandemic. Regarding sources of support for mental health and wellbeing, more than half reported seeking the help of family and friends. 

We asked how they rate the level of support they received from RNAO, their employer and the government. Most respondents rated RNAO as providing good to excellent support, while rating their employer as fair to good, and the government as poor.

RNAO’s mandate is to speak out for nursing and to speak out for health. We are encouraged that 44% of respondents never felt discouraged by their employer from discussing their work experiences outside the workplace. This is significant, as nurses must continue to share their perspectives about what it is like to work during a pandemic. This must be welcomed and encouraged.

Future at work

We are still studying the results about how much nurses are working and their future intentions. Here are preliminary observations. Of the total, 31% reported working more than 40 hours per week. We received numerous comments about nurses working more than the 50-hour threshold. The burden of that work fell on nurses in some sectors (e.g., public health, acute care and LTC) more heavily than others (e.g., primary care).

We asked about intentions to retire. In terms of being eligible to retire at the time of the survey, 22% reported they are, while the remaining 78% were not. 52% of respondents said they planned to continue working for at least another 10 years and 22% said they plan to work another five to 10 years. That leaves about a quarter of respondents who said they plan to retire within four years, which represents a huge human resource challenge.

We have yet to compare the responses on likelihood to leave nursing (and the extent to which stress plays a role in that decision) with normal rates of attrition. Nurses in the sectors that faced a higher burden of work and stress (again, public health, acute care and LTC) indicated higher likelihood that they would leave the profession after the pandemic.

One bright spot: Respondents who are RNAO members are less likely to leave the profession after the pandemic than non-RNAO members. We are so pleased you feel supported by your professional association.

Takeaways

The impact of the pandemic is universal but the experiences of nurses are as unique as the nurses themselves. Each RN, NP and nursing student has lived through this differently.

The pandemic is jeopardizing the tenure of nursing colleagues in the profession with younger nurses experiencing more challenges coping and experienced nurses considering when they will retire. Those departures threaten the health system, which is why we must ensure we have strong retention plans in place. This is true at any time and with any employer. It is especially important now given the pandemic and its length’s impact on the nursing workforce.

Also critical is planning adequately for the future by increasing the capacity of nursing school programs. We need more RNs and NPs to meet the growing demand for their expertise. RNAO has already included this ask in our provincial budget submission.

A few lessons

The findings underline that hospitals were the only sector that fared well during the initial stage of the pandemic. The lessons learned from SARS meant they were ready – except for the insufficient stocks of PPE. However, that readiness didn’t translate across other sectors. Consider the tragedy in LTC as the worse prepared sector.  

Employers that improve working conditions for RNs and NPs in ICUs and LTC will have satisfied and supported staff. Staff shines when you have models of care with clear accountability, adequate resources and support. Nurses have choices about where to work and they will make those choices based on working conditions, leadership support, education support, and so on.  De-skilling is a poor practice – avoid replacing RNs with RPNs, RPNs with PSWs, PSWs with lesser trained personnel.

When considering retention efforts, ensure the ability of nurses to thrive…not just to survive. That‘s what will keep the nursing profession going.

Webinar participant comments

After presenting the early findings, we asked the 160 participants in our webinar if the findings reflect their own experiences. An overwhelming majority said yes. Here is a sample of the comments in the meeting’s chat box:

“Very interesting results, which should help in {health} human resource planning for the near future.”

“I respect what the nurses have gone through during this pandemic.”

“Yay to RNAO for leading this research.”

“Thank you so much for all the good information.”

Next steps

We thanked participants for the thoughtful comments. Our work isn’t complete. We are now conducting a deep dive into the results. Numerous narrative comments will help inform the analysis. We will finalize a comprehensive report to be released on March 31. You can watch the webinar here and see the presentation slides here.