Registration still rising: New reports

More nurses are working in Ontario’s health care system, and where they are working continues to shift, say two new reports from CNO. The reports focus on the number of nurses entering and leaving the health care system, and the employment patterns of new nurses. Collecting and analyzing data about nursing registration is one way CNO achieves its purpose to protect the public by promoting safe nursing practice.

"As the authoritative source of province-wide data about nursing employment in Ontario, CNO tracks trends in how and where nurses practice over time," says Brent Knowles, Director, Analytics and Planning. "This provides valuable information for health human resource planning to our partners in health care including government, to inform their decision-making."

CNO continues to increase the number of nurses in the health care system modernizing the way we assess and register applicants. This includes reducing barriers for internationally educated applicants, initiating new programs such as Supervised Practice Experience Partnership, and making changes to our Language Proficiency policy, Temporary Class registration and reinstatement.

Upward trend in registrations

The new Gains and Losses Report 2022 shows that over the past five years, the number of nurses in Ontario has continued to grow. This year saw a net gain of 4,041 (+2.4%) Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs), compared to 2,944 (a 1.8% increase) in 2021. Total registrations also grew in 2022, with RNs increasing by 1,934; NPs by 317; and RPNs by 1,762 registrations.

New registrations (nurses who are joining CNO for the first time in a specific category and class), are responsible for the vast majority of registration gains of nurses now available to the health care system (93.6% for RNs and 96% for RPNs). The main reason for losses of nurses to the system is because nurses have resigned. Since 2020, CNO has noticed a shift in the proportion of gains working in full-time employment for RNs (from 42.5% to 63.3%). This trend is similar for RPNs over the same time period (27.6% to 44.1%). 

More nurses entering public health

When it comes to where nursing gains (new registrations, reinstatements or nurses who changed class) are employed, public health experienced the biggest jump. The proportion of RN gains entering public health settings increased from 0.9% in 2020 to 5.3% in 2022, while RPN gains in public health settings grew four-fold from 0.5% in 2021 to 2.1% in 2022.

Interestingly, we saw some shifts in gains and losses across age groups. The health care system lost more RNs aged 25 to 34, compared to previous years. Of all RN losses, the proportion in the 25 to 34 age group grew from 13.6% in 2021 to 22.2% in 2022. While some of the RN losses represent gains to NPs, and stay in the system, the proportion of NP gains aged 24 to 35 remained stable in the same time frame. In contrast, the proportion of RNs aged 65 and over who gave up their registration fell from 31.0% of all RN losses in 2021, to 23.2% in 2022.

Data show that fewer RNs are going into long-term care facilities (14.6% of all RN gains in 2019 and 10.0% in 2022). The proportion of RPN gains entering the workforce in acute care hospitals increased from 18.2% of all RPN gains in 2019 to 28.8% in 2022.

New nurses working full-time

A second report, First-Time Renewals Report 2022, contains statistics about nurses who renewed their registration as RNs, RPNs and NPs for the first time between 2015 and 2022. Since 2015, at least 95% of nurses have renewed their registration in the first year after their initial registration, across all categories and classes.

Like the Gains and Losses Report 2022, this report shows that more new nurses are entering the profession right away as full-time nurses. This year saw the highest number: 55.8% of across all categories and classes, compared to 44.9% in 2021 and 38.8% in 2015. The proportion of new nurses reporting overall part-time and casual employment decreased.

Trends in employment

Other trends in this report echo those in Gains and Losses, too. Overall, since 2019, the proportion of employment positions of nurses renewing for the first time in acute care hospitals has increased, most noticeably for RPNs. While the proportion of reported public health positions has increased in first-time renewals, long-term care positions have steadily decreased since 2015. In 2021 and 2022, new registrations identifying as visiting nurses also decreased.

For the first time since at least 2015, the proportion of all positions new NPs reported working in fell below 40% for acute care hospitals. New NPs are increasingly finding work in the NP role, as opposed to another role such as RN. The proportion of positions NPs reported working in reached 61.8%, which is the highest level in the last eight years.