Re: A health system on the verge of total collapse – An open letter to Premier Doug Ford

RNAO issued the following letter on Jan. 5, 2022.

Dear Premier Ford,

As the fifth wave of this pandemic rages, the cracks in our health system are clear for all to see. Witness: the implementation of Code Orange in hospitals and the cancellation of surgeries and procedures yet again; nursing homes desperately short of health-care workers; the severe shortage of RNs in our hospital emergency departments, ICUs and other critical areas; a home care sector with drastically declining acceptance rates, unable to keep up with demand; and a shortage of paramedics. And all of this is happening under your watch - even before the devastation of Omicron peaks. 

Throughout the entire course of this pandemic, you have continually shown disrespect for nurses and the nursing profession, turning a pre-pandemic nursing shortage into a full-blown nursing crisis. 

Two actions are required immediately to avert the full collapse of Ontario’s health system: 

• Move Ontario back to Step One of Ontario’s Roadmap to Reopen.
• Repeal Bill 124, top up compensation and improve working conditions for nurses so we retain those working and the thousands who have left hopefully return.

Premier, your reactive and last-minute management of this pandemic must end. It ought to be clear to you by now that your approach is failing Ontarians. You must also recognize that there is no separate trajectory for Ontario’s economy while this virus ravages the people of this province and threatens to bring our health system to its knees. COVID-19 must be confronted and defeated with steely courage and determination. 

Ontarians desperately needs the help of the nursing profession to succeed in fighting Omicron. As the premier of this province, it is on you to understand this, change the conduct of your government and bring hope back to our nursing profession. It is clear from your remarks at recent media conferences that you have turned a blind eye to the realities on the ground as nurses, and RNs in particular, continue in vain to fight COVID-19. This happens as the Omicron variant sweeps through Ontario communities at breakneck speed. 

In our Nov. 29 letter to you, we outlined the serious RN understaffing crisis facing the province. This crisis existed long before the pandemic and it is one that is now demonstrably worse. Its effects are being felt across the health system. Every day, nurses are making the difficult choice to leave their chosen profession after careful and considered thought. There are many reasons why nurses have reached this breaking point. Too many days with excessive and dangerous patient workloads. Too many shifts without a day off. Too much time spent away from their families and loved ones. And, too many days under Bill 124 – legislation your government passed in a misguided attempt at austerity. This has left nurses with an absurd salary “increase” this year that in reality constitutes a four per cent reduction in their real income after inflation. 

The true cost of Bill 124 is now laid bare for all to see; the system doesn’t have enough RNs to deal with the Omicron crisis. At a critical time in this latest wave of new infections and staggering numbers, nurses who remain in their roles are continuing to prop up our health system as best they can - but just barely. We do not want to think what will happen when Omicron reaches the elderly population in Ontario, which is only starting now. Nurses and the healthcare system are hanging on by a thread and it is only going to get worse. Lives are at stake. 

For 23 months, we have been warning you that the pandemic is not over. We have been warning that real system planning needs to happen. And at the centre of that planning is ensuring there is a robust RN workforce to care for those who need it. As we have outlined time and again, you cannot have a well-functioning system if you have a crisis in nursing. The two are interdependent.   

An effective response to Ontario’s nursing crisis begins by repealing Bill 124. The fall session of the legislature ended without acknowledging the plea of thousands of nurses to repeal this bill. As a result, over the holidays we stepped up our campaign by asking our members to get in touch with their local MPPs. Nurses brought greeting cards to those who signed a pledge to support our call for the repeal of this legislation; they asked those who have not signed, why not? 

Leaders Andrea Horwath, Steven Del Duca and Michael Schreiner have all signed our pledge to support our call to repeal Bill 124. So have all of their MPPs. But, premier, you have not signed, and nor have any of your MPPs, despite several wanting to do so. Your marching orders to them are clear: ignore nurses. The question is why? Only you can answer.  

In addition to repealing Bill 124, the work to rebuild Ontario’s nursing profession must begin. We have laid out essential building blocks in that process. It starts with retention – making sure the RNs currently caring for patients remain in the profession. We need every single one of them. We have called for specific measures to support nursing careers in Ontario:

• Immediately repeal Bill 124 to signal respect for nurses as essential workers.
• Increase the supply of RNs by increasing school enrolment by 10 per cent in each of the next eight years.
• Expand bridging programs from PSW to RPN, from RPN to RN, and from RN to NP.
• Expedite the processing for internationally educated RNs (there are thousands waiting).
• Support faculty retention and recruitment in nursing programs.
• Develop and fund a Return to Nursing Now program to attract RNs back to the workforce.
• Expand the Nursing Graduate Guarantee (NGG) program and reinstate the Late Career Nurse Initiative.
• Establish a nursing task force to make additional recommendations.

Premier, although we have had an RN shortage for decades, you and your government continue to compound the problem by disrespecting nurses and devaluing our expertise. Nurses see Bill 124 as ample evidence of that. The length of the pandemic and the ensuing stress and burnout it has caused demand your immediate attention. Inaction will inevitably bring Ontario’s health system to a complete collapse, costing more suffering and more lives lost. The system needs more RNs and more NPs. We have been warning you of the need to take action. Critical time has been lost and now, speed is of the essence.

We are deeply worried about our colleagues on the frontlines. And we are deeply worried that Ontarians of all ages, including children, will not get the access they need to emergency departments, ICUs and other critical areas.

Premier Ford, nurses urge you to immediately move Ontario back to Step One of Ontario’s Roadmap to Reopen. And repeal Bill 124 - let’s work together to rebuild the nursing profession so it is there for all Ontarians.

Yours warmly,

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

Morgan Hoffarth, RN, MScN 
President