As I reflect on another year, I cannot help but consider how we all—nurses, employers, the public, academia, government, unions and associations—play an important role in fostering the collaboration needed to address complex health system needs while promoting patient safety.
In many ways, the COVID-19 pandemic exposed vulnerabilities that continue to impact Ontario’s nursing workforce, underscoring the urgent need for collective and collaborative action. Against the backdrop of Ontario’s culturally diverse communities and aging patient populations, nurses are called upon increasingly to help reduce health inequities and remain steadfast in their commitment to provide high-quality care.
With more than 450,000 registrants, nurses represent the largest group of regulated health professionals in the country, according to Health Canada. And as of November 2024, more than 198,000 of those nurses were registered and eligible to work in Ontario.
But, in Ontario and more broadly across Canada, Health Canada has reported that nurses are facing increased workloads, high rates of burnout, stress, anxiety and depression. Earlier this year, Canada’s Chief Nursing Officer released a Nursing Retention Toolkit, which provides a framework to be used by employers and organizations, such as CNO, to enhance safe nursing practice in the interest of public protection. In addition, the Government of Ontario announced it is investing $743 million over three years to continue addressing immediate health care staffing needs and grow the workforce for years to come.
Support for nurses across the province—and the country—is a key opportunity for action toward creating more sustainable health systems.
CNO contributes to a more resilient, patient-focused system through the province-wide nursing registration, application and employment data we collect and share with system partners. We believe our data is a critical resource for many of our partners in patient safety and workforce planning—that is, helping nursing and health system leaders promote transparency in decision-making on local and national scales. For example, CNO provides de-identified record level data to the Canadian Institute for Health Information to inform understanding of health human resources at a federal level and to the Health Professions Database at the Ministry of Health to inform a similar understanding provincially.
Our data tell us CNO continues to register new nurses into Ontario’s health care system. From November 1, 2023 to October 31, 2024, we have registered 6,051 internationally educated nurses (IENs) and 8,608 Canadian registrants, for a total of 14,659 new nurses available to support Ontario’s health care system. Our Nursing Statistics Report shows there was a 3.6% increase in the nursing workforce (the number of nurses employed in nursing in the province) year-over-year—the largest increase since 2019.
With the Government of Ontario expanding nursing enrolment in colleges and universities by 2,000 Registered Nurse and 1,000 Registered Practical Nurse seats over the next three years, CNO continues to identify ways of improving our capacity to register new nurses into the system. For IENs, for example, we know it can be difficult to meet the education requirement. CNO proposed changes to enable applicants to meet the education requirement if they have completed relevant nursing education recognized or approved in the jurisdiction where they were educated. The Ontario government approved the updated education requirements earlier this month and the changes will take effect on Tuesday, April 1, 2025. This change reflects CNO’s efforts to streamline and modernize how we assess individuals who want to become registered to practice nursing in Ontario.
To support IENs in gaining valuable practice experience, CNO initiated the Supervised Practice Experience Partnership (or SPEP) together with the ministry. This partnership allows us to register more nurses quickly and safely by providing them with supervised practice experience under an experienced nurse mentor. To date, we have matched more than 5,700 applicants with over 770 employers, enabling more than 4,300 nurses to register with CNO and provide safe care to Ontarians. Earlier this year the ministry also announced that this program will be made permanent. The SPEP program is a great example of how CNO is partnering with employers across the province to provide innovative solutions to increasing nursing resources.
We know that for every 100 Canadian nurses who started working in the field in 2022, 40 nurses below the age of 35 quit, according to a recent report by the Montreal Economic Institute. Ontario ranked third, with more than 35 young nurses leaving for every 100 entering in 2022, which is 83% higher than in 2013. The rationale for leaving the profession: workplace stress.
Workplace culture and supportive working environments can reduce stress by reflecting nurses’ professional values. CNO supports nurses through our Quality Assurance (QA) Program, which engages them in activities to improve their practice through self-reflection and enhancing their skill, knowledge and judgment alongside the evolving nature of the health care system. In 2024, approximately 5,000 nurses were randomly selected for QA assessment, many of whom were considered to be in “high risk roles,” including Long Term Care, Agency and Extended Class.
We understand health care professionals across the province are experiencing higher rates of burnout, stress, anxiety and depression. This is why, in 2019, CNO collaborated with several organizations—including the Ontario Nurses’ Association, Registered Nurses’ Association of Ontario and Registered Practical Nurses Association of Ontario—to implement a voluntary program for Ontario nurses designed to encourage them to seek treatment for substance use and/or mental health disorders that may affect their ability to practice nursing safely. The Nurses’ Health Program embraces the philosophy that nurses experiencing these disorders should have an opportunity for education, treatment and recovery. This program is fully funded by CNO because we believe that, with the right support, nurses can continue or return to safe nursing practice benefiting both the nurse and the public.
These are just a few of many examples of how CNO is collaborating with system partners to ensure all issues affecting Ontario’s nurses are heard and, where possible, integrated into all aspects of our core regulatory functions.
I would like to close out 2024 by taking this opportunity to thank you for your incredible work and dedication to the nursing profession and patient safety. Let’s continue to learn from the challenges and build on the successes, as we keep our sights firmly set on the future.
Season’s greetings,
Silvie Crawford, RN, BHScN, LLM - Health Law
Registrar/Executive Director and Chief Executive Officer