Title Page Health Human Resource Series Andrea Baumann Series Number #19 Mabel Hunsberger Dina Idriss-Wheeler Mary Crea-Arsenio Employment Integration of Nursing Graduates: Evaluation of a Provincial Policy Strategy Nursing Graduate Guarantee 2008-2009 November 2009
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Title Page
Health Human Resource Series Andrea Baumann
Series Number #19 Mabel Hunsberger
Dina Idriss-Wheeler
Mary Crea-Arsenio
Employment Integration of Nursing Graduates:
Evaluation of a Provincial Policy Strategy
Nursing Graduate Guarantee 2008-2009
November 2009
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Employment Integration of Nursing Graduates: Evaluation of a Provincial Strategy, November 2009 Number #19
Andrea Baumann, RN, PhD, Associate Vice President, International Health,
& Director, Nursing Health Services Research Unit (McMaster University site)
Mabel Hunsberger, RN, PhD, Associate Professor, Nursing Health Services Research Unit (McMaster University site)
Dina Idriss-Wheeler, MSc, MHA, Research Coordinator, Nursing Health Services Research Unit (McMaster University site)
Mary Crea-Arsenio, MSc, Research Coordinator, Nursing Health Services Research Unit (McMaster University site)
This research has been generously funded by a grant from the Government of Ontario. The views expressed in this report do not necessarily reflect those of the Government of Ontario.
EXECUTIVE SUMMARY ....................................................................................................... 8 Employment Trends: Status, Location, Sector and Preferences............................................ 8 NGG Evaluation: Posting and Matching on the HealthForceOntario Portal ...................... 8 NGG Evaluation: Online Budget Reporting .......................................................................... 9 NGG Evaluation: Orientation/Mentorship Phase ................................................................. 9 NGG Evaluation: Offering Full-Time Permanent Positions ................................................. 9 Bargaining Units and Employer Collaboration .................................................................... 9 Overall Impact of the Initiative ............................................................................................ 10
RECOMMENDATIONS ......................................................................................................... 10 INTRODUCTION ................................................................................................................... 12 OVERVIEW OF LABOUR MARKET TRENDS .................................................................. 12
Historical Trends in Nurse Employment ............................................................................. 14 Workforce Planning in the New Millennium ....................................................................... 15 New Graduate Initiative 2004-2008 .................................................................................... 16 Factors Affecting Integration of New Graduates Into the Workplace ................................. 17 Markets Change ................................................................................................................... 18
THE NEW SUPPLY: REGISTERED NURSES AND REGISTERED PRACTICAL NURSES IN ONTARIO .......................................................................................................... 19
Nurse Education in Ontario................................................................................................. 19 Data Gaps ............................................................................................................................ 21 Data on Graduating Nurses ................................................................................................. 21 Recent Trends in RN and RPN Graduation ......................................................................... 22
Figure 1. First Year Intake and Supply of Ontario Registered Nurse Graduates ........... 23 Figure 2. First Year Intake and Supply of Ontario Registered Practical Nurse Graduates ......................................................................................................................................... 23
INTEGRATION OF NEW GRADUATES INTO THE WORKFORCE ............................... 24 Nursing Graduate Guarantee Initiative: Background and Description .............................. 24 Nursing Graduate Portal – HealthForceOntario ................................................................ 25 Evaluation of Nursing Employment in Ontario 2008 .......................................................... 25 Methods ................................................................................................................................ 26
DEMOGRAPHIC CHARACTERISTICS OF SURVEY RESPONDENTS .......................... 28 RN and RPN New Graduates ............................................................................................... 28
EMPLOYER PROFILE AND PARTICIPATION .................................................................. 29 Registered Employers ...................................................................................................... 29 Table 2. Percentage of Registered Employer Survey Respondents by Type of Organization .................................................................................................................... 29 Table 3. Percentage of Non-Registered Employer Survey Respondents by Type of Organization .................................................................................................................... 30 Union Representatives ..................................................................................................... 31
ACTUAL EMPLOYMENT OF REGISTERED NURSES AND REGISTERED PRACTICAL NURSES ........................................................................................................... 31
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Distribution of Nursing Graduates by Type of Employer .................................................... 31 Table 4. Distribution of Registered Nurse and Registered Practical Nurse Graduates by Type of Employer for 2007 and 2008-2009 ..................................................................... 32
Distribution of Nursing Graduates by Age and Sector of Employment............................... 33 Table 5. Percentage Distribution of New Nurse Graduate Survey Respondents by Nurse Group, Age Group and Sector of Employment ................................................................ 34
Distribution of Nursing Graduates by Primary Area of Practice ....................................... 34 Distribution of Nursing Graduates by Employment Status ................................................. 35
Table 6. Comparison of Employment Status of Registered Nurse and Registered Practical Nurse Graduands 2005 to 2008 ....................................................................... 35
Distribution of Nurse Graduates by Work Status and Type of Employer............................ 37 Table 7. Proportion of Nurse Graduates by Employment Status and Sector of Employer ......................................................................................................................................... 37
Mobility and Migration: RNs and RPNs ............................................................................. 37 EMPLOYMENT PREFERENCES OF REGISTERED NURSE AND REGISTERED PRACTICAL NURSE GRADUATES .................................................................................... 38
Preferences for Full-Time/Part-Time Work Status: RNs and RPNs ................................... 38 Table 8. Preferences for Full-Time Employment Status .................................................. 38 Table 9. Percent Distribution of Employment Preference by Nurse Group 2008 ........... 39
Preferences for Employment Location: RNs and RPNs ...................................................... 39 Preferences for Sector of Employment and Clinical Area of Practice: RNs and RPNs ...... 40 Preferences for Mobility and Migration: RNs and RPNs .................................................... 41
PROVINCIAL AND CANADIAN COMPARISON .............................................................. 41 Comparison to College of Nurses of Ontario General Class New Members ...................... 42
Figure 4. Comparison of Employment Status Between Registered Practical Nurse Graduates 2007-2008 and College of Nurses of Ontario Registered Practical Nurse New General Class Members 2005-2007 ................................................................................ 43 Table 10. Portal Survey Employment Status 2007-2008 Compared to the College of Nurses of Ontario New General Class Members 2005-2007 .......................................... 44
Comparison to Canadian Institute for Health Information Work Status Figures for Ontario 2004-2006 ............................................................................................................................ 44
Figure 5. Comparison of Employment Status Between Registered Nurse Graduates 2007-2008 and the Canadian Institute for Health Information Registered Nurses in Ontario 2004-2006 .......................................................................................................... 45 Figure 6. Comparison of Employment Status Between Registered Practical Nurse Graduates 2007-2008 and Canadian Institute for Health Information Registered Practical Nurses in Ontario 2004-2006 .......................................................................... 46
Comparison to Canadian Institute for Health Information Work Status Figures for Canada 2004-2006 ............................................................................................................................ 46
Figure 7. Comparison of Employment Status Between Registered Nurse Graduates 2007-2008 and Canadian Institute for Health Information Registered Nurses in Canada 2004-2006 ........................................................................................................................ 47
EVALUATION OF THE NURSING GRADUATE GUARANTEE ..................................... 48 Launching of the Nursing Graduate Guarantee: How Information Was Received ............. 49 Is the Nursing Graduate Portal an Efficient Matching Tool? ............................................. 49
Employer Experience Using the Portal ............................................................................ 49
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Figure 9. Employers’ Rating of Their Overall Experience With the Nursing Graduate Portal ............................................................................................................................... 50 The Time Factor for Employers ...................................................................................... 51 New Graduate Experience Using the Portal .................................................................... 52 Figure 10. New Graduates’ Rating of Their Overall Experience With the Nursing Graduate Portal ............................................................................................................... 52 Table 11. Registered Nurse and Registered Practical Nurse Evaluation of the Employment Portal Dimensions ...................................................................................... 53 Using the Nursing Graduate Portal Help Line ................................................................. 54
THE CHALLENGE OF MATCHING FOR SUPERNUMERARY POSITIONS: WHAT WERE THE BARRIERS? ....................................................................................................... 54
Are There Gaps: How Matched are the Applicants and Available Jobs? ........................... 55 New Graduate Behaviours and Job Searching: The Need for Immediate Full-Time Job Security ................................................................................................................................ 56 Reasons for Not Offering Supernumerary Positions ........................................................... 56
Table 12. Reasons Given by Employers for not Offering a Temporary Full-Time Position ......................................................................................................................................... 57
New Graduate Reasons for not Matching Through the Portal............................................ 57 Table 13. Reasons Given by Nursing Graduates for not Matching Into a Temporary Full-Time Position Through the Portal ........................................................................... 58
CREATING SUPERNUMERARY POSITIONS FOR NEW GRADUATES: BENEFITS OUTWEIGH THE CHALLENGES ........................................................................................ 58
Staff Shortages and RN Graduation .................................................................................... 58 License and Exams issues: Challenges and Strategies ........................................................ 59 Orientation Benefits: Mentoring and Support For New Graduates .................................... 59
Table 14. Employer and New Graduate Ratings of the Mentoring Process ................... 60 Mentoring Model Used During Bridging ............................................................................ 61 Creating and Sustaining Mentoring Resources: Educational and Administrative Challenges ........................................................................................................................... 62 The Challenge of Integrating New Graduates: The Tension of Workload and Learning ... 62
OFFERING PERMANENT FULL-TIME POSITIONS WITHIN THE REALITY OF THE WORKPLACE ........................................................................................................................ 63
Reasons Why New Graduates Were Not Offered Permanent Full-Time Positions ............. 63 Table 15. Reasons Given by Employers for not Bridging a New Graduate into a Permanent Full-Time Position ........................................................................................ 64
Sector Variables: Maximizing the Creation of Full-Time Positions ................................... 64 New Graduate Preferences: A Variable in Transitioning to Regular Full-Time Positions 66 Employee Seniority and Bargaining Unit Contracts ........................................................... 66
BARGAINING UNIT AND EMPLOYER COLLABORATION: WHERE ARE THE GAPS? ................................................................................................................................................. 67
Communication of Employers With the Bargaining Unit .................................................... 67 Figure 11. Percentage of Union Representatives Consulted Prior to Employer Participation in the Nursing Graduate Guarantee .......................................................... 67 Figure 12. Percentage of Union Representatives Consulted Prior to Employer Posting on Nursing Graduate Guarantee Portal .......................................................................... 68
New Graduates in Specialty Positions: What are the Issues for the Bargaining Unit ........ 68
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Table 16. Percent Distribution of Union Representatives' Perceptions that New Graduates Transitioned into a Specialty Area Position Ahead of Existing Staff ............ 69
Reinvestment of Funds: Who is Involved in Decisions ........................................................ 69 Figure 13. Percentage of Union Representatives Consulted Regarding the Reinvestment of Nursing Graduate Guarantee Funds ........................................................................... 70
Decisions About Bridging Into Full-Time Position ............................................................. 70 OVERALL IMPACT OF THE NURSING GRADUATE GUARANTEE ............................ 70
Stakeholder Response .......................................................................................................... 70 Table 17. Employer Rating of Clinical and Administrative Staff Responses to the Nursing Graduate Guarantee Initiative........................................................................... 71
Workplace Improvements to Promote Recruitment and Retention ...................................... 71 Reinvestment of Funds: How are They Used and Who Benefits? ....................................... 72
Table 18. Percent Distribution of Initiatives Employers Chose to Reinvest Funds ........ 72 ADMINISTRATIVE AND BUDGETARY ISSUES ............................................................. 73
Employer Communication with the Ministry of Health and Long-Term Care .................... 73 Table 19. Employer Rating of Their Experience Accessing Nursing Graduate Guarantee Funds and Using the Ministry of Health and Long-Term Care Service Level Agreement ......................................................................................................................................... 74
ORGANIZATIONAL BENEFITS AND FINANCIAL RESTRAINTS ................................ 75 Would There be Employer Support for the Initiative at Level IV Clinical? ........................ 76
Preference for More Advanced Skills and Temporary License ....................................... 76 University Semester is too Short ..................................................................................... 77 Impact of Variation in Clinical Placement Experiences .................................................. 77 Support Mixed With Ambivalence .................................................................................. 78
How can Nurses be Recruited into Long Term Care: Employer Perspective From all Sectors .................................................................................................................................. 78
Issue of Differences in Remuneration ............................................................................. 78 A Different Emphasis on Long-Term Care in School ..................................................... 78
CONCLUSION........................................................................................................................ 79 Employment Trends: Status, Location, Sector and Preferences.......................................... 79 NGG Evaluation: Posting and Matching on the HealthForceOntario Portal .................... 79 NGG Evaluation: Online Budget Reporting ........................................................................ 79 NGG Evaluation: Orientation/Mentorship Phase ............................................................... 80 NGG Evaluation: Offering Full-time Permanent Positions ................................................ 80 Bargaining Units and Employer Collaboration .................................................................. 80 Overall Impact of the Initiative ............................................................................................ 81
Appendix A. Nursing Graduate Guarantee Application Process ........................................ 88 Appendix B. Nursing Graduate Guarantee Initiative .......................................................... 89 Appendix C. Data Collection and Refinement of the Nursing Graduate Portal Evaluation Survey .................................................................................................................................. 90 Appendix D. Percent Distribution of Nursing Graduates by Nurse Type and Local Health Integration Network Region ................................................................................................ 91 Appendix E. Data Collection and Refinement of the Employer Portal Evaluation Survey . 92
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Appendix F. Percent Distribution of Employer Survey Respondents by Registration Status and Local Health Integration Network ................................................................................ 93 Appendix G. Percent Distribution of Nursing Graduates by Primary Area of Practice and Nurse Group 2007 to 2008 .................................................................................................. 94 Appendix H. Number and Proportion of Nurse Graduates by Nurse Group, Employment Status and Sector of Employment 2007 and 2008 ............................................................... 95 Appendix I. Distribution of Nursing Graduates by Employment Location and Nurse Group ............................................................................................................................................. 97 Appendix J. A comparison of Employment Preferences of Nursing Graduates by Nurse Group 2007-2008 ................................................................................................................. 98 Appendix K. Employment Region Preference of Nursing Graduates by Nurse Group ....... 99 Appendix L. Local Health Integration Locations Where New Graduates Seek Employment by Nurse Group .................................................................................................................. 100 Appendix M. Employers’ Rating of Their Satisfaction With the Employment Portal ....... 101 Appendix N. New Nursing Graduate and Employer Recommendations for the Improvement of Nursing Graduate Employment Portal .......................................................................... 102
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EXECUTIVE SUMMARY
This report presents the results of an evaluation of the Ontario provincial strategy for hiring
new graduates, the Nursing Graduate Guarantee (NGG), for the year 2008-2009. Over the
past 10 years, there has been a dramatic improvement in the employment status for nurses in
Ontario. In 1998, over 60% of nurses were part-time (PT) or casual. Today, 64% of all nurses
and 76% of new graduates are employed full-time (FT).
EMPLOYMENT TRENDS: STATUS, LOCATION, SECTOR AND PREFERENCES
Since 2005, FT employment has increased 24% for new graduate registered nurses (RNs) and
29% for new graduate registered practical nurses (RPNs). The Toronto Central Local Health
Integration Network employs the largest percentage of new graduates, and 75% of all new
graduates are employed in the acute care sector. Overall, the community and long-term care
sectors hired fewer new graduates in 2008 compared to 2007. The majority of RNs (88%) and
RPNs (73%) surveyed indicated they were working in their preferred area of clinical practice.
The primary areas of practice for RNs were medicine, surgery, emergency and maternal-
newborn. The primary areas of practice for RPNs were geriatrics, medicine and complex
continuing care.
NGG EVALUATION: POSTING AND MATCHING ON THE HEALTHFORCEONTARIO PORTAL
The NGG uses an online employment portal (HealthForceOntario or HFO) to link new
nursing graduates with employers who are interested in hiring them (HFO, 2009). Compared
to last year, employers and new graduates found the portal easier to use; however, employers
reported that new graduates required assistance from them to apply on the portal. The
applicant pool was found to be smaller for certain sectors and locations (e.g., long-term care
and rural areas). Some new graduate portal registrants (34%) said they secured a position
outside the portal (compared to 43% last year). The portal was viewed positively in regard to
posting and matching, but employers expressed frustration with the online budget reporting
and found the E-signatures to be labour intensive.
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NGG EVALUATION: ONLINE BUDGET REPORTING
Although not all employers had difficulty, a substantial number indicated the online budget
reporting method is an area that they would like to see improved. Obtaining E-signatures was
the most reported problem area. Those who had difficulty also indicated that the help line was
not sufficiently available during the week of the report deadline and felt it was likely due to
an overwhelming number of calls to the Ministry of Health and Long-Term Care.
NGG EVALUATION: ORIENTATION/MENTORSHIP PHASE
Experienced nurses were supportive and willing to provide the mentorship needed for the
new graduates, although some employers expressed concern about mentor and preceptor
burnout. Some of the employers in public health and community reported that one-to-one
supervision can interfere with client load demands. The overall response to this phase of the
NGG was overwhelmingly positive. However, the experience was not positive for a small
percentage of the new graduates in acute care and long-term care.
new graduates in particular were finding it difficult to secure FT permanent employment.
Recent MOHLTC initiatives have been directed at addressing this issue.
FACTORS AFFECTING INTEGRATION OF NEW GRADUATES INTO THE WORKPLACE
The chief employer is the hospital sector with 24/7 service and over 31,000 patient beds. The
overall number of nursing employer organizations is 1,198 and includes 159 (13.3%)
hospitals and 606 (50.6%) long-term care facilities. The remaining 433 (36.1%) organizations
include public health, community and other (A. Ferretti, personal communication, October
27, 2009). There are a total of 91,965 RNs and 27,432 RPNs employed in nursing in Ontario
(CNO, 2008). Typically, there are high rates of job turnover in large acute care hospitals and
lower rates in community and rural facilities (Hayes et al., 2006).
The ability for organizations to provide employment for new nurses changes over time and is
affected by numerous variables. Identifying and quantifying their capacity to employ new
graduates is a challenge for researchers because availability of jobs cannot be estimated by
counting vacancies or job postings. Organizations define vacancies in various ways. Some
organizations do not differentiate internal vacancies from external vacancies. Internal
vacancies are created by workers transferring within an organization, whereas external
vacancies are created when workers leave an organization. Internal vacancies do not
represent employment opportunities for new applicants.
Vacancies that are posted are not necessarily related to new job opportunities. Vacancies are
not always associated with funded positions and often remain unfilled because related work
hours are covered by overtime or casual hours (Baumann, Keatings, Holmes, Oreschina, &
Fortier, 2006). Part-time and casual jobs are not always advertised; consequently, jobs exist
but not specific positions. Even posted jobs representing funded positions may not be
available for new graduates because they are not suited to a new nurse or seniority within the
organization precludes new nurses from being offered the job. This is particularly the case
with FT employment. In a recent study on vacancies, the term has been redefined with the
recognition that “organizational flexibility strategies have altered nurse utilization and
rendered data on vacancy statistics inaccurate measures of nursing shortage” (Fisher,
The chief nursing employer is the hospital sector.
The definition of vacancies is not standardized across the province.
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Baumann, & Blythe, 2007). Additional difficulties occur when statistical reports do not
distinguish FT status from FT hours. For example, the Ministry of Training, Colleges and
Universities (MTCU; 2005) considers nursing graduates to have FT employment if they work
more than 30 hours per week. However, nurses with casual or PT status may work FT hours.
Factors that influence where a nurse seeks employment include the number of potential
employers in the area. Nurses graduating from schools in Toronto, for example, have more
employment opportunities than those educated in Windsor. Lack of local employment
opportunities encourages graduate mobility. Hiring cycles are another factor. An organization
that hires heavily in one year will not do so in the next, unless it has a low rate of retention or
is expanding its services. Smaller organizations are likely to have more unpredictable hiring
cycles than larger ones. The role of timing also bears consideration. For example, what is the
relationship between new job hires and an organization’s financial position? Is there a
relationship between when nurses graduate and the ease with which they find jobs? An
additional factor is the effect that unionized environments and certain employment policies
have on the availability of FT employment for graduating nurses.
MARKETS CHANGE
There is no doubt that the balance between the supply and demand for nurses has fluctuated
in recent years. Important factors in nurse recruitment include market conditions and the
availability of employers to hire new graduates and integrate them into the workforce.
Growth in the health sector increases employment opportunities. Organizations should have
sufficient annual turnover and a relatively large system to absorb new employees (Baumann,
Keatings et al., 2006). The turnover of nurses is affected by retirement, job changes and
personnel leaving the profession or moving between sectors (e.g., hospital to community).
There has been a dearth of research examining changes in nursing employment opportunities
over time in relation to macro economic indicators such as labour market trends.
Nursing labour markets are sensitive to government investments and policy decisions.
Starting in 1999, in an attempt to reverse the attrition of nurses from Ontario’s labour market,
the provincial government led multiple initiatives aimed at increasing the FT equivalents of
nurses working in acute care hospitals and long-term care facilities. This was done through
The number of potential employers/ employment opportunities at any one time is difficult to assess.
Important factors in nurse recruitment include market conditions and the availability of employers to hire new graduates.
Nursing labour markets are sensitive to government investments and policy decisions.
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baseline funding to these organizations to support the hiring of new nurses and/or convert
casual and PT nurses into FT staff. The ultimate investment was in 2007, when the MOHLTC
first announced $89 million to support every new Ontario nursing graduate (RN and RPN) in
finding FT employment upon graduation through the NGG.
THE NEW SUPPLY: REGISTERED NURSES AND REGISTERED PRACTICAL NURSES IN ONTARIO
Each year the nursing workforce is augmented by newly graduating nurses, internationally
educated nurses and nurses who re-enter the workforce (Blythe et al., 2008; Simoens,
Villeneuve, & Hurst, 2005). This report focuses on 2008 new graduates. It is essential to
develop a profile of new graduates that includes an overview of both nurse education and
demographics and clarifies how well nurses are integrated into the workforce. Little is known
about the distribution of new graduates across sectors, areas of practice and geographical
location. Recent restructuring of nurse education (e.g., combining community college and
university education) continues to have an impact on the number of nurse graduates and
where they seek employment upon graduation. Consequently, it is important to describe the
characteristics of the educational system and employment possibilities for new entrants into
the profession.
NURSE EDUCATION IN ONTARIO
In Ontario, the MTCU is responsible for education at the community college and university
levels. The MOHLTC shares the responsibility for health care and is interested in the
education of health care workers to supply and maintain the system. However, the
responsibility for funding nurse education, with the exception of a few targeted areas (e.g.,
nurse practitioner education and recent investments in clinical simulation equipment), lies
with the MTCU.
Three historical events temporarily or permanently affected the supply of new graduates.
First, in 2003, secondary education in Ontario was reduced to four years, temporarily
increasing the number of potential applicants to nursing programs. Second, on January 1,
2005, the CNO changed its educational requirements for registration in the general class to a
degree for RNs and a diploma for RPNs. The new requirements resulted in changes to RN
A profile of annual graduates is essential to understand how well nurses are integrated into the workforce.
It is necessary to track changes in educational programs.
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and RPN nursing education in Ontario. As a result, there was an influx of students into RN
nursing diploma programs in the last year they were offered (2001). New entry to practice
legislation specifying baccalaureate degrees for RNs encouraged community colleges and
universities to enter into college-university collaborative programs leading to a degree from
the university partner. The upshot was a new educational way of delivering the four-year
basic nursing program through partnerships between the 13 universities and 22 colleges
offering nursing.
To facilitate the transition to all baccalaureate nursing, the MTCU made funding available to
support enrolment growth in the new collaborative programs. It also provided funding for
compressed degree programs in universities and the final intake of diploma students to the
colleges. The intention was to boost the number of graduates in 2003-2004, the year in which
reduced numbers were anticipated due to the elimination of the three-year college diploma.
Third, in 2001, RPN programs altered their curricula and increased their lengths to two years
to produce graduates capable of expanded practice roles. In addition, the MTCU announced
that effective January 2001, enrolment quotas on RPN programs were lifted.
The number of nurses entering the workforce has traditionally been supply driven. With the
introduction of the baccalaureate entry to practice requirement, the government of Ontario
committed to funding an intake of 4,000 first-year collaborative nursing degree students per
annum for potential RNs (B. Gough, personal communication, May 2, 2005). The overall
annual intake of RN students has almost reached this target of 4,000 (3,515 RN admissions in
2008). Capital funding for physical plant infrastructure dedicated to nursing education has
been sporadic in most educational institutions, although there have been government
strategies in targeted areas to help educational institutions increase enrolment. For example,
from 2004 to 2006, there was a $20 million investment by the MOHLTC in clinical
simulation equipment for schools of nursing. The MTCU also increased Basic Income Unit
funding for growth in RN nursing programs. As a sequel to the time-limited funding for
compressed degrees announced in 2001, the MTCU approved new Second-Entry Programs,
which began in 2005-2006. These programs are geared to students with previous post
secondary education, including diploma-prepared RPNs wishing to upgrade to a degree. The
initiative was intended to increase the intake of nursing students.
Ontario moved to baccalaureate education for all RNs in 2001.
In 2001, RPN programs altered their curricula and increased their programs to two years.
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DATA GAPS
According to the 2005 Data Quality Report: The State of Data Quality in Ontario
(MOHLTC, 2005),
Producing better data is a key objective of the province’s Information Management
Strategy. Sound health care planning decisions require accurate, timely and accessible
data. Quality information is essential to making effective evidence-based decisions,
which ultimately impact on the province’s ability to adequately meet the health care
needs of Ontarians.
To link the supply of new nursing graduates to the needs of the provincial health care system,
good data about the supply of new graduates and information about market requirements are
essential. Gaps currently exist in relation to the supply of new nurses and their uptake into the
workforce. However, Statistics Canada has decided to include a health human resources
survey of new graduates on its agenda. A recent report by Statistics Canada includes a
detailed outline of key data that should be collected (Allen, Ceolin, Ouellette, Plante, &
Vaillancourt, 2006).
DATA ON GRADUATING NURSES
National educational data is currently stored by two organizations: the Canadian Nurses
Association (CNA) and the Canadian Association of Schools of Nursing (CASN). Data on
enrolment and graduation from schools of nursing is collected yearly. In addition, Statistics
Canada collects annual degree statistics from registrars of the educational institutions.
However, recent changes to Statistics Canada data-sharing policies meant that after 2002,
Statistics Canada was no longer able to share the data with the MTCU. Since 2003, the
MTCU has collected data on degrees granted directly from the colleges and universities. This
is to be used in conjunction with nursing school enrolment data to track nurse supply. Data
collection has been a challenge because of various factors such as differing graduation times,
FT and PT student counts and the capacity of individual institutions to create and maintain
adequate databases.
In addition, the creation of college-university collaborative programs has resulted in data
integration challenges related to applications, registration and enrolment. For example, in
There was a $20 million investment by the MOHLTC in clinical simulation equipment for schools of nursing.
Statistics Canada has decided to include a health human resources survey of new graduates on its agenda.
The MTCU has collected data on degrees granted directly from the colleges and universities.
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some college-university partnerships, applicants apply to the Ontario College Application
Service and the Ontario Universities’ Application Centre. The CNO data on new registrants is
also used to analyze the supply of nurses because enrolment and graduation data do not
capture graduates who never register with the CNO.
Student employment upon graduation is not well measured. Some schools of nursing may
survey their alumni sporadically to gain information about their absorption into the
workforce. Yet there is no mandatory reporting of alumni employment data at the provincial
or national level. In its statistics on new members, the CNO differentiates nurses educated in
Ontario from those educated abroad or in other provinces. While this group is mainly
composed of new graduates, it also includes reinstated members. Furthermore, the CNO
reports only the age, gender and place of initial education of new members, not their
employment status. The employment status is rolled up in the totals of the proceeding year’s
release of the Annual Membership Statistics report.
RECENT TRENDS IN RN AND RPN GRADUATION
As shown in Figure 1, the number of nurses graduating each year varies over time and there
is no consistent pattern. In the year of interest (2008), there were 4,902 graduates (2,776 RNs
and 2,126 RPNs). These numbers can vary depending on the point in time they are collected.
The “ebbs and flows” of the number of RN graduates have been affected by the
implementation of the baccalaureate degree as entry to practice in 2004 (Baumann, Blythe et
al., 2006). The overall numbers for RPNs are steadily increasing (see Figure 2). This reflects
the 2001 provincial government strategy to lift caps on enrolment in programs.
Student employment upon graduation is not well measured.
The overall number of RPN graduates is steadily increasing.
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Figure 1. First Year Intake and Supply of Ontario Registered Nurse Graduates
Note. First year intake and graduation numbers are based on full-time students entering the first year of the
baccalaureate program (includes Second-Entry Programs but excludes post RN programs).
2001-2002 – Last intake of diploma programs; first intake for collaborative programs; first intake of compressed
baccalaureate.
2004 – Graduates of last intake of diploma + compressed + part-time and diploma and baccalaureate graduates
(not collaborative).
Source: Individual university and college reports, 2008.
Figure 2. First Year Intake and Supply of Ontario Registered Practical Nurse Graduates
Source: Ministry of Training, Colleges and Universities 2008; Individual university and college reports, 2008.
The intake and graduation numbers of RNs fluctuate but are on an upward trend.
The intake and graduation numbers of RPNs are on a continual upward trend.
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INTEGRATION OF NEW GRADUATES INTO THE WORKFORCE
Recognizing the prevalence of PT and casual employment in the provincial nursing
workforce, the government has made major policy changes to support every new Ontario
nursing graduate (RN and RPN) to find FT employment upon graduation. A targeted
employer incentive was launched to build capacity within the health care system for the
planning and management of the nursing workforce. The NGG was designed by the
MOHLTC to increase FT employment and to improve integration of new graduate nurses
into the workforce. A goal of the initiative is to provide FT positions to nurses who may
otherwise seek employment in other jurisdictions or professions. The overall intent is to
increase the total supply of nurses in Ontario (MOHLTC, 2008).
NURSING GRADUATE GUARANTEE INITIATIVE: BACKGROUND AND DESCRIPTION
In 2007, the MOHLTC announced $89.9 million to fund the NGG. The purpose of the
initiative is to finance FT six-month supernumerary (above staff complement) nursing
positions for all new nursing graduates. As part of the MOHLTC Health Human Resource
Strategy, the NGG is intended to ensure that every new RN and RPN nursing graduate who
wishes to work FT in Ontario will have that opportunity (MOHLTC, 2007).
According to the guidelines of the NGG initiative, the MOHLTC provides funding for
temporary FT supernumerary positions for six months for new nursing graduates who have
secured their position by using the online nursing graduate portal. The intent is to provide
employers with the time to build capacity within their organizations, so that they might be
able to offer permanent FT employment to the new graduate nurses. After a minimum period
of three months but within six months, the MOHLTC expects employers to use their best
efforts to hire new graduate nurses into a permanent FT position, unless there are outstanding
reasons not to continue the employment. Employers must commit to providing an additional
six weeks of FT supernumerary time and funding for the new graduate nurses if they are
unable to offer them a permanent FT position within the six-month period. The NGG has
completed its second year of funding (2008-2009) and is continuing for the graduates of
2009-2010.
A targeted employer incentive was launched to build capacity within the health care system.
The NGG funds provide temporary Full-time supernumerary positions for six months for new nursing graduates.
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NURSING GRADUATE PORTAL – HEALTHFORCEONTARIO
The NGG uses an online employment portal (HealthForceOntario or HFO) to link new
nursing graduates with employers who are interested in hiring them (HFO, 2009). Both
nursing students and employers must register on the portal to participate. Appendix A
clarifies the NGG application process via the nursing graduate portal.
EVALUATION OF NURSING EMPLOYMENT IN ONTARIO 2008
This report is the second year evaluation of the NGG. Appendix B outlines the strategies,
methodology and participants involved in the study. There are four target populations: new
nursing graduates, employers, mentors and union representatives. The objectives of the NGG
initiative, as outlined by the MOHLTC (2008), are as follows:
• Provide every new graduate with the opportunity for FT employment in Ontario
• Promote the availability of permanent FT positions for new graduates
• Facilitate “matching” between new graduates and employers
• Create bridging positions for new graduates
• Support Ontario’s new graduates as they transition into practice
• Improve integration of new graduates into the workforce
• Promote retention among Ontario’s nurse graduates
• Facilitate recruitment to all sectors
• Transform employer practices to maximize availability of FT nursing positions for all
nurses
• Increase the total supply of nurses in Ontario by providing FT employment to nurses who
may otherwise seek employment in other jurisdictions or professions
An online employment portal links new nursing graduates with employers who are interested in hiring them.
Both nursing students and employers must register on the portal to participate.
26
METHODS
A triangulation design (see Box 1) was used to assess the employment status of 2008
graduating nurses in Ontario and evaluate the NGG.
Box 1. Triangulation Design
Data was collected by administering surveys to new graduates (RNs and RPNs), employers
(registered and non-registered) and union representatives. The surveys were designed to
evaluate users' experiences with the nursing graduate portal and during extended orientation
and transition into employment, employment status and area of practice, new graduate
preferences and collaboration with bargaining units. Data was also collected through focus
groups with select employers and key informant interviews with new graduates, nurse
mentors and union representatives. A comparison was made to other existing databases (CIHI
and CNO). The data reported in this study identifies both the source and the relevant
respondents.
SAMPLE
The overall sample included new graduates, employers, mentors and union representatives.
Information was obtained using the three surveys outlined above and the stakeholder analysis
(employers, new graduates, nurse mentors and union representatives). The surveys and
guidelines for the focus groups and interviews were developed with input from expert senior
researchers at the Nursing Health Services Research Unit (NHSRU) and senior policy
analysts from the MOHLTC. A grey literature search of media releases and news bulletins
Surveys • New Graduate Evaluation of the Nursing Graduate Guarantee 2008-2009 • Employer Evaluation of the Nursing Graduate Guarantee 2008-2009 • Union Representative Evaluation of the Nursing Graduate Guarantee 2008-2009
Focus Groups • Employer Focus Groups – acute care (large, medium, small, and rural), long-term
care, public health and community
Key Informant Interviews • New Graduates of 2008 Key Informant Interview Guide • Nurse Mentor Key Informant Interview Guide • Union Representative Key Informant Interview Guide
The evaluation of a policy requires a variety of research approaches.
Findings were compared to secondary databases (CIHI and CNO).
27
was conducted to collect all information related to the initiative. Content and face validity
testing were performed.
Participation in the qualitative stakeholder analysis included (i) 7 employer focus groups with
54 participants from acute care (large, medium, small and rural), long-term-care, public
health and community and (ii) key informant interviews with 16 new graduates (9 RNs and 7
RPNs), 4 frontline/experienced nurse mentors and 2 nursing union representatives. All survey
participants were directed to an information page that outlined the rationale of the study and
asked each person to consent to participate.
For the interviews and focus groups, the purpose of the study was explained to all participants
before the interview process began. All research instruments underwent the necessary ethics
review process and received final approval from the Hamilton Health Sciences Research
Ethics Board. The research team and the MOHLTC obtained the participants’ consent to
publish the survey and interview findings. Participants were guaranteed anonymity and
assured that no personal identifiers would be associated with responses to the questions.
Response rates for the quantitative survey are outlined in Table 1.
Table 1. Quantitative Survey Response Rates
New Graduate Evaluation of Nursing Graduate Guarantee 2008-2009 There were 998 respondents out of 3,550 NGP registrants (28%) • 715 RNs and 283 RPNs
Employer Evaluation of Nursing Graduate Guarantee 2008-2009 There were 435 respondents out of 1,300* employers (34%)
• 254 (58%) of the survey respondents were registered on the NGP • 181(42%) of the survey respondents were not registered on the NGP
Union Representative Survey 2008-2009 There were 144 respondents out of 413 representatives (35%) Note. NGP = nursing graduate portal; RNs = registered nurses; RPNs = registered practical nurses.
*This number includes registered and non-registered employers (contacted through Local Health Integration
Network CEOs).
ANALYSIS
Surveys were analyzed through SPSS (version 17.0). Responses to the interview and focus
group questions were taped during the time of the interview and subsequently transcribed.
28
Thematic analysis of the major issues was carried out. Upon detailed examination of the
interview results, major themes were highlighted and key findings were grouped
appropriately under each thematic heading. Recommendations were then developed from the
interview and focus group themes and survey findings.
DEMOGRAPHIC CHARACTERISTICS OF SURVEY RESPONDENTS
RN AND RPN NEW GRADUATES
The new graduate evaluation survey was sent to 3,550 new nurse graduates who were
registered on the nursing graduate portal (D. Torres, personal communication, May 20,
2009). Data collection took place between January 2009 and May 2009. Upon completion of
data collection, cleaning and refinement, a total of 998 valid responses remained in the
database; 715 from RNs and 283 from RPNs (see Appendix C).
Data analysis revealed that RN and RPN nursing graduates were comparable in gender
distribution but differed in age distribution. The ratio of females to males was 92:8 for RNs
and 90:10 for RPNs. Similar to last year’s findings, RN nursing graduates were younger
compared to their RPN counterparts; 68% of new graduate RPNs were older than 25 years of
age compared to only 49% of new graduate RNs. This age difference is important when
comparing the two nursing groups because age influences the worklife span of nurse
graduates as well as their work preferences and career mobility (Blythe et al., 2008).
According to the survey, the majority of RN (96%) and RPN (85%) new graduates were
working as nurses at the time of questionnaire completion. Almost all RN (98.9%) and RPN
(99.6%) new graduates who were working indicated that Ontario was their main employment
location. In terms of geographical location, the Toronto Central Local Health Integration
Network (LHIN) employed the largest percentage of RN (33%) and RPN (13%) new
graduates, followed by the Champlain LHIN (11% for both RNs and RPNs) and the
Hamilton, Niagara, Haldimand, Brant LHIN (9% for RNs and 12% for RPNs). Appendix D
shows the breakdown by LHIN for RNs and RPNs. According to the CNO (2008), general
class new RN and RPN member statistics were consistent with survey data in that the largest
percentage of RNs and RPNs were employed in the Toronto Central LHIN (26% and 12%
respectively) and the Champlain LHIN (13% and 12% respectively).
New graduate RPNs were older than new graduate RNs.
The CNO (2008), general class new RN and RPN member statistics were consistent with survey data.
29
EMPLOYER PROFILE AND PARTICIPATION
The employer evaluation survey was sent to all nursing employer organizations in Ontario
(1,300). In an effort to understand the underlying causes for not using the nursing graduate
portal, the evaluation included employers who did not register. Data collection was carried
out between January 2009 and April 2009. Upon completion of data collection, cleaning and
refinement, the final employer database had 435 valid responses; 254 (58%) from employers
who posted positions on the employment portal in 2008 and 181 (42%) from employers who
did not (see Appendix E). Of the employers surveyed, 449 (35%) registered on the
employment portal. Of those who registered, 301 (67%) matched employment positions with
new nurse graduates (D. Torres, personal communication, May 20, 2009). The following
section provides a demographic profile of employer survey respondents broken down by
registration status (i.e., employer registrants versus employer non-registrants).
Registered Employers
The majority of registered employers who responded to the survey fell into two main
organizational categories: acute care hospitals (41%) and long-term care facilities (36%).
Table 2 provides the full breakdown of employer survey respondents registered on the portal.
These percentages represent the number of employers who responded to the survey and are
not reflective of the number of jobs posted or nurses hired by each sector.
Table 2. Percentage of Registered Employer Survey Respondents by Type of Organization
Type of Organization Percentage (%)
Acute Care Hospital 40.6
Long-Term Care Facility 35.8
Public Health 5.5
Community (Community Health Centre, Community Care Access Centre, Mental Health, Physician Offices, Nursing Agency, Hospice)
4.7
Other Hospitals (Continuing Complex Care/Rehabilitation, Addiction and Mental Health)
4.3
Other (Family Health Team, Combined Acute and Long-Term Care, College/University)
9.0
Total 100.0
Source: Employer Evaluation of Employment Portal Survey, 2008-2009.
The main nurse employers in the province of Ontario are acute care hospitals and long-term care facilities.
30
In comparing the sector breakdown of portal registrants to the sector breakdown in the
province, an inverse relationship exists. Thirteen percent (13%) of nurse employers in
Ontario are acute care, 51% are long-term care and 36% are found in other sectors. However,
the opposite is true for the 449 portal registrants, 53% (238) of which were acute care
hospitals, 15% (67) were long-term care and 32% (144) were in other sectors. Based on the
data, there are many long-term care facilities in Ontario that are not registered on the portal.
Despite this, however, long-term care facilities provided a good response to the survey.
Half of the employer survey respondents were located in the following four LHIN regions:
North East (15%), Toronto Central (12%), Hamilton, Niagara, Haldimand, Brant (11%) and
Champlain (11%). The remaining organizations were distributed among the other nine LHINs
(on average 5% per LHIN). Appendix F provides a full breakdown of employer respondents
by LHIN.
Non-Registered Employers
Community organizations (35.8%) and long-term care facilities (32.0%) comprised the
majority of non-registered survey respondents. Table 3 provides the full breakdown of
organizational categories among non-registered employers.
Table 3. Percentage of Non-Registered Employer Survey Respondents by Type of Organization
Type of Organization Percentage (%)
Community (Community Health Centre, Community Care Access Centre, Mental Health, Physician Offices, Nursing Agency, Hospice)
35.8
Long-Term Care 32.1
Public Health 4.3
Other Hospitals (Continuing Complex Care/Rehabilitation, Addiction and Mental Health)
4.3
Acute Care Hospital 3.7
Other (Government, Association, Regulatory Body, Union, College/University, Retirement Home, Family Health Team)
19.8
Total 100.0
Source: Employer Evaluation of Employment Portal Survey, 2008-2009.
Large acute care hospitals have more postings on the portal compared to other sectors.
The highest percentage of non-participating employers was found in the community sector.
31
Over 60% of non-registered employers were found in the following five LHIN regions: North
East (16%), Hamilton, Niagara, Haldimand, Brant (14%), Toronto Central (13%), Champlain
(9%) and North West (9%). The remaining organizations were distributed across the other
nine LHINs (4% per LHIN on average). Additional information about the non-registered
employers can be found in the companion series report, Employer Engagement in a Policy
Initiative: Uptake of the New Graduate Guarantee.
Union Representatives
The union survey was sent to approximately 413 union representatives across the province.
This was the first wave of data collected from union representatives. Data collection took
place during March 2009. Upon completion of data collection, cleaning and refinement, a
total of 144 valid responses remained in the database.
ACTUAL EMPLOYMENT OF REGISTERED NURSES AND REGISTERED PRACTICAL NURSES
The New Graduate Evaluation of Nursing Graduate 2008 Portal Survey is the source for the
actual employment figures and results reported below. Comparisons are made with other
sources as indicated.
DISTRIBUTION OF NURSING GRADUATES BY TYPE OF EMPLOYER
As shown in Table 4, acute care hospitals were the largest employer of nursing graduates in
2008 (74.5%), with 86.1% for RNs and 40.8% for RPNs. By comparison, in 2007, there were
64.5% new graduates (83.2% for RNs and 32.7% for RPNs) employed by acute care hospitals
Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009. According to the New Graduate Evaluation of Nursing Graduate Portal Survey, 78% of RN
and 58% of RPN respondents indicated that their current employment status was by choice.
For nursing graduates who are not in a preferred employment status, the majority of RNs
(89.4%) and RPNs (72.7%) indicated that they preferred permanent FT positions. These rates
are higher than those reported by Ontario RN (75%) and RPN (60.5%) nursing graduates in
2005 (Baumann, Blythe et al., 2006). An additional 5.7% of RNs and 14.3% of RPNs
indicated preference for permanent PT employment in the 2008 portal survey (see Table 9).
Interestingly, this trend in preference for PT work has continued to decrease for RNs (from
The overall preference for full-time continues to increase.
The full-time employment trend continues in an upward direction.
39
10.0% in 2007 to 5.7% in 2008) but increase for RPNs (from 10.3% in 2007 to 14.3% in
2008). See Appendix J for a full breakdown of employment preference.
Table 9. Percent Distribution of Employment Preference by Nurse Group 2008
Nurse Group
Is Employment Status by Choice? Employment Status is not by Choice
Yes
No
Would Prefer Permanent Full-Time
Would Prefer Permanent Part-Time
Registered Nurses
78.0% (432)
22.0% (123)
89.4% (108)
5.7% (7)
Registered Practical Nurses
58.2% (106)
42.8% (76)
72.7% (57)
14.3% (11)
Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009. Respondents who were not currently employed in nursing (4% of RNs and 15% of RPNs) but
who were looking for jobs in their field were asked to identify the type of position they were
looking for. Overall, 50% of new graduates (57% of RNs and 45% of RPNs) indicated that
they were looking for a permanent FT job. In addition, 13% (9% of RNs and 17% of RPNs)
were seeking permanent PT employment, 2% were seeking temporary PT (4% of RNs and
0% of RPNs) and 6% (4% of RNs and 7% of RPNs) were seeking casual employment. The
remaining 29% of new graduates indicated they were seeking multiple employment. This rate
was higher for RPNs than RNs (31% and 26% respectively).
PREFERENCES FOR EMPLOYMENT LOCATION: RNS AND RPNS
The majority of New Graduate Evaluation of Nursing Graduate Portal Survey respondents
indicated that they were employed in a geographic region of choice. This rate was higher for
RNs (96.3%) than RPNs (91.4%) and has increased for both groups since 2007. In previous
years, respondents were asked to select "all that apply" when giving preferences for
employment. This year, respondents were asked to prioritize their preferences for
employment location, sector and area of practice by selecting only their top three choices.
This method was used to obtain a more accurate view of nurse preferences. The preferences
were then weighted according to their priority and given a weighted value. A total of 3.7% of
RNs and 8.6% of RPNs were not employed in their geographic region of choice. The three
most preferred LHINs for RNs were Erie St. Clair, Toronto Central and South West. The
The majority of respondents indicated that they were employed in a geographic region of choice.
The regions of choice for RNs are Central and Southern Ontario.
40
three most preferred LHINs for RPNs were Toronto Central, Central and Central East. See
Appendix K for a full list of LHINs ranked by preferred employment location.
It is difficult to make a valid comparison between 2007 and 2008 because of the difference in
data collection methods used for employment location preferences. However, some trends
may be noted. In 2007, 18.4% of RN respondents preferred to work in the Mississauga
Halton and Central East LHINs, followed by 16.4% in the Toronto Central LHIN and 14.3%
in the Central West LHIN. In contrast, 21.5% of RPN respondents preferred to work in the
Toronto Central LHIN, followed by 13.9% in the Mississauga Halton LHIN and 11.4% in the
Erie St. Clair LHIN.
Respondents who were not currently employed (4% of RNs and 15% of RPNs) in nursing but
who were looking for jobs in their field were asked to identify the top three LHIN locations
where they were seeking employment. Using a similar weighting system as described above,
it was found that RN new graduates were seeking employment in the Toronto Central,
Central and Central East LHINs. They were not looking for employment in the Waterloo
Wellington, South East or North Simcoe Muskoka LHINs (all received a zero rating by RNs).
The top three locations for RPN new graduates were the Toronto Central, Central and
Mississauga Halton LHINs. See Appendix L for full breakdown of the LHIN locations where
new graduates seek employment.
PREFERENCES FOR SECTOR OF EMPLOYMENT AND CLINICAL AREA OF PRACTICE: RNS AND RPNS
Trends in preferences for sector of employment and area of clinical practice help to inform
recruitment strategies. The majority of respondents indicated that they were working in their
preferred area of practice (88% for RNs and 73% for RPNs). For RNs not working in their
clinical area of choice, almost three-quarters (73%) preferred to be working in the following
five areas of practice: maternal-newborn (18%), public health (15%), surgery (15%), critical
care (14%) and emergency (11%). For RPNs, almost two-thirds (60%) preferred to be
working in the following five areas of practice: medicine (14%) maternal-newborn (13%),
surgery (13%), emergency (11%) and mental health/psychiatric/addiction (9%).
The top regions of choice for RPNs were in the Greater Toronto Area.
The majority of nurses work in their preferred area of practice.
41
Respondents who were not currently employed (4% of RNs and 15% of RPNs) in nursing but
who were looking for jobs in their field were asked to identify the type of employer being
sought. Registered nurses rated acute care (weighted value of 216) as the top sector (weighted
value of 216), followed by community (124), public health (85) and long-term care (34).
Acute care (177) was the sector most sought by RPNs, followed by long-term care (104),
community (76) and public health (27).
In terms of clinical area of practice, RNs were seeking employment in emergency (89),
closely followed by medical-surgical (83) and maternal-new born (82). Registered practical
nurses were seeking employment in geriatrics (105), followed by medical-surgical (68) and
complex continuing care (53). These findings are similar to previous years. The primary areas
of practice sought by RNs who graduated in 2005 and 2007 were medical-surgical units in
acute care hospitals and emergency. The primary areas of practice sought by RPNs in 2007
were geriatrics and complex continuing care.
PREFERENCES FOR MOBILITY AND MIGRATION: RNS AND RPNS
In 2008, 5.9% of survey respondents indicated that they did not want or were not seeking
employment in Ontario. Compared to the results from the 2007 RN and RPN surveys, this
percentage is substantially lower. According to the earlier survey, 33% of RNs and 22% of
RPNs were interested in seeking employment outside Ontario. In addition, 0.9% of all 2008
survey respondents reported their current location of employment as outside Ontario but
within Canada. The top three reasons why nurses chose to accept a position in nursing outside
Ontario were better salary and benefits (21.7%), the belief that better career opportunities
existed (17.4%) and personal (17.4%). Payment of relocation expenses (13.2%), better
scheduling practices (13.2%) and education and training (13.2%) would motivate these
nurses to return to Ontario.
PROVINCIAL AND CANADIAN COMPARISON
To further analyze the change in employment status for Ontario nursing graduates, the
following section presents comparisons of two sets of employment data publications (CNO
new members, 2008 and CIHI, 2006) to the 2007 and 2008 new graduate portal data findings.
Five comparisons are drawn with the 2007 and 2008 portal findings:
The percentage of nurses seeking employment outside Ontario is small.
42
(i) CNO general class new members for years 2005-2007
(ii) CIHI Ontario work status numbers for RNs for years 2004-2006
(iii) CIHI Canadian work status average for RNs for years 2004-2006
(iv) CIHI Ontario work status average for RPNs for years 2004-2006
(v) CIHI Canadian work status average for RPNs for years 2004-2006
COMPARISON TO COLLEGE OF NURSES OF ONTARIO GENERAL CLASS NEW MEMBERS
Full-time employment status of 2007 CNO RN new members (76%) compared to the 2008
RN new graduates (83%) shows a similarly high proportion of RNs working on a FT basis in
Ontario. This trend can be seen across the three years of CNO data and the two years of
portal data presented here. As shown in Figure 3, there has been an increase in the proportion
of CNO RN new members working FT since 2005 (from 47% in 2005 to 76% in 2007). For
portal data, the trend across the two years shows a slight drop in the proportion of RNs
working FT (from 85% in 2007 to 83% in 2008), but the rate of FT status remains high. This
is coupled with a drop in the proportion of RNs working on a PT basis over the same time
period. In 2005, 40% of CNO RN general new class members were working PT. By 2007,
however, this rate had dropped to 21%. For new graduates, no change was seen across the
two years (2007 and 2008).
Figure 3. Comparison of Employment Status Between Registered Nurse Graduates 2007-2008
and College of Nurses of Ontario Registered Nurse New General Class Members 2005-2007
Neither receptive nor unreceptive 13.2 1.6 2.7 2.7
Unreceptive or very unreceptive 2.2 0.8 1.4 0.7 Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009.
WORKPLACE IMPROVEMENTS TO PROMOTE RECRUITMENT AND RETENTION
Stakeholders strongly supported the NGG initiative, indicating that the overall impact has
positive effects on the future employment of nurses. Employers in the focus groups thought
the 24/7 availability of the portal was valuable for recruitment activities. They like it because
"everything is there, the history is there, the résumés, the offer letter . . . it’s terrific." An
employer described as "one of the most important recruitment initiatives we take part in."
Employers stated that they get very high calibre RNs and RPNs through the NGG. The
extended orientation, supplementary FT positions and the reinvestment of additional funding
were viewed as definite benefits to the workplace and human resource planning.
Employers and new graduates saw the opportunity to offer extended orientation as a major
benefit to the ease of transition of new graduates into the workplace. One employer said:
I would hope that the NGG has an impact on recruitment into the nursing profession .
. . it builds their confidence, skills, working relationships, and understanding . . . so if
there was some sense of permanence to this initiative, I think that would send a great
message to people who might be considering nursing.
Employers reported that their regular orientations were improved because new graduates and
new nurses often oriented together. One employer noted that orientation has been totally
revamped.
Human resource planning is affected by the innovative strategies used to create FT positions.
Employers indicated that the initiative assists them in their workforce planning because they
know in advance that they can prepare for the employment of new graduates. They have
Employers believe this is an important recruitment initiative.
Employers reinforce that the NGG is a unique human resource strategy.
72
developed strategies to hire new graduates such as float pools and collapsing PT positions.
While new graduates reported that they sometimes prefer to stay in a PT position in an area
of choice, the NGG increased the option of FT positions. Employers reported that the
initiative forced them to build capacity by focusing on how to keep new graduates employed
in their organization, especially in the face of the high numbers of nurses approaching
retirements.
REINVESTMENT OF FUNDS: HOW ARE THEY USED AND WHO BENEFITS?
All sectors viewed the ability to reinvest the funds into educational initiatives as a major
benefit of the NGG. Variability existed across sectors and LHINs in the ability of the
organization to transition out the new graduates before the six-month orientation period
ended. The larger acute care centres realized the greatest benefits because they were able to
bridge the new graduates into FT positions after three to five months of orientation.
Employers reported that educational activities were enhanced province wide through various
ways.
On the survey, employers were asked about the reinvestment of remaining funds. Of those
who answered the question, 38.6% said they were able to use remaining funds for
reinvestment initiatives, 61.4% said they were not. As shown in Table 18, the majority of
employers allocated funds to backfill the 80/20 initiative (70.2%), support interprofessional
mentorship and preceptorship programs (59.6%) and internships for experienced nurses in
specialty areas (34.0%).
Table 18. Percent Distribution of Initiatives Employers Chose to Reinvest Funds
Initiatives Percentage of Employers
80/20 for staff nurses 70.2
Interprofessional mentorship and preceptorship programs 59.6
Internships for experienced nurses in specialty areas 34.0
Support internationally educated nurses and nurses re-entering the workforce 14.9
Other 12.8 Note: Numbers do not add to 100% because employers were asked to check all that apply Employers in the focus groups provided additional information and suggestions regarding the
reinvestment of extra funds. Employers in public health explained that they are usually
A variety of strategies were used for reinvesting the remaining funds.
73
unable to realize any extra funding because the FT positions offered in public health are in
the contract category. The larger acute care centres had the option to bridge new graduates
into large float pools as early as three months. Thus they were able to benefit by being able to
keep the extra funds.
Some employers also offered suggestions about the use of the funding. One employer thought
it would be helpful to use the bridging money to "carry" new graduates who fail the exam.
The nurses would be kept in a personal support worker role until they passed their exam.
Employers mentioned the short time line between when they know they will have the funding
to when it needs to be spent. One employer noted that this is particularly problematic when
someone is starting a position in June (or even later): "We may not realize until December
that we have extra funding but it needs to be spent by March 31 of the following year . . .
because it's a perpetual program and the funding isn’t perpetual. So they don’t match, they
don't align." Employers would like the money to be usable for a full year as opposed to the
current time limits.
ADMINISTRATIVE AND BUDGETARY ISSUES
EMPLOYER COMMUNICATION WITH THE MINISTRY OF HEALTH AND LONG-TERM CARE
The majority of employers were either neutral or satisfied with their experience accessing
funds through the NGG (75.4%) and using the MOHLTC service level agreement (77.6%).
However, compared to 2007, a greater percentage of employers rated accessing funds through
the NGG as difficult or very difficult (24.6% compared to 12.4%) and using the MOHLTC
services agreement as difficult or very difficult (22.5% compared to 4.7%). Table 19 provides
a breakdown of employer ratings of their experiences.
There continue to be issues with the online service agreements.
74
Table 19. Employer Rating of Their Experience Accessing Nursing Graduate Guarantee
Funds and Using the Ministry of Health and Long-Term Care Service Level Agreement
Rating
Accessing Funds Through the Nursing Graduate Guarantee
Initiative (%)
Using the Ministry of Health and Long-Term Care Services Level Agreement
(%)
2007 2008 2007 2008
Easy or very easy 36.1 28.3 43.0 31.2
Neither easy nor difficult 51.5 47.1 52.3 46.4
Difficult or very difficult 12.4 24.6 4.7 22.5
Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009.
Employer responses in the focus groups were varied and not sector specific. Some indicated
that they had no concerns and found it easier when the service agreement was done
electronically. The increased difficulties expressed by employers in the survey were also
reflected in the focus groups. Technical difficulties were a strong theme and were mentioned
across the sectors. The most frequently mentioned difficulty was the E-signature. As reported
by long-term care, "the biggest concern from all the homes was the signing of reports and
having the different log-on names."
Obtaining the sign-offs was a time-consuming process that involved multiple steps.
Furthermore, the timelines were very tight. One acute care employer suggested it would be
easier to enter monthly: "We have 200 graduates . . . it's a huge endeavour given the short
turnaround." The timeline was especially tight because of the deadline coinciding with
Christmas. Employers would like acknowledgement that the submission was received. One
employer stated, "No one got back to me . . . even the ones that were done and signed off in
December . . . we’re still waiting."
Employers also commented on their experience of trying to get help with electronic reporting.
Some employers found the help to be excellent and timely. However, an employer from long
term care said, "I actually put in for help and I never got any." An acute care employer
reported being able to get help earlier in the process, but when the deadline was approaching,
The help line was sometimes not accessible due to volume issues.
75
"it was anxiety-producing to not have someone on the other end when we called." An
employer from a rural area reported: "[It] was well over a week before we had a report back
from help desk . . . I guess they were inundated so much for the submission period." A
community employer said:
When doing the interim report and budget submission, [there is] only one person at
HFO and one at the Ministry to service all of us . . . they are on the phone constantly,
so it is hard to get through. Additional resources are needed at the time of the
deadlines.
The difficulties employers had were in relation to report submission, which they said was a
challenge even with support. Some felt the support they received was excellent: "Helpline for
funding submission was very helpful . . . received very good support." Others found that the
helpline was too busy during report and budget submission time and that "turnaround time for
help with reinvestment funds submission was days." Similar to last year, employers
mentioned that there was some confusion around HFO and the Nursing Secretariat with
respect to who was responding to which issues.
ORGANIZATIONAL BENEFITS AND FINANCIAL RESTRAINTS
Employers reported strong support for the initiative from a financial perspective. Although
some organizations benefited more than others, all sectors said they would participate again.
The larger acute care urban centres particularly benefited because they offered FT positions,
in many cases after three months. In the sectors where FT positions could not be readily
offered, organizations realized fewer benefits. For example, long-term care employers
reported that while they felt it was an excellent initiative, they do not have FT positions to
offer. Thus, in most cases, they paid the last six weeks of the orientation and then found that
nurses left for a FT position in another sector. The organization then felt it had committed a
lot of time, effort and money without the long-term benefits. The community sector has
similar problems offering FT positions and finds it difficult to compete with acute care.
Graduates leaving after the supernumerary position has ended is also a concern for acute care
centres. Organizational investment of time becomes problematic when new graduates do not
stay. One employer in the long-term care sector suggested that the issue of allowing for an
The long-term care and community sectors believed there was still an issue with new nurses being oriented and then leaving.
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administrative cost should be revisited. The public health sector also indicated that because
their positions are contract, they generally do not realize any extra funding. The option to use
the remaining funds for educational programs was viewed as a major benefit by those who
can offer FT positions.
All stakeholders, employers, new graduates, mentors and union representatives strongly
believe that the orientation and mentoring is a major benefit to all concerned. Unfortunately,
there were some circumstances where new graduates felt used by the organization and
indicated they did not have a good mentoring experience. However, the overwhelming
response by new graduates was that the opportunity to integrate into the workplace gradually,
with the support of mentors and other staff members, was professionally beneficial.
Employers are unanimous in their recognition of the financial and workforce planning
benefits the initiative provides. They are able to factor in the new graduate recruits into their
workforce planning from year to year, knowing the initiative produces high quality
employees ready to take on FT employment.
WOULD THERE BE EMPLOYER SUPPORT FOR THE INITIATIVE AT LEVEL IV CLINICAL?
There were diverse responses to the question of whether there was any support for beginning
the initiative during the fourth-year clinical experience. The following issues were mentioned
by employers participating in the focus groups.
Preference for More Advanced Skills and Temporary License
A common concern was that fourth-year students would not work as well for the initiative as
new graduates because they would be more limited in what they would be able to do. Without
a temporary license, they would not be able to participate in the same capacity as a new
graduate. The issue of independent practice was raised by the public health sector, which
preferred to have new graduates with a "temporary license because then they can do pretty
well everything once they get oriented." Some employers in acute care had mixed feelings
and indicated they are not sure they would be in favour of having the initiative moved to
fourth-year clinical placement rather than upon graduation.
Financial and workforce planning benefits far outweigh any organizational issues.
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University Semester is too Short
It was mentioned that for those who need only three months, the initiative might work during
fourth-year clinical. However, for those who need four to six months, the timing would
conflict with the student schedule for other courses and other clinical placements. The
varying lengths of time needed by the new graduates to transition into FT work can be
accommodated within the current arrangements. As noted by one employer: "It works well as
a new graduate initiative."
Impact of Variation in Clinical Placement Experiences
The larger acute care hospitals expressed concern that placing the initiative at fourth-year
clinical would limit the number of new graduates they could hire. One employer explained,
"It is very competitive to get a consolidation here, so we can’t bias our new graduate
positions to only those who are successful in getting a placement."
Employers in rural areas had different concerns. They said they may not be able to access the
dollars for such an initiative in fourth-year clinical because they do not have that many
consolidation students—maybe only a couple a year. They did say it might be possible if they
could work it out by having partnerships with universities. Another rural employer had a
different response and indicated that they have been trying to make connections with students
sooner: "We are way up north and they only stay a couple of years. It doesn’t matter whether
it is a student or new graduate; they only stay a few years."
Community employers said that it would be almost like an internship, which they felt can be
successful. They were concerned, however, that they would have some of the same
recruitment issues in fourth-year clinical as they do now because "the wage parity just isn’t
there." Long-term care saw it as a way of getting clinical placements for fourth year, which
they would support. They feel they need students at the third- and fourth-year levels. They
would like to have fourth-year students so that the students could learn more about
leadership. One long-term care employer said, "We have been trying to get a fourth-year
placement in long-term care for quite a while."
The long-term care sector was the only sector that was interested in the initiative being offered in fourth-year clinical placement.
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Support Mixed With Ambivalence
Even those employers who could support the idea said they were ambivalent, particularly
because they did not want to give up the new graduate initiative. One employer from a
smaller acute care hospital expressed interest because currently "the students don’t get a lot
of placements in the hospital but lots . . . [in the] community." The overall concern is that
they like the NGG and hesitate to give that up for an initiative that has more unknowns for
them. Employers who had the least reservations were from the long-term care sector.
HOW CAN NURSES BE RECRUITED INTO LONG TERM CARE: EMPLOYER PERSPECTIVE FROM ALL SECTORS
Issue of Differences in Remuneration
One of the major concerns mentioned by employers in long-term care and other sectors was
salary differences with lower remuneration. One rural employer stated, "People are not going
to work in a long-term care facility where the wages are 30% less than it would be in a
hospital." Long-term care employers were in agreement about the issue of wage disparity and
felt something needs to be done to equalize both wages and pensions.
A Different Emphasis on Long-Term Care in School
Employers also mentioned that students are exposed to long-term care in their first and
second year and that this exposure is the personal support worker side of long-term care.
Long-term care employers said, "If we could get them exposed in the third and fourth year,
they would see the leadership component of the role of the RN and the community health
work that the RN does within a long-term care setting." Employers agreed that there needs to
be more emphasis on the complexity of the role: "[Students] come out of school thinking they
are going to be functioning with a very limited scope of practice in the long-term care sector."
One of the long-term care rural employers observed:
They can see many patients with a vast array of issues and that is one of the
challenges . . . there is a lot of talent involved . . . [there] has to be greater emphasis in
school on what long-term care offers.
A long-term care employer said: "What we have seen over the last few years with the RNs is
they just don’t know that long-term care is a career choice." Numerous employers also
Sector differences in remuneration continue to be a recruitment issue.
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mentioned that the reason long-term care is not attractive to graduates is because of the paper
work involved.
CONCLUSION
Over the past 10 years, there has been a dramatic improvement in the employment status for
nurses in Ontario. In 1998, over 60% of nurses were PT or casual. Today, 64% of all nurses
and 76% of new graduates are employed FT.
EMPLOYMENT TRENDS: STATUS, LOCATION, SECTOR AND PREFERENCES
Since 2005, FT employment has increased 24% for new graduate RNs and 29% for new
graduate RPNs. The Toronto Central LHIN employs the largest percentage of new graduates,
and 75% of all new graduates are employed in the acute care sector. Overall, the community
and long-term care sectors hired fewer new graduates in 2008 compared to 2007. The
majority of RNs (88%) and RPNs (73%) surveyed indicated they were working in their
preferred area of clinical practice. The primary areas of practice for RNs were medicine,
surgery, emergency and maternal-newborn. The primary areas of practice for RPNs were
geriatrics, medicine and complex continuing care.
NGG EVALUATION: POSTING AND MATCHING ON THE HEALTHFORCEONTARIO PORTAL
Compared to last year, employers and new graduates found the portal easier to use; however,
employers reported that new graduates required assistance from them to apply on the portal.
The applicant pool was found to be smaller for certain sectors and locations (e.g., long-term
care and rural areas). Some new graduate portal registrants (34%) said they secured a position
outside the portal (compared to 43% last year). The portal was viewed positively in regard to
posting and matching, but employers expressed frustration with the online budget reporting
and found the E-signatures to be labour intensive.
NGG EVALUATION: ONLINE BUDGET REPORTING
Although not all employers had difficulty, a substantial number indicated the online budget
reporting method is an area that they would like to see improved. Obtaining E-signatures was
the most reported problem area. Those who had difficulty also indicated that the help line was
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not sufficiently available during the week of the report deadline and felt it was likely due to
an overwhelming number of calls to the Ministry.
NGG EVALUATION: ORIENTATION/MENTORSHIP PHASE
Experienced nurses were supportive and willing to provide the mentorship needed for the
new graduates, although some employers expressed concern about mentor and preceptor
burnout. Some of the employers in public health and community reported that one-to-one
supervision can interfere with client load demands. The overall response to this phase of the
NGG was overwhelmingly positive. However, the experience was not positive for a small
percentage of the new graduates in acute care and long-term care.
*Ministry of Health and Long-Term Care provides funding for up to six months for each matched position
Bridge to FT Position
No reinvestment opportunity
Did not bridge to FT position
Employer must provide and fund an additional six weeks of FT supernumerary employment
Bridge to FT
Did not bridge. Employer obligation completed
Before six months
At six months
NEW GRADUATE REGISTRATION
EMPLOYER REGISTRATION
Employers may reinvest remaining funds in the following: - Interprofessional mentorship and preceptorship programs - 80/20 for staff nurses - Internships for experienced nurses in specialty areas - Support internationally educated nurses re-entering the workforce
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APPENDIX B. NURSING GRADUATE GUARANTEE INITIATIVE
Orientation & Mentoring Programs
HealthForceOntario Nursing Graduate
Portal
NHSRU New Graduand 2007
Survey
Temporary Full-Time Positions
(Supernumerary)
Employer Demonstration
Projects
Ontario Nursing Employers
Ontario 2007 New Graduates
MOHLTC New Graduate
Guarantee
Impact and Process Evaluation (i) Surveys • New Graduate Evaluation of Nursing Graduate Portal 2008-2009 • Employer Evaluation of Employment Portal 2008-2009 • Evaluation of the Nursing Graduate Guarantee --Union Representative Survey
2008-2009 (ii) Stakeholder Analysis Focus Groups • 7 Employer Focus Groups with 54 participating employers from acute care (large,
medium, small, and rural), long-term care, public health and community) Interviews • New Graduates of 2008 Key Informant Interview Guide • Senior Nursing Staff Key Informant Interview Guide • Union Representative Key Informant Interview Guide
APPENDIX C. DATA COLLECTION AND REFINEMENT OF THE NURSING GRADUATE PORTAL EVALUATION SURVEY
Cleaning Stages Nursing Graduates Total Valid Responses Response Rate
Number of Responses Received
Number Providing
Consent to Participate
Number of Valid Entries
(Complete and Non Duplicate)
Registered Nurses
Registered Practical Nurses
Total Responses/
Total Registered*
Total Valid/Total Registered*
1048 1035 998 715 283 29.5% 28.1% Note. Total number of Nursing Graduate Guarantee portal registrants was 3,550.
Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009.
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APPENDIX D. PERCENT DISTRIBUTION OF NURSING GRADUATES BY NURSE TYPE AND LOCAL HEALTH INTEGRATION NETWORK REGION
Number Local Health Integration Network Region
Registered Nurse
Registered Practical
Nurse
Total
1 Erie St. Clair 4.1% 7.1% 4.7% 2 South West 8.2% 8.4% 8.3% 3 Waterloo, Wellington 4.7% 5% 4.7% 4 Hamilton, Niagara, Haldimand,
Brant 8.8% 11.8% 9.5%
5 Central West 1.6% 2.5% 1.7% 6 Mississauga, Halton 6.5% 9.7% 7.2% 7 Toronto, Central 33.4% 12.6% 28.2% 8 Central 7.1% 7.6% 7.1% 9 Central East 5.2% 7.9% 5.8% 10 South East 0.01% 5.5% 2.1% 11 Champlain 11.1% 11.3% 11.1% 12 North Simcoe Muskoka 2.0% 3.8% 2.4% 13 North East 4.3% 5.5% 4.6% 14 North West 3.0% 1.3% 2.6% Total 100.0% 100.0% 100.0%
Note. The vast majority of graduate registered nurses (96%) and registered practical nurses (91%) indicated that
they were employed in their geographic region of choice.
Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009.
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APPENDIX E. DATA COLLECTION AND REFINEMENT OF THE EMPLOYER PORTAL EVALUATION SURVEY
Cleaning Stages Employers Valid Responses
Response Rate
Number of Responses Received
Number Providing
Consent to Participate
Number of Valid Entries (Complete &
Non Duplicate)
Posting Position on Portal
Valid Registered/
Total Registered
Valid Posting/Total
Posting
486 479 435 210 56.5%* 82.6%** Note. Response rate calculations will be based on the number of employers registered at the portal rather than
**Valid postings (210)/total number of registered employers (254) = 82.6%.
Source: Employer Evaluation of Employment Portal Survey, 2008-2009.
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APPENDIX F. PERCENT DISTRIBUTION OF EMPLOYER SURVEY RESPONDENTS BY REGISTRATION STATUS AND LOCAL HEALTH INTEGRATION NETWORK
Number Local Health Integration Network Region
Portal Registered
Non-Registered
Total
1 Erie St. Clair 4.33 2.67 3.7% 2 South West 9.06 3.21 6.7% 3 Waterloo, Wellington 4.72 2.67 3.9% 4 Hamilton, Niagara, Haldimand,
Brant 11.42 13.90 12.6%
5 Central West 1.97 4.81 3.2% 6 Mississauga, Halton 3.54 6.42 4.8% 7 Toronto, Central 11.81 13.37 12.6% 8 Central 3.54 4.81 4.1% 9 Central East 8.27 3.74 6.4% 10 South East 2.36 5.35 3.7% 11 Champlain 11.02 8.56 10.1% 12 North Simcoe Muskoka 3.94 3.74 3.9% 13 North East 15.35 16.04 15.9% 14 North West 6.69 8.56 7.6% Other 1.97 2.14 2.1% Total 100.0% 100.0% 100.0%
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APPENDIX G. PERCENT DISTRIBUTION OF NURSING GRADUATES BY PRIMARY AREA OF PRACTICE AND NURSE GROUP 2007 TO 2008
APPENDIX I. DISTRIBUTION OF NURSING GRADUATES BY EMPLOYMENT LOCATION AND NURSE GROUP
Employment Location Percentage Within Nurse Group Total Registered Nurse Registered Practical
Nurse Employed in Ontario 99.0 99.6 99.1 Employed in another Canadian province 1.0 0.4 0.9 Employed in the United States 0.0 0.0 0.0 Employed outside Canada 0.0 0.0 0.0 Total 100.0 100.0 100.0 Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009.
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APPENDIX J. A COMPARISON OF EMPLOYMENT PREFERENCES OF NURSING GRADUATES BY NURSE GROUP 2007-2008
Nurse Group Employment Status is by Choice
Employment Status is not by Choice
2007 2008 Would Prefer Permanent Full-Time
Would Prefer Permanent Part-Time
2007 2008 2007 2008
Registered Nurses
76.5% 78.0% 85.5% 89.4% 10.0% 5.7%
Registered Practical Nurses
51.9% 58.2% 88.5% 72.7% 10.3% 14.3%
Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.
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APPENDIX K. EMPLOYMENT REGION PREFERENCE OF NURSING GRADUATES BY NURSE GROUP
Registered Nurse Registered Practical Nurse
Employment is in region of choice 96.4% 91.4%
If not, where would you like to work?
Local Health Integration Network Location Ranked By Preference
Weighted Value
Erie St. Clair 132 77 South West 73 56 Waterloo, Wellington 34 45 Hamilton, Niagara, Haldimand, Brant 31 26 Central West 36 22 Mississauga, Halton 70 53 Toronto, Central 73 98 Central 39 81 Central East 17 79 South East 11 19 Champlain 35 30 North Simcoe Muskoka 14 0 North East 22 15 North West 14 0 Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009.
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APPENDIX L. LOCAL HEALTH INTEGRATION LOCATIONS WHERE NEW GRADUATES SEEK EMPLOYMENT BY NURSE GROUP
Registered Nurse Registered Practical Nurse
Percentage seeking employment 5% 14%
Local Health Integration Location Ranked by Preference
Weighted Value
Erie St. Clair 15 22
South West 43 24
Waterloo, Wellington 0 16
Hamilton, Niagara, Haldimand, Brant 15 30
Central West 32 47
Mississauga, Halton 72 87
Toronto, Central 192 126
Central 107 109
Central East 82 42
South East 0 7
Champlain 15 34
North Simcoe Muskoka 0 27
North East 13 18
North West 15 11
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APPENDIX M. EMPLOYERS’ RATING OF THEIR SATISFACTION WITH THE EMPLOYMENT PORTAL Table 1. Employers’ Rating of Their Satisfaction With Employment Portal Instructions
Rating (%) Clarity of Registration Instructions
Clarity of Posting Instructions
Clarity of Matching Instructions
2007 2008 2007 2008 2007 2008
High or very high 69.1 73.2 63.2 75.2 66.7 70.5
Neutral 11.8 12.1 17.1 11.8 19.0 18.1
Low or very low 19.1 14.8 19.7 13.1 14.3 11.4 Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009. Table 2. Employers’ Rating of Their Satisfaction With Employment Portal Website
Rating (%) Design of Portal’s Website User-Friendliness of Website
2007 2008 2007 2008
High or very high 36.5 23.4 39.6 40.4
Neutral 30.2 39.0 37.7 35.5
Low or very low 33.3 37.6 22.7 24.1 Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009.
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APPENDIX N. NEW NURSING GRADUATE AND EMPLOYER RECOMMENDATIONS FOR THE IMPROVEMENT OF NURSING GRADUATE EMPLOYMENT PORTAL Introduction
The employment portal evaluation surveys were conducted from January 2009 to June 2009.
Both new nursing graduates and employers gave the portal high ratings.
This document is a subsection of the larger report on the evaluation of the Nursing Graduate
Guarantee. It is a summation of data that comes from open-ended survey questions: questions
#23/45 from the New Graduate Portal Evaluation Survey and questions #18, #26 and #41
from the Employer Portal Evaluation Survey.* These qualitative responses provided input on
how to improve the overall design, user-friendliness and utility of the employment portal. It is
recognized that improvements to the portal are ongoing and several of the recommendations
listed in this report may have already been addressed.
Table 1 presents the recommendations for improvement and is divided into three sections:
1. Similar recommendations reported by both new nursing graduates and employers
2. New nursing graduate specific recommendations
3. Employer specific recommendations
_________________________ *Question #23/45 in the New Graduate Portal Evaluation Survey: If you could change one thing in the Nursing
Graduate Portal, what would it be?
Question #18 from the Employer Portal Evaluation Survey: Do you have any suggestions to improve the process
for employer registration and posting of positions?
Question #26 from the Employer Portal Evaluation Survey: Do you have any suggestions to improve the
matching, confirmation and funding agreement process from and employer perspective?
Question #41 from the Employer Evaluation Survey: If you could change one aspect of the nursing graduate
portal, what would it be?
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Additional support for the recommendations from employer focus groups and new nursing
graduate interview data is indicated by an asterisk (*).
Tables 2 and 3 are frequency counts of responses from question #24 from the New Graduate
Portal Evaluation Survey and questions #19, #25 and #31 from the Employer Portal
Evaluation Survey.
Table 1. New Nursing Graduate and Employer Recommendations for Nursing Graduate
Employment Portal
Similar Recommendations Reported by Both New Nursing Graduates and Employers
New Nursing Graduate Employer
1. Improve portal design (ease of use, layout and user-friendliness; include search boxes, navigation tools, quick links to important documents).
Improve portal design (ease of navigation, layout, set-up, time efficiency and user-friendliness, site is too buy and complicated).
2. Improve job search engine: allow the flexibility to search jobs by nurse group, date of posting, LHIN region, city, area of responsibility and unit; include save function for search strings).
Improve posting process (include unit description with posting number, allow search by ID, better flexibility in job categories, e.g., post medical and surgical vacancies separately; have separate section for small organizations).
3. Enhance the instructions section (how to register, post resume, apply for jobs, etc.).
Enhance the instruction section for employers (e.g., more distinction between NGG and general site for job postings).
4. Increase the number of training sessions to educational institutions and employers about the portal process (have someone visit schools for graduating class).
Increase the number of training sessions to employers and educational institutions about the portal process (e.g., create a module system or have webinars).
5. Regularly update site (especially job postings; create archive of old postings).
Regularly update site (remove new grad if accepted position elsewhere).
6. Allow direct communication between employer and new graduate (want better follow-up and call backs from employers).
Allow for direct communication between employer and new graduate.
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Table 2: New Nursing Graduate Recommendations for Nursing Graduate Employment Portal
New Nursing Graduate Specific Recommendations
1. Increase number of posted jobs for registered practical nurse.
2. Increase number of posting across all employer types & geographic regions, especially under-serviced and rural areas.
3. Removal of postings by employers for all filled jobs from the portal database (no later than six months).
4. Evaluate the feedback mechanism (number of emails, windows and pop ups) (e.g., reminder emails not sent or sent repeatedly; too many emails/junk mail sent).
5. Refine the application of resume builder (make it easier to upload, don’t like resume wizard format, allow one to personalize; include tips on resume building).
6. Clearly outline new graduate rights and employer responsibilities when accepting a position (ensure new graduate not taken advantage of).
7. Don’t limit number of interviews (allow new graduate to interview with more than one employer or choose another employer if first choice does not work).
8. More clarity on dates on program needed (when to sign up, how long one is eligible to participate).
9. Job postings page needs to be better organized (e.g., create sub-folders for institutions and list positions for each).
10. Provide job security (post positions that will bridge to FT positions).
11. Enlarge evaluation parameters to include employer survey on real time job vacancies.
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Table 3: Employer Recommendations for Nursing Graduate Employment Portal
Employer Specific Recommendations
1. Include save function for employers to decrease repetition of work (ability to save clinical information and hospital description).
2. Include one password for entire system.
3. Allow employer to search applicant pool.
4. Improve help desk (more timely responses).
5. Limit number of positions new grad can apply to (waiting for students to apply is time consuming if they have accepted job elsewhere).