Provincial budget fails to deliver urgent nursing investments to care for Ontarians and to sustain the profession through the pandemic and beyond

RNAO’s media release on March 24 responded to the presentation of the Ontario budget in the legislature. Here it is.

The Registered Nurses’ Association of Ontario (RNAO) is disappointed the government is failing to make the investments desperately needed to help nurses in the fight against COVID-19 and to sustain the nursing workforce after the pandemic.

“The length and intensity of the pandemic has hit nurses especially hard. They are exhausted, feel let down and unsupported by the government and yet, are soldiering on during a third wave of COVID-19,” says Dr. Doris Grinspun, RNAO’s CEO. A recent survey conducted by the association shows nurses, particularly those early in their career, are seriously considering leaving the profession and this budget offers little indication that help is on the way, adds Grinspun.

This includes a commitment to hire thousands of additional registered nurses (RN) and nurse practitioners (NP), measures to retain nurses currently working in the system and redoubling our efforts to recruit future nurses.

The budget, which was unveiled by Finance Minister Peter Bethlenfalvy, titled Ontario’s Action Plan: Protecting People’s Health and Our Economy, provides details on the government’s ongoing response to the pandemic.   

While RNAO fully supports the government’s substantial investments in the hospital sector including adding thousands of hospital beds, the association is perplexed that there is no plan or investments in the budget for the nurses needed to provide care.

The $933 million in funding to create additional spaces in the long-term care sector (LTC) and modernize existing ones for residents who call LTC home addresses only one aspect of life in the sector. Missing again are details about the $4.9 billion the government says it will invest over four years to increase nursing and personal care. More RNs, NPs and registered practical nurses (RPN) are needed in addition to the thousands of personal support workers (PSW) that Minister Bethlenfalvy cited in his budget address in the legislature. “Nurses work alongside PSWs and we respect their commitment and work, however, we regret that the minister failed both to praise and outline exactly how many RNs and RPNs will be hired to deliver the four worked hours of nursing and personal care it says it is committed to delivering,” says Grinspun.

The LTC sector was essentially abandoned during COVID-19, leaving staff, residents and their families reeling as the virus swept through nursing homes, resulting in a devastating loss of life and 3,753 resident deaths to date. “Residents should not have to wait until 2024-25 to receive the care they deserve today,” says Grinspun. She says the association’s Nursing Home Basic Care Guarantee is a ready-made evidence-based staffing formula that provides four worked hours of nursing and personal care for each resident with 48 minutes of RN care, 60 minutes of RPN care and 132 minutes of PSW care on a daily basis. The guarantee also calls for a nurse dedicated to infection prevention and control in each home, and an NP in each nursing home in Ontario. On the latter, we asked that this budget invest a minimum of $15 million to hire at least 100 Attending NPs in nursing homes, which would reduce unnecessary transfers to hospital, resulting in better quality of life for residents and their loved ones, and lower health system costs.

When it comes to the work of NPs, this budget contains no funding to increase their numbers, despite Premier Ford’s commitment at the association’s Feb. 25 Queen’s Park Day, where he said he was open to boosting the number of NPs in Ontario. Not only are NPs urgently needed in LTC, the need for them in primary care is also dire, especially in regions where Ontarians have no access to primary care – a key reason why RNAO calls for immediately funding at least three additional NP-led clinics.

RNAO says the government also missed an opportunity to shore up future care needs of Ontarians by committing to increase the number of seats in RN nursing education programs by 10 per cent this year and further increases of 10 per cent in subsequent years. “This is surprising given the government’s awareness of attrition from the profession,” says Grinspun.

Given the pandemic, the importance of public health cannot be emphasized enough. RNAO was also looking for a commitment that would see the 625 RN positions dedicated to schools funded permanently, along with funding for an additional 50 community wellness nurses in First Nations communities. “The needs in school will continue to be heightened for years to come,” says Grinspun.

The budget falls short when it comes to the delivery of home care. A tax credit without accompanying home and community care supports will do little to allow seniors to remain in their homes longer. RNAO called for a 20 per cent boost in funding to give Ontarians a choice to receive healthy and safe care in their own homes and to relieve pressure on both the hospital and long-term care sectors. “People should be allowed to choose whether they want to live in LTC or remain in their homes. And when nursing and other support services are offered through home care, aging in place is preferred by the public. It is also safer and ultimately a less expensive alternative,” says Morgan Hoffarth, RNAO’s president.

While the government touted its success in its vaccine rollout, RNAO says more than 20,000 nurses working in primary care and home care are eager to be brought onboard to speed up the government’s program by getting vaccines to seniors and others who are homebound.

When it comes to the social determinants of health, RNAO is concerned the budget does not address the need for paid sick days to protect essential workers. “There is overwhelming evidence that providing paid sick days would reduce workplace infections for those who lack access to this employee benefit,” says Hoffarth. And, “as long as COVID-19 remains a threat and employment is precarious, the province has an obligation to protect tenants who are unable to pay rent by re-instituting a moratorium on evictions and deploying funding for rent payment support,” adds Hoffarth.

While much of the province’s attention has been focused on the pandemic and a vaccination rollout to help end it, there is no vaccine to combat the deadly effects of the opioid crisis. More than 2,200 people died from overdose last year and recent figures show the crisis claims an average of six lives each day. The government needs to confront this public health epidemic with harm reduction. It can do so by funding urgent public health needs sites (UPHNS), which essentially function as overdose prevention sites. It also needs to fulfill its promise to approve and fund the 21 consumption and treatment services sites that it announced in 2018. “Addiction is an illness and we can prevent more unnecessary deaths by offering the supportive services and dignified care that people struggling with substance use need,” says Hoffarth.

“We understand the need to support small businesses and other aspects of our economy affected by COVID-19, however, nurses expected that the budget would also address the nursing  shortfalls that exist in our health system so we can provide the best care that Ontarians need now and after the pandemic ends,” says Hoffarth.