Employment Integration of Nursing Graduatesfhs.mcmaster.ca/nhsru/documents/Series-38-NGG... · 1...
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Employment Integration of Nursing Graduates: Evaluation of a Provincial Policy Strategy Nursing Graduate Guarantee 2012-2013 Nursing Health Services Research Unit Health Human Resources Series 38 December 2013 Andrea Baumann, RN, PhD Mabel Hunsberger, RN, PhD Mary Crea-Arsenio, MSc
Transcript of Employment Integration of Nursing Graduatesfhs.mcmaster.ca/nhsru/documents/Series-38-NGG... · 1...
Employment Integration of Nursing Graduates:
Evaluation of a Provincial Policy Strategy Nursing Graduate Guarantee 2012-2013
Nursing Health Services Research Unit
Health Human Resources Series 38
December 2013
Andrea Baumann, RN, PhD
Mabel Hunsberger, RN, PhD
Mary Crea-Arsenio, MSc
1
Employment Integration of Nursing Graduates:
Evaluation of a Provincial Policy Strategy
Nursing Graduate Guarantee 2012–2013
Number 38
Andrea Baumann, RN, PhD, Associate Vice President, Global Health, Faculty of
Health Sciences & Scientific Director, Nursing Health Services Research Unit
(McMaster University site)
Mabel Hunsberger, RN, PhD, Associate Professor, School of Nursing & Research
Associate, Nursing Health Services Research Unit (McMaster University site)
Mary Crea-Arsenio, MSc, Research Coordinator, Nursing Health Services Research
Unit (McMaster University site)
Contact Andrea Baumann
Phone (905) 525-9140, ext. 22581
Email [email protected]
Website www.nhsru.com
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.
2
TABLE OF CONTENTS
EXECUTIVE SUMMARY ............................................................................................................ 8
INTRODUCTION ........................................................................................................................ 10
Background to the Nursing Graduate Guarantee ...................................................................... 10
Evaluation.................................................................................................................................. 11
LITERATURE REVIEW ............................................................................................................. 11
Overview of Labour Market Trends.......................................................................................... 11
Factors Affecting Integration of New Graduates into the Workplace ...................................... 12
CONTEXT .................................................................................................................................... 15
Overview of Nurse Supply in Ontario....................................................................................... 15
Figure 1. College of Nurses of Ontario Registered Nurse Renewal Counts 1994–2013 ... 15
Figure 2. College of Nurses of Ontario Registered Practical Nurse Renewal Counts 1994–
2013.................................................................................................................................... 16
The New Supply: RNs and RPNs in Ontario ............................................................................ 16
Historical Overview of Nurse Education in Ontario ............................................................. 17
Data on Graduating Nurses .................................................................................................... 18
Trends in RN and RPN Intake and Graduation ..................................................................... 19
Figure 3. First Year Intake and Supply of Ontario Registered Nursing Education 1998–
2012.................................................................................................................................... 19
Figure 4. First Year Intake and Supply of Ontario Registered Practical Nursing Education
1998–2012.......................................................................................................................... 20
Data Sources .............................................................................................................................. 21
HEALTH HUMAN RESOURCE PLANNING: NURSING STRATEGIES .............................. 21
Overview of Financial Investments 1999–2013........................................................................ 21
Nurse Graduate Initiatives 2004–2013 ...................................................................................... 22
NGG: INTEGRATING NEW GRADUATES INTO THE WORKFORCE ................................ 23
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How it Works ............................................................................................................................ 23
EVALUATION OF THE NGG 2012–2013 ................................................................................. 24
Methods ..................................................................................................................................... 24
Table 1. Summary of Methods Triangulation .................................................................... 25
Analysis ..................................................................................................................................... 26
RESULTS ..................................................................................................................................... 27
New Graduate Nurse and Employer NGG Participation 2007–2012 ....................................... 27
Table 2. New Graduate Nurse (RN/RPN) Matches by Sector of Employment 2007–2012
............................................................................................................................................ 28
Table 3. Participating Employers 2007–2008 to 2012–2013............................................. 28
Table 4. Participating Organizations by Sector of Employment 2007–2008 to 2012–2013
............................................................................................................................................ 29
New Graduate Nurse and Employer NGG Participation 2012–2013 ....................................... 29
Table 5. Employers by Sector of Employment and Participation in the NGG 2012–2013 29
Sample ....................................................................................................................................... 30
Table 6. Survey Response Rates 2012–2013 ..................................................................... 30
Demographic Characteristics of Survey Respondents .............................................................. 30
RN and RPN New Graduates ................................................................................................ 30
Employer Profile and Participation ....................................................................................... 32
Participating Employers ........................................................................................................ 32
Table 7. Participating Employer Survey Respondents by Sector of Employment 2008–
2012.................................................................................................................................... 32
Union Representatives ........................................................................................................... 33
REGISTERED NURSE AND REGISTERED PRACTICAL NURSE EMPLOYMENT 2012–
2013............................................................................................................................................... 33
Distribution of Nursing Graduates by Sector of Employment .................................................. 33
4
Table 9. New Graduate (RN/RPN) Survey Respondents by Sector of Employment 2007–
2012.................................................................................................................................... 34
Distribution of Nursing Graduates by Age and Sector of Employment ................................... 35
Table 10. New Graduate (RN/RPN) Survey Respondents' Age Group by Sector of
Employment 2012 .............................................................................................................. 36
Distribution of Nursing Graduates by Primary Area of Practice .............................................. 36
Distribution of Nursing Graduates by Employment Status ....................................................... 36
Table 11. RN New Graduate Survey Respondents Employment Status 2004–2012 ........ 37
Table 12. RPN New Graduate Survey Respondents Employment Status 2005–2012 ...... 38
Comparison to CNO New Member Employment Data ............................................................ 38
Table 13. CNO RN New Member Working Status 2005–2012 ........................................ 39
Table 14. CNO RPN New Member Working Status 2005–2012 ...................................... 40
Figure 5. Full-Time Employment Rates for Participant and Non-Participant New Graduate
RNs .................................................................................................................................... 41
Figure 6. Full-Time Employment Rates for Participant and Non-Participant New Graduate
RPNs .................................................................................................................................. 41
Distribution of Nurse Graduates by Work Status and Type of Employer ................................ 42
Table 15. New Graduate Survey Respondents' Employment Status by Sector of
Employment 2012 .............................................................................................................. 42
Mobility and Migration: RNs and RPNs ................................................................................... 43
EMPLOYMENT PREFERENCES OF RN AND RPN GRADUATES ...................................... 43
Preferences for Full-Time Work Status .................................................................................... 44
Figure 7. New Graduates' Preference for Full-Time Employment 2005–2012 ................. 44
Figure 8. Percentage of New Graduates Working in Employment Status of Choice 2007–
2012.................................................................................................................................... 45
Preferences for Employment Location ...................................................................................... 46
Preferences for Sector of Employment and Clinical Area of Practice ...................................... 46
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Preferences for Mobility and Migration .................................................................................... 47
STAKEHOLDER PERCEPTIONS OF THE NGG 2011-2012 ................................................... 47
Promotion of the NGG: How Employers and New Graduates Were Informed ........................ 47
Recruiting NGNs: Evaluating the Effectiveness of the Employment Portal (HFOJobs) .......... 48
Website Design and Functionality: Employer and New Graduate Ratings .............................. 49
Figure 9. Employers' Rating of Their Overall Experience with the Nursing Graduate
Guarantee Website ............................................................................................................. 50
Figure 10. New Graduates' Rating of Their Overall Experience with HFOJobs Nursing
Graduate Guarantee Program Website 2012–2013 ............................................................ 51
Factors Affecting New Graduate Participation ......................................................................... 51
Figure 11. New Graduate Survey Respondents Indicating They Obtained an NGG
Position 2007–2012 ........................................................................................................... 51
Table 16. Reasons Given by Nursing Graduates Who Did Not Match Into an NGG
Position 2011–2012 ........................................................................................................... 52
EMPLOYER CHALLENGES IN CREATING BRIDGING POSITIONS ................................. 53
Facilitating NGN Transition to Work: Mentoring and Support for New Graduates ................ 54
Table 17. Employer Survey Respondents' Ratings of Mentoring Process 2008–2012 ..... 55
Table 18. New Graduate Survey Respondents Ratings of the Mentoring Process 2008–
2012.................................................................................................................................... 55
Mentor Perspectives .................................................................................................................. 57
Offering New Graduates Permanent Full-Time Positions ........................................................ 58
Table 19. Employer Survey Respondents' Reasons for Not Transitioning to Full-Time
2010, 2011 and 2012 .......................................................................................................... 59
New Graduates' Experiences Following Their NGG Position .................................................. 60
Table 20. New Graduate Experience Following their Nursing Graduate Guarantee
Position 2010-2012 ............................................................................................................ 61
BARGAINING UNIT AND EMPLOYER COLLABORATION: WHERE ARE THE GAPS? 61
Communication of Employers with the Bargaining Unit.......................................................... 62
6
Table 21. Union Representative Survey Respondents' Collaboration with Employers
During Phases of the Nursing Graduate Guarantee 2012 .................................................. 62
New Graduates in Specialty Positions: Union Concerns .......................................................... 63
Table 22. Union Representatives' Perceptions that New Graduates Transitioned to a
Specialty Area Position Ahead of Existing Staff 2008–2012 ............................................ 63
Reinvestment of Funds: Who is Involved in Decisions ............................................................ 64
Figure 12. Percentage of Union Representatives Consulted Regarding the Reinvestment of
Nursing Graduate Guarantee Funds 2012 .......................................................................... 64
Table 23. Employer Survey Respondents Reinvestment of Funds 2008–2012 ................. 65
ADMINISTRATIVE AND BUDGETARY ISSUES ................................................................... 65
Evaluation of the Nursing Graduate Guarantee Management Module ..................................... 65
Table 24. Employer Rating of Their Experience Accessing Nursing Graduate Guarantee
Funds and Using the Ministry of Health and Long-Term Care Transfer Payment
Agreement .......................................................................................................................... 66
Ministry Response to Employer Challenges ............................................................................. 66
Table 25. Methods Employers Used to Obtain Help With the NGGMM 2012–2013 ...... 67
OVERALL IMPACT OF THE NURSING GRADUATE GUARANTEE .................................. 67
Table 26. Employer Rating of Clinical and Administrative Staff Responses to the Nursing
Graduate Guarantee Initiative ............................................................................................ 68
CONCLUSION ............................................................................................................................. 68
Limitations ................................................................................................................................ 69
Recommendations ..................................................................................................................... 69
REFERENCES ............................................................................................................................. 71
Appendix A. Nursing Graduate Guarantee Application Process .................................................. 77
Appendix B. Briefing Note – February 1, 2013............................................................................ 78
Appendix C. Data Collection and Refinement of the Nursing Graduate Guarantee Evaluation
Survey ........................................................................................................................................... 80
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Appendix D. Percent Distribution of Nursing Graduates by Nurse Category and Local Health
Integration Network Region 2012–2013 ...................................................................................... 81
Appendix E. Participating Employer Survey Respondents by Local Health Integration Network
Region ........................................................................................................................................... 82
Appendix F. Distribution of Nursing Graduates by Sector of Employment ................................. 83
Appendix G. Distribution of Nursing Graduates by Primary Area of Practice ............................ 84
Appendix H. NursING Graduates by Nurse Category, Employment Status and Sector of
Employment 2007–2012 ............................................................................................................... 88
Appendix I. Distribution of Nursing Graduates by Employment Location and Nurse Group ..... 94
Appendix J. Comparison of Employment Preferences of Nursing Graduates by Nurse Category
2007–2012..................................................................................................................................... 95
Appendix K. Employment Preferences of Nursing Graduates by Group ..................................... 96
Appendix L. Local Health Integration Locations Where Nursing Graduates Seek Employment 97
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EXECUTIVE SUMMARY
The Nursing Graduate Guarantee (NGG) was launched in 2007 to encourage full-time (FT)
employment for registered nurse (RN) and registered practical nurse (RPN) graduates in Ontario.
This provincial government initiative was created in response to an increasing trend towards
casualization of the nursing workforce, particularly new graduate nurses (NGNs). The NGG
funds six months of supernumerary FT employment for NGNs.
In 2012, there were 6648 nursing graduates (3383 RNs and 3265 RPNs); 2249 participated in the
NGG (1813 RNs and 436 RPNs). Additionally, 214 employers participated. Hospitals hired the
majority of new graduates (85%), followed by long-term care facilities (10%) and community
organizations (5%). During the past six years, 14,395 NGNs participated in the NGG. An
average of 200 healthcare employers per year also participated.
Survey data demonstrate that NGNs who participated in the NGG obtained FT employment at a
higher rate than those who did not participate. In 2012, 62% of RNs and 50% of RPNs who
participated in the NGG secured FT positions compared to 38% of RNs and 17% of RPNs who
did not participate. According to the College of Nurses of Ontario new registrant data, there has
been an overall 5% decrease in FT employment for RNs (61% to 56%) and RPNs (35% to 30%).
However, there has been a 9% increase in FT employment for both RNs (47% to 56%) and RPNs
(21% to 30%) over the six years of the NGG.
Recommendations
1. Improve access to employment-level data following the six-month supernumerary period.
2. Encourage participation across sectors and regions.
3. Monitor nursing employment trends and assess the outcome of the NGG on new graduates'
FT employment, retention and professionalism.
4. Invest in developing, managing and digitizing longitudinal data repositories of nurse
employment and employing agencies.
5. Examine overall labour trends such as the impact of employment saturation on the hiring of
NGNs in Ontario.
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6. Evaluate the extension of the NGG to include new graduate nurses from other provinces and
territories in Canada who have settled in Ontario and are seeking employment.
7. Determine the feasibility of extending the NGG to include nurses transferring to Ontario
from other provinces and territories in Canada.
8. Examine RPN workforce to get a better understanding of participation.
9. Calculate the FT rates of employment outside the Greater Toronto Area to estimate job
availability and proportion of FT to PT.
10. Identify best practices to integrate and retain new graduates in the nursing workforce.
10
INTRODUCTION
The Nursing Graduate Guarantee (NGG) was launched in 2007 to encourage full-
time (FT) employment of new graduate nurses (NGNs) in Ontario. The NGG has
been evaluated annually since its inception. This report presents the results of the
2012–2013 evaluation. It includes NGN and employer survey findings, a
secondary analysis of the College of Nurses of Ontario (CNO) new members
database and interview findings from healthcare employers, NGNs and staff nurse
mentors. Conclusions and recommendations are also provided.
Background to the Nursing Graduate Guarantee
Over the past two decades, non-standard work arrangements in the private and
public sector have increased. In Ontario, healthcare restructuring in the 1990s led
to an increase in part-time (PT) and casual employment of nurses province-wide.
The Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 demonstrated
that Ontario had little surge capacity to respond to the epidemic and highlighted
the issue of PT and casual nursing staff throughout the province (Baumann et al.,
2006b; Walker, 2004). Subsequent findings from a baseline study by Baumann et
al. (2006a) indicated that although 75% of NGNs wanted FT employment, only
35% obtained it six months post-graduation. In response, Ministry of Health and
Long-Term Care (MOHLTC) investments were targeted to FT employment of
NGNs.
In 2007, the MOHLTC launched the NGG. This policy initiative is intended to
fund supernumerary (above staff complement) temporary FT nursing positions for
up to six months for all NGNs in Ontario. As part of the MOHLTCs
HealthForceOntario (HFO) health human resources strategy, the goal of the NGG
has been to "provide every New Graduate Nurse with the opportunity to obtain
full time employment in Ontario" (MOHLTC, 2011a, p. 4).
The NGG is a
provincial
strategy created
to promote FT
employment of
new graduate
nurses in Ontario.
Over the past two
decades, structural
changes in society
have resulted in a
trend towards non-
standard work
arrangements in
both the private
and public sector.
In 2007, the
MOHLTC
announced the
creation of the
NGG.
11
Evaluation
The study was guided by the following research question: What is the impact of
the NGG on FT employment and the transition to work of NGNs in Ontario? The
objectives of the study were
To identify demographics, employment status and preferences of recent
nursing graduates;
To examine trends in new graduate employment status over time;
To describe stakeholder perceptions (employers, NGNs, staff nurses mentors)
of the NGG, including barriers and facilitators to participation; and
To analyze the impact of the extended orientation and mentorship component
of the NGG program on the transition of NGNs to work.
LITERATURE REVIEW
Overview of Labour Market Trends
Economic insecurity and global casualization have negative implications for
workers, both nationally and internationally (Baumann, Hunsberger, & Crea-
Arsenio, 2012b; Standing, 2008). During recessions, unemployment rates increase
while labour force participation rates remain unchanged, indicating that a loss of
individual jobs is the primary cause of labour market downturn (Borbely, 2009).
During the recession in 2008, employed Canadians faced lower rates of layoffs
compared to those employed during the recessions of the early 1990s and early
1980s (Chan, Morissette, & Frenette, 2011). Manual labourers and trades
personnel experienced the most layoffs (Chan et al., 2011).
Labour markets are influenced by escalating costs, reduced supply, job
substitution and growth or decline in particular subsectors. With the economic
"bust" in 2008, budget constraints and fiscal accountabilities increased, resulting
in fewer job opportunities for workers (Batch, Bernard, & Windsor, 2009). The
most notable change in employment patterns was an increase in PT and casual
staff. In 2009, one in every eight employed Canadians was in a temporary
position; most were young professional workers (Galarneau, 2010).
Economic insecurity
and global
casualization have
negative implications
for workers, both
nationally and
internationally.
Labour markets are
influenced by
escalating costs,
reduced supply, job
substitution and
growth or decline
in particular sub
sectors.
12
During recent decades, there has been a movement towards flexible, non-
standardized work and increased casualization (Baumann & Blythe, 2003). The
notion of "casual labour" (Standing, 2008, p. 15) is situated within a universal
movement fuelled by rising competition among industries and the need to reduce
labour costs (Batch et al., 2009). In Canada, casualization of the workforce has
affected public and private sectors. In the public sector, the fields of education,
public administration and health have simultaneously experienced a high rate of
temporary employment and the fastest growth in absolute terms (Galarneau, 2010;
Heery & Salmon, 2000).
A notable impact is evident in poor labour market conditions for NGNs compared
to their older counterparts. During an economic downturn, NGNs are usually the
first to face layoffs because of their low position in a unionized environment
(Benjamin, Gunderson, & Riddel, 2002). Furthermore, the availability of
positions for new graduates may decrease due to an increased supply of nurses
and a decreased demand for their services (Alameddine et al., 2012). As families
struggle financially, veteran nurses may return to the workforce or remain
committed to their current jobs, limiting openings for new graduates (Buerhaus,
2009). This effect is exacerbated by the decreased financial ability of
organizations to maintain an adequate level of health human resources
(Alameddine et al., 2012).
Some PT nurses voluntarily choose their PT status and prefer it, but research
evidence suggests most favour FT over PT status (Baumann et al., 2012b; Blythe
et al., 2005; Grinspun, 2003). Studies have explored the impact of new types of
work arrangements on employee health and the decline of standard FT jobs
(Cummings & Kreiss, 2008; Joyce et al., 2010).
Factors Affecting Integration of New Graduates into the Workplace
The chief nursing employer in Ontario is the hospital sector with 24/7 service and
over 35,000 patient beds. There are approximately 1198 employer organizations
in Ontario, including 155 (12.9%) hospitals, 630 (54.6%) long-term care (LTC)
During recent
decades, there
has been a
movement
towards flexible,
non-
standardized
work and
increased
casualization.
In times of
economic
downturn, NGNs
are usually the
first to face
layoffs due to
their low
position in a
unionized
environment.
The large and
predominantly
female nursing
workforce followed
the trends of
increasing
proportions of PT
and casual workers.
13
An organization that
hires heavily one
year will not do so
the next, unless it has
a low rate of
retention or is
expanding its
services.
facilities and approximately 413 (35%) community organizations (MOHLTC,
2012b, 2012c). The latter includes 101 Community Health Centres, 36 public
health units, 14 Community Care Access Centres and 262 other organizations.
According to the CNO (2013), there are currently 93,766 RNs and 32,858 RPNs
employed in nursing in Ontario. 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). A mean turnover rate of 19.9% has been reported in Canadian
hospitals (O'Brien-Pallas et al., 2010).
An organization's ability to provide employment for new nurses is affected by
changes over time and numerous variables (Baumann, Hunsberger, & Crea-
Arsenio, 2012a). Identifying and quantifying 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 distinguish internal vacancies from external
vacancies. Internal vacancies are created by workers transferring within an
organization, while external vacancies are created when workers leave an
organization. Internal vacancies do not represent employment opportunities for
new applicants.
Posted vacancies are not necessarily 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 et al., 2006b).
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 study on vacancies, the term was redefined with the understanding that
"organizational flexibility strategies have altered nurse utilization and rendered
data on vacancy statistics inaccurate measures of nursing shortage" (Fisher,
Baumann, & Blythe, 2007, p. 49). Further difficulties occur when statistical
Employers
perceive that
flexible
employment
practices reduce
personnel cost;
however, this
comes with the
associated risk of
an unstable
workforce
There are
approximately 1198
employer
organizations in
Ontario, including
155 hospitals, 630
LTC facilities and
approximately 413
community
organizations.
An organization's
ability to provide
employment for new
nurses is affected by
changes over time
and numerous
variables.
14
Factors that
influence where a
nurse seeks
employment include
the number of
potential employers
in a given area.
When newly
graduated nurses
first enter the
workforce, they may
experience
"transition shock" as
the discrepancies
between nursing
education and the
real world are
experienced.
reports do not differentiate FT status from FT hours. In addition, the CNO
(2012b) captures FT status through self-report data that does not make a
distinction between temporary contracts and permanent FT.
Factors that influence where a nurse seeks employment include the number of
potential employers in a given 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 one year will
not do so 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. There is a direct relationship between new job hires and an
organization's financial situation. The timing of graduation may also be a factor,
with the major supply of nurses entering the workforce at one time. An additional
factor is the effect of unionized environments and employment policies on the
availability of FT employment for graduating nurses.
When newly graduated nurses enter the workforce, they may experience
"transition shock" as the discrepancies between nursing education and the real
world become evident (Duchscher, 2009). This shock can cause stress, anxiety
and burnout, which ultimately increases turnover (Bratt & Felzer, 2012). Poor
retention of new graduates has financial implications and consequences for patient
safety (O'Brien-Pallas et al., 2010). There is a wealth of research documenting a
gap between nursing education and entering the workforce (Romyn et al., 2009;
Wolff et al., 2010). To address this gap and increase the retention of new
graduates, two strategies for integration have been identified: orientation and
mentorship programs. Both of which are designed to help new graduates
transition into their professional practice role (Hunsberger, Baumann, & Crea-
Arsenio, 2013).
15
Between 1994 and
2001, there was a
7% loss of RNs from
the workforce. This
trend began to
reverse in 2002.
CONTEXT
Overview of Nurse Supply in Ontario
Figure 1 shows the trend in RN renewals and employment from 1994 to 2013.
Between 1994 and 2001, there was a 7% loss of RNs from the workforce.
Figure 1. College of Nurses of Ontario Registered Nurse Renewal Counts 1994–
2013
Note. Date of renewal counts reflects members who renewed at the end of the previous calendar
year (e.g., 2013 data represents members who renewed at the end of 2012 for the 2013 practice
year).
Source: College of Nurses of Ontario, 2013.
This trend began to reverse in 2002. By 2005, there was a full recovery of RNs
lost in the 1990s and early 2000s. The trend continued to increase from 2006 to
2010. From 2010 to 2012, there was a loss of 1037 RNs employed in nursing in
Ontario. This was counteracted by a gain of 1507 RNs in 2013 (CNO, 2013).
In contrast, RPN supply in Ontario has been slower to recover since the
restructuring of the healthcare system in the 1990s (CNO, 2013). Figure 2 shows
the trend in RPN renewals and employment from 1994 to 2013. The trend in the
75,000
80,000
85,000
90,000
95,000
100,000
105,000
110,000
115,000
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
Co
un
t
Year of Renewal Total Possible Workforce Employed in Nursing
16
The trend in the RPN
workforce decreased
over an 11-year
period beginning in
1994.
Each year the
nursing workforce is
augmented by NGNs,
internationally
educated nurses and
nurses who re-enter
the workforce.
RPN workforce decreased over an 11-year period beginning in 1994. From 1994
to 2005, there was a 14% loss of RPNs from the workforce. This trend began to
reverse in 2006. By 2010, there was a full recovery of RPNs lost in the 1990s and
early 2000s.
Figure 2. College of Nurses of Ontario Registered Practical Nurse Renewal
Counts 1994–2013
Note. Date of renewal counts reflects members who renewed at the end of the previous calendar
year (e.g., 2013 data represents members who renewed at the end of 2012 for the 2013 practice
year).
Source: College of Nurses of Ontario, 2013.
The New Supply: RNs and RPNs in Ontario
Each year the nursing workforce is augmented by NGNs, internationally educated
nurses and nurses who re-enter the workforce (Blythe et al., 2008; Simoens,
Villeneuve, & Hurst, 2005). This report focuses on 2012 nursing graduates. It is
essential to develop a profile of this group, including an overview of nurse
education and the distribution of NGNs across sectors, areas of practice and
geographical location.
17
Three historical
events have affected
the supply of NGNs
in Ontario.
To facilitate the
baccalaureate
degree requirement
for entry to practice
for RNs, the MTCU
made additional
funding available to
support enrolment
growth in the new
collaborative
programs.
Historical Overview of Nurse Education in Ontario
In Ontario, the Ministry of Training, Colleges and Universities (MTCU) oversees
community college and university education. The MTCU is responsible for
funding nurse education, with the exception of a few targeted areas (e.g., nurse
practitioner education and investments in clinical simulation equipment). Three
historical events have affected the supply of NGNs in Ontario. First, in 2001,
practical nursing programs altered their curricula in preparation for the two-year
diploma program requirement in 2005. In addition, the MTCU announced that
effective January 2001, enrolment quotas on practical nursing programs would be
lifted. Second, in 2003, Ontario reduced secondary education to four years,
temporarily increasing the number of potential applicants to nursing programs.
The increase occurred from 2003 to 2005, before numbers stabilized again in
2006. Third, 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 nursing degree education and
practical nursing education in Ontario. In response, enrolment in RN nursing
diploma programs increased substantially in the last year they were offered
(2001). New entry to practice legislation specified that baccalaureate degrees
were required for RNs as of January 1, 2005. The result was the establishment of
collaborative four-year baccalaureate nursing programs through partnerships
between universities and colleges, leading to a degree from the university partner.
To facilitate the baccalaureate degree requirement for entry to practice for RNs,
the MTCU made additional funding available to support enrolment growth in the
new collaborative programs. It also provided funding for compressed degree
programs in universities and the final college intake of diploma RN students. The
intention was to boost the number of RN graduates in 2003–2004, the year in
which reduced numbers were anticipated due to the elimination of the three-year
college diploma for RNs.
18
The number of
nurses entering the
workforce has
traditionally been
supply driven.
Currently, two
organizations store
national education
data: the Canadian
Nurses Association
and the Canadian
Association of
Schools of Nursing.
In Ontario,
graduation data is
used in conjunction
with nursing school
enrolment data to
track nurse supply.
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 4000 first-year nursing
degree students per annum (MOHLTC, 2005). This was intended to bring nursing
graduate levels to those produced in the 1990s prior to restructuring. This target
was met in 2009–2010 and it has continued to grow.
The MTCU has also committed to funding nursing program enrolment with no
caps on nursing degree and practical nursing education intake. In addition to the
time-limited funding for compressed degrees announced in 2001, the MTCU
approved Second-Entry Programs, which began in 2005–2006. These programs
were designed for students with previous post-secondary education. The initiative
was intended to increase the intake of nursing students in RN programs.
Data on Graduating Nurses
Currently, two organizations store national education data: the Canadian Nurses
Association and the Canadian Association of Schools of Nursing. For RNs, the
Ontario MTCU collects data about annual enrolment and degrees granted directly
from universities in the province. As per agreement, it shares this information
with Statistics Canada for its Postsecondary Student Information System (PSIS)
database. For RPNs, some colleges report individually to Statistics Canada, but
not all schools include enrolment and graduation data. Beginning with 2012–2013
enrolment data, changes to the collection of college data will result in either
MTCU or the Ontario College Application System (OCAS) providing RPN
enrolment data to Statistics Canada to meet the basics of the PSIS survey.
In Ontario, graduation data is used in conjunction with nursing school enrolment
data to track nurse supply. However, data collection has been difficult because of
differing graduation times, FT and PT student counts and the capacity of
individual institutions to create and maintain adequate databases. In addition, the
establishment of college-university collaborative programs has resulted in data
integration challenges related to applications, registration and enrolment. For
19
The number of nurses
graduating each year
varies over time. In
2012, there were
6648 graduates
(3383 RNs and 3265
RPNs).
example, in some college-university partnerships, applicants apply to OCAS and
the Ontario Universities' Application Centre.
Employment of new graduates is not well measured. Some schools of nursing
may survey their alumni sporadically to obtain information about their absorption
into the workforce, but 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.
Trends in RN and RPN Intake and Graduation
The number of nurses graduating each year varies over time. In 2012, there were
6648 graduates (3383 RNs and 3265 RPNs). Figure 3 shows the trend in intake
and supply of Ontario RN graduates.
Figure 3. First Year Intake and Supply of Ontario Registered Nursing Education
1998–2012
*Graduation numbers represent all graduates within that calendar year.
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Co
un
t
Year
First Year Intake
Graduates*
20
Note. First year intake and graduation numbers are based on FT 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 + PT and diploma and baccalaureate
graduates (not collaborative).
Source: Ministry of Training, Colleges and Universities, 2013.
The sharp increase and subsequent decrease in the number of RN graduates
between 2004 and 2005 reflects the implementation of the baccalaureate degree as
entry to practice in 2005 (Baumann et al., 2006a). Figure 4 shows the intake and
supply of Ontario RPN graduates. The overall trend for RPN intake and
graduation has increased steadily over time.
Figure 4. First Year Intake and Supply of Ontario Registered Practical Nursing
Education 1998–2012
*Graduation numbers represent all graduates within that calendar year.
Source: Ministry of Training, Colleges and Universities, 2013.
0
500
1000
1500
2000
2500
3000
3500
4000
98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12
Co
un
t
Year
First Year Intake
Graduates*
21
In 2008, through the
HealthForceOntario
(HFO) health human
resources strategy,
the MOHLTC began
working in
collaboration with
regulatory colleges to
develop a health
professions database
(HPDB).
Nursing labour
markets are
sensitive to
government
investments and
policy decisions.
In 1999, the
Nursing
Enhancement
Fund was
introduced as part
of the Ontario
Nursing Strategy
to create new
permanent FT and
PT nursing
positions.
Data Sources
In 2008, through the HFO health human resources strategy, the MOHLTC began
working in collaboration with regulatory colleges to develop a health professions
database (HPDB). The database is intended to "provide standardized, consistent
and comparable demographic, geographic, educational, and employment
information on all of the regulated allied health professionals in Ontario" (HFO,
2013a, § 3). In 2011, the CNO provided its first data submission to the HPDB.
To link the supply of NGNs to the needs of the provincial healthcare system, valid
data about the supply of new graduates and information about market
requirements are essential. Gaps currently exist concerning the supply of new
nurses and their integration into the workforce.
HEALTH HUMAN RESOURCE PLANNING: NURSING STRATEGIES
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 to
increase the FT equivalents of nurses working in acute care hospitals and LTC
facilities (MOHLTC, 2012a). This was done through baseline funding to
organizations to support the hiring of new nurses and/or the conversion of casual
and PT nurses into FT staff. The ultimate investment was in 2007, when the
MOHLTC announced $89 million to support every NGN (RNs and RPNs) in
Ontario in finding FT employment upon graduation (MOHLTC, 2007).
Overview of Financial Investments 1999–2013
In 1999, the MOHLTC began investing in initiatives to create new nursing
positions in the province. In 2004, the MOHLTC announced a policy for hospitals
to increase FT employment of nurses towards a goal of 70%. The government's
commitment to create new nursing positions in hospitals includes the following
(MOHLTC, 2004a, 2004b):
1999–2000: $130 million new base funding annually to hospitals to create
3300 new nursing positions
22
Between 2004 and
2006, the total
funding for new
graduate initiatives
was $30.4 million.
2003–2004: $25 million annually provided to 33 hospitals (with operating
budgets greater than $100 million) to hire new FT nurses and convert casual
and PT nurses into FT staff; 664 new FT nursing positions have been created
with this investment
2004–2005: $25 million annually provided to remaining hospitals in the
province (with operating budgets under $100 million) to create FT nursing
positions; 538 new FT positions have been created with this investment
2006: $40 million held in trust for hospitals to orient and train RNs and RPNs
interested in working in other clinical areas or nursing roles within the
hospital vacancies exist (MOHLTC, 2006b)
In May 2004, the provincial government announced an additional investment of
$191 million to hire 2000 new healthcare staff, including 600 nurses. The main
objective was to ensure all LTC and acute care residents have 24-hour access to
an RN seven days a week. The money was rolled out over a two-year period
(MOHLTC, 2004c).
Nurse Graduate Initiatives 2004–2013
Between 2004 and 2006, the total funding for new graduate initiatives was $30.4
million (MOHLTC, 2006b); $17.7 million was invested in fiscal year 2004–2005
(MOHLTC, 2006a); and $12.7 million was invested in fiscal year 2005–2006. An
additional $26.7 million was invested in the 2006–2007 fiscal year (MOHLTC,
2008). The NGG was launched in 2007 with $88.9 million in funding (MOHLTC,
2007). This was followed by $94.2 million in 2008–2009, $85.8 million in 2009–
2010, $87.5 million in 2010–2011, $99.6 million in 2011–2012 and $99.6 million
in 2012–2013 (Baumann et al., 2012c; MOHLTC, 2013b).
In May 2013, the Ontario government announced it was expanding the NGG to
include NGNs from other provinces and territories in Canada. In addition, the
Nursing Career OrIENtation (NCO) initiative was created to support
internationally educated nurses (IENs) as they begin practising in the province.
Similar to the NGG, the NCO provides employers with funding to create FT
23
Through the NGG,
the MOHLTC
provides funding for
temporary FT
supernumerary six-
month positions for
NGNs.
After a minimum
period of three
months but within six
months, the
MOHLTC expects
employers to use
their best efforts to
transition NGNs into
a permanent FT
position.
temporary supernumerary positions for up to six months and includes extended
orientation and mentorship (MOHLTC, 2013a). The NCO and the expanded NGG
will be included in the $99.69M provincial government investment for the 2013–
2014 fiscal year.
NGG: INTEGRATING NEW GRADUATES INTO THE WORKFORCE
How it Works
Through the NGG, the MOHLTC provides funding for temporary FT
supernumerary six-month positions for NGNs (MOHLTC, 2011). The NGG uses
an online employment portal through HFO to link graduates with employers who
are interested in hiring them (HFO, 2013b). New graduates and employers must
register on the website to participate. Appendix A clarifies the NGG application
process.
After a minimum period of three months but within six months, the MOHLTC
expects employers to use their best efforts to transition NGNs into permanent FT
positions, unless there are outstanding reasons not to continue the employment
(MOHLTC, 2011a). Employers must commit to providing an additional six weeks
of FT supernumerary time and funding for the NGNs if they are unable to offer
them permanent FT positions within the six-month period. Objectives of the NGG
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 new graduates as they transition into practice
Improve integration of new graduates into the workforce
Promote retention among Ontario nurse graduates
Facilitate recruitment to all sectors
24
The use of
quantitative and
qualitative methods
to assess policy
ensures that a study
is well contextualized
and policy relevant.
EVALUATION OF THE NGG 2012–2013
The following sections describe the NGG 2012–2013 evaluation study. Data are
aligned with MOHLTC figures regarding employer and NGN participation in the
initiative.
Methods
A mixed methods approach was used (Tashakkori & Teddlie, 2003). The use of
quantitative and qualitative methods to evaluate policy ensures that a study is well
contextualized and policy relevant (White, 2008). There were four stakeholder
groups: healthcare employers, NGNs, staff nurse mentors and union
representatives.
Quantitative methods included online surveys of healthcare employers, NGNs and
union representatives. Qualitative methods included focus groups with healthcare
employers and individual interviews with NGNs and staff nurse mentors. Patton
(1999) describes the use of quantitative and qualitative methods of research as
methods triangulation that verifies the consistency of findings and provides a
"well-integrated picture of the situation" (p. 1193). Table 1 outlines the
methodologies and participants involved in the study.
25
The new graduate
and employer
interview guides
were aligned to
capture perceptions
from both groups on
similar questions.
Two secondary
databases were
analyzed.
Table 1. Summary of Methods Triangulation
Method Stakeholder Group
Online Surveys (English and
French) New Graduate Evaluation of the NGG (2012–2013)
Employer NGG Participant Survey (2012–2013)
Union Representative Survey (2012–2013)
Teleconference Focus Groups NGG participant employers: acute care (large, medium,
small, rural), long-term care, public health and community
Teleconference Interviews 2012 New graduate nurses (RN and RPN)
Staff nurse mentors
Secondary Database Analysis CNO new members database
MOHLTC NGG program data
The surveys were designed to evaluate users' experiences with the NGG
employment portal, perceptions of the extended orientation/mentorship and
transition into employment, employment status and area of practice, new graduate
employment preferences and collaboration with bargaining units. Semistructured
interview guides were developed for the employer focus groups and interviews
with NGNs and staff nurse mentors.
The questions in the semistructured interview guides were sequenced according to
the NGG process: hearing about the initiative, using the employment portal,
hiring into the NGG, orientation/mentorship and transitioning into permanent
jobs. The employer and NGN interview guides were aligned to capture
perceptions from both groups on similar questions. Staff nurse mentors were
asked additional questions about their experiences in mentoring a new graduate
through the NGG.
The surveys and semistructured guide for the focus groups and interviews were
developed with input from expert senior researchers at the Nursing Health
Services Research Unit and senior policy analysts from the MOHLTC. A grey
literature search of media releases and news bulletins was conducted to collect all
information related to the initiative.
The surveys
were designed
to evaluate
users’
experiences with
the NGG.
26
Data is analyzed as
a snapshot in time
for each year and
then compared to
previous years to
examine overall
trends.
For the individual interviews and focus groups, the purpose of the study was
explained to all participants in advance. For survey participants, an
information/consent page outlining the rationale of the study and a request for
consent to participate was provided at the beginning of the survey. All research
instruments underwent the necessary ethics review process and received final
approval from the Hamilton Health Sciences Research Ethics Board. The research
team obtained the participants' consent to publish findings from the survey and
interviews. Participants were guaranteed anonymity and assured that no personal
identifiers would be associated with responses to the questions.
Additionally, two secondary databases were analyzed. The MOHLTC NGG
program database was used to assess employer and new graduate participation in
the NGG from 2007–2012. The CNO regulatory database of new member RNs
and RPNs was used to compare employment status of new members to the new
graduate survey data.
Analysis
Trends in NGN and employer participation in the NGG were analyzed using the
MOHLTC NGG program database. The database holds count data about the total
population of NGG participants (NGNs and employers) across all years of the
initiative. Data is analyzed as a snapshot in time each year and then compared to
previous years to examine overall trends.
Survey data were entered into R version 2.15.2 (R Core Team, Vienna, Austria).
Responses to each item were summarized using descriptive statistics. Frequency
distributions were calculated on demographics and employment data. Survey data
of NGN employment status were compared to the CNO database of general class
new member RNs and RPNs. Chi-square tests were conducted to compare
employment status pre-policy (reference year) for RNs and RPNs in each year of
the NGG (2007–2008 to 2012–2013).The reference year was 2004 for RNs and
2006 for RPNs. The null hypothesis for each comparison was no difference
27
The employer focus
groups and
individual interviews
were conducted by
telephone,
audiotaped and
transcribed.
Over the past six
years, 14,395
NGNs (11,132
RNs and 3263
RPNs) were hired
into temporary
FT positions
through the
NGG.
between the reference year and each year of the initiative. An alpha level of .05
was used for all statistical testing.
The employer focus groups and individual interviews were conducted by
telephone, audiotaped and transcribed verbatim. During data collection, the
research team followed a sequence of interview, transcription, analysis, reflection
and modification. Interviews were coded into QSR NVivo version 10.0 (QSR
International Pty Ltd, Doncaster, Victoria, Australia). Texts were then interpreted
through thematic analysis (Boyatzis 1998).
During preliminary coding, each member of the research team coded several texts
independently. Team members then collaborated to develop a refined scheme to
code the texts. Additional codes were assigned as new themes emerged. Major
themes were highlighted, and key findings were categorized appropriately under
each thematic heading.
RESULTS
The following sections present the results of the NGG evaluation for 2012–2013.
Survey data on trends in NGN and employer participation are presented first,
followed by survey results. The latter includes a comparison to the CNO new
members database and union perspectives. Findings from the employer focus
groups and interviews with NGNs and staff nurse mentors are integrated
throughout.
New Graduate Nurse and Employer NGG Participation 2007–2012
Over the past six years, 14,395 NGNs (11,132 RNs and 3263 RPNs) were
matched and hired into temporary FT positions through the NGG. Table 2 shows
the number of new graduates matched for employment by sector. Based on the
2012–2013 survey data, 84% of all 2012 new graduate matches were in the
hospital sector, followed by 12% in LTC and 4% in community. These results are
similar to the 2011 new graduate distribution of matches by sector.
28
The majority of
employers were
from the hospital
and LTC sectors.
Table 2. New Graduate Nurse (RN/RPN) Matches by Sector of Employment
2007–2012
Sector Year of Graduation N(%)
2007 2008 2009 2010 2011 2012 Total
Hospital 2269(85) 2566(90) 2204(85) 1435(80) 1874(84) 1889(84) 12237(85)
Long-Term Care 209(8) 132(5) 231(9) 253(14) 287(13) 264(12) 1376(10)
Community/
Other
183(7) 141(5) 169(6) 112(6) 81(3) 96(4) 782(5)
Total 2661(100) 2839(100) 2604(100) 1800(100) 2242(100) 2249 (100) 14395(100)
Note. All totals as of September 3, 2013.
Source: Ministry of Health and Long-Term Care, 2013c.
Table 3 shows the number of employers who participated in the NGG by year. On
average, approximately 212 employers participate each year. In 2012–2013, there
were 214 participating organizations; 48% were from the hospital sector and 38%
were from LTC (see Table 4).
Table 3. Participating Employers 2007–2008 to 2012–2013
Year of NGG Number of
Participating
Employers
2007–2008 222
2008–2009 175
2009–2010 224
2010–2011 230
2011–2012 212
2012–2013 214
Note. All totals as of September 3, 2013.
Source: Ministry of Health and Long-Term Care, 2013c.
29
Overall, 18% of
employers
participated in the
NGG in 2012– 2013.
Table 4. Participating Organizations by Sector of Employment 2007–2008 to
2012–2013 Sector N(%)
2007–2008 2008–2009 2009–2010 2010–2011 2011–2012 2012–2013
Hospital 97(44) 91(52) 106(47) 104(45) 96(45) 103(48)
Long-Term
Care
87(39) 64(37) 86(38) 99(43) 94(44) 82(38)
Community 37(17) 19(11) 28(13) 26(11) 17(8) 20(9)
Other 1(0) 1(1) 4(2) 1(0) 5(2) 9(4)
Total 222(100) 175(100) 224(100) 230(100) 212(100) 214(100)
Note. All totals as of September 3, 2013.
Source: Ministry of Health and Long-Term Care, 2013c.
New Graduate Nurse and Employer NGG Participation 2012–2013
Of the 2012 graduates (N=6648), approximately one-third (N=2249) participated
in the NGG. Eighty-one percent were RNs (1813 out of 2249) and 19% were
RPNs (436 out of 2249). Of the total NGN pool entering the labour market in
2012, 51% were RNs and 49% were RPNs. In terms of NGG participation by
nurse group, 54% (1813 out of 3383) of RNs participated, a 3% increase
compared to 2011. However, only 13% (436 out of 3265) of RPNs participated, a
5% decrease compared to 2011. Overall, 18% of employers participated in the
NGG in 2012–2013 (see Table 5). The highest participation came from the
hospital sector (66%). See Appendix B for participation rates over time.
Table 5. Employers by Sector of Employment and Participation in the NGG
2012–2013 Sector Participating Non-Participating Total
N(%) N(%) N(%)
Hospital 103(66) 52(34) 155(100)
Long-Term Care 82(13) 548(87) 630(100)
Community/Other 29(7) 384(93) 413(100)
Total 214(18) 984(82) 1198(100)
Note. All totals as of September 3, 2013.
Source: Ministry of Health and Long-Term Care, 2013c.
30
The new graduate
nurse survey was
sent to 5669 NGNs
(RNs and RPNs)
who graduated in
2012 and who were
registered on the
employment portal.
Sample
The sample included NGNs, employers, staff nurse mentors and union
representatives. Response rates for the surveys are provided in Table 6.
Participation in the teleconference focus groups and interviews included the
following:
Eight employer focus groups with 41 healthcare organizations from acute care
(large, medium, small and rural), LTC, public health and community
organizations
Key informant interviews with 18 NGNs (14 RNs and 4 RPNs)
Key informant interviews with seven staff nurse mentors
Table 6. Survey Response Rates 2012–2013
Survey Number of
Surveys Sent
Number of
Respondents
Response
Rate
New Graduate Nurse Survey
(English and French)
5669a 1292 23%
Participating Employer Survey
(English and French)
181b 145 80%
Union Representative Survey
(English)
413 91 22%
aOf the total portal registrants, there are some (i) double registrants, (ii) nursing students who have
not yet graduated, (iii) 2012 new graduates from out of province nursing programs and (iv)
internationally educated nurses who completed an Ontario bridging program that was deemed
ineligible.
bTotal number of employers (corporations) funded as of March 4, 2013.
Demographic Characteristics of Survey Respondents
The sections below focus on the 2012–2013 survey data. Comparisons are made
with the CNO registration database where appropriate.
RN and RPN New Graduates
The new graduate nurse survey was sent to 5669 NGNs (RNs and RPNs) who
graduated in 2012 and who were registered on the employment portal
(HealthForceOntario Marketing and Recruitment Agency, 2013). Data collection
occurred between March 2013 and May 2013. Upon completion of data
31
The majority of RN
(88%) and RPN
(65%) new
graduates were
employed in
nursing at the time
of survey
completion.
collection, cleaning and refinement, 1292 valid responses remained in the
database; 808 from RNs and 484 from RPNs (see Appendix C).
Data analysis revealed that RN and RPN nursing graduates were similar in gender
distribution but differed in age distribution. Ninety-one percent (90.7%) of RNs
and 89.4% of RPNs were female. As in previous years (2007–2011), RNs were
younger than RPNs. Seventy-six percent of new graduate RNs were younger than
30 years of age compared to 47% of new graduate RPNs. This difference is
important because age influences the work span of nurse graduates as well as their
work preferences and career mobility (Blythe et al., 2008). These data are
consistent with CNO data of new general class RN and RPN members: 80% of
new member RNs and 51% of new member RPNs were younger than 30 years of
age (CNO, 2012a).
The majority of RN (88%) and RPN (65%) new graduates were employed in
nursing at the time of survey completion. Compared to last year's new graduate
survey data, there was a 1.5% decrease in the percentage of RNs and a 10.8%
decrease in the percentage of RPNs employed in nursing at the time of survey
completion. Almost all employed RN (98.2%) and RPN (99.7%) new graduates
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 (18.2%) of RN and RPN new graduates,
followed by the Champlain LHIN (11.5%) and the Hamilton Niagara Haldimand
Brant LHIN (11.4%). Appendix D shows the percentage distribution by LHIN for
employment of new graduate RNs and RPNs.
According to the CNO (2012b), general class new member RN statistics were
consistent with RN survey data in that the top three LHINs employing RNs were
Toronto Central (17%), Champlain (12%) and Hamilton Niagara Haldimand
Brant (11%). In contrast, the top three LHINs employing general class new
member RPNs were Hamilton Niagara Haldimand Brant (13%), Champlain
(11%) and Central East (10%).
32
There were 181
participating
organizations at
the time of survey
distribution; 145
(80%) responded
to the survey.
Employer Profile and Participation
Contact information for healthcare organizations that participated in the 2012–
2013 NGG was obtained from the Nursing Policy and Innovation Branch at the
MOHLTC. Participating organizations were defined as those that hired and
received funding for NGNs in 2012. There were 181 participating organizations at
the time of survey distribution and 145 (80%) responded to the survey. A contact
list of healthcare organizations in Ontario has been created, updated and
maintained over the past six years of the NGG. Data were collected between
March 2013 and May 2013. The following section provides a demographic profile
of participating and non-participating employer survey respondents.
Participating Employers
As shown in Table 7, most of the participating employers who responded to the
survey were acute care hospitals (48.5%) and LTC facilities (36.0%).
Table 7. Participating Employer Survey Respondents by Sector of Employment
2008–2012 Sector % of Survey Respondents
2008 2009 2010 2011 2012
N=254 N=155* N=152 N=129 N=136**
Acute Care Hospital 41% 43% 45% 44% 49%
Long-Term Care Facility 36% 31% 33% 38% 36%
Public Health 6% 7% 1% 5% 1%
Community (Community Health Centre,
Community Care Access Centre, community mental
health, physician offices, nursing agency, hospice)
5% 6% 5% 5% 4%
Other Hospitals (continuing complex
care/rehabilitation, addiction and mental health) 4% 6% 9% 3% 4%
Other (Family Health Team, combined acute and
long-term care, college/university) 9% 6% 7% 6% 6%
Total 100% 100% 100% 100% 100%
*Missing data N=7; **Missing data N=9.
Data is rounded to the nearest whole number.
Source: Baumann et al., 2012c; Participating Employer Survey 2012–2013.
Data collection
for the
employer
surveys took
place between
March 2012
and May 2013.
33
Over half (54.4%)
of the participating
employer survey
respondents were
located in the
following five
LHIN regions:
North East
(14.7%),
Champlain
(12.5%),South
West (9.6%),
Central (8.8%),
and South East
(8.8%)
Acute care
hospitals were the
largest employer of
all nursing
graduates in 2012.
These data are consistent with the previous year's findings and align with
MOHLTC figures for overall employer participation in 2012–2013. It is important
to note that 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.
Over half (54.4%) of the participating employer survey respondents were located
in the following five LHIN regions: North East (14.7%), Champlain (12.5%),
South West (9.6%), Central (8.8%) and South East (8.8%). The remaining
organizations were distributed across the other eight LHINs, with the lowest
percentage located in the Central West LHIN (1.5%). Appendix E provides the
breakdown of participating employer survey respondents by LHIN.
Union Representatives
The union survey was sent to 413 union representatives across the province. Data
were collected between March 2013 and May 2013. Upon completion of data
collection, cleaning and refinement, 91 valid responses remained in the database.
REGISTERED NURSE AND REGISTERED PRACTICAL NURSE
EMPLOYMENT 2012–2013
The following sections report on the 2012–2013 employment data. The data
reflects NGNs who indicated they were employed in nursing in Ontario at the
time of survey completion (N=986). Comparisons are made between the 2012
new graduate data and CNO new member data. It is important to note that
comparisons do not represent similar points in time. Survey data of 2012 new
graduates are collected in 2013, while CNO employment data on new members
are collected at the end of 2012 and reported in 2013.
Distribution of Nursing Graduates by Sector of Employment
As shown in Table 9, the largest employer of NGNs in 2012 was the acute care
sector (62%), followed by the LTC (17%) and community sectors (8.4%).
34
When examined by
nurse group, the
largest percentage
of RN new
graduate survey
respondents were
employed in the
hospital sector.
In comparison, the
largest percentage
of 2012 new
graduate RPN
survey respondents
were working in
LTC facilities
Table 9. New Graduate (RN/RPN) Survey Respondents by Sector of Employment
2007–2012 Sector Year of Graduation N(%)
2007 2008 2009 2010 2011 2012
Acute Care Hospital 933(65) 649(73) 712(62) 572(54) 626(58) 604(62)
Addiction and Mental
Health/Psychiatric
43(3) 25(3) 22(2) 35(3) 59(5) 36(4)
Community* 133(9) 75(8) 117(10) 120(11) 108(10) 81(8)
Continuing Complex
Care/Rehabilitation
94(7) 49(6) 71(6) 80(8) 66(6) 55(6)
Long-Term Care Facility 190(13) 70(8) 182(16) 221(21) 186(17) 164(17)
Other 53(4) 26(3) 42(4) 38(4) 41(4) 30(3)
Total 1446(100) 894(100) 1146(100) 1066(100) 1086(100) 970(100)
*Includes public health.
Source: Baumann et al., 2012c; New Graduate Evaluation of the Nursing Graduate Guarantee
Survey 2012–2013.
From 2007 to 2012, there was a 3% decrease in the percentage of NGNs working
in acute care hospitals and a 1% decrease in the percentage working in the
community sector. However, there was a 4% increase in the percentage of NGNs
working in LTC facilities. Appendix F provides a breakdown by nurse category.
When examined by nurse group, the largest percentage of RN new graduate
survey respondents were employed in the acute care sector (77.7%), followed by
the community (7.6%) and LTC sectors (5.5%). Since 2007, there has been a
5.5% decrease in the percentage of new graduate RNs working in acute care
hospitals and a 0.1% decrease in the percentage working in community
organizations. There has also been a 4.3% increase in the percentage of new
graduate RNs working in LTC facilities. According to the CNO (2012b), the
majority of employment positions reported by new member RNs were in the
hospital sector (70.7%), followed by the LTC (13.1%) and community (12.7%)
sectors.
In comparison, the largest percentage of 2012 new graduate RPN survey
respondents were working in LTC facilities (41.9%), followed by acute care
hospitals (28.4%) and community organizations (9.9%). Over the six years of data
35
collection, there has been a 4.3% decrease in the percentage of new graduate
RPNs working in acute care hospitals and a 1.9% decrease in the percentage
working in community organizations. The percentage of new graduate RPNs
working in LTC facilities has increased 8.4%. These findings are consistent with
CNO (2012b) data in that the majority of employment positions reported by new
member RPNs were in the LTC sector (49.8%), followed by the hospital (32.7%)
and community (14.7%) sectors.
Distribution of Nursing Graduates by Age and Sector of Employment
Compared to their RPN counterparts, RN survey respondents were younger across
all sectors of employment (see Table 10). Employer categories are the same as
CNO classifications: hospital, community, LTC and other. The age difference was
most pronounced in the hospital sector, in which 79.1% of RNs were less than 30
years of age compared to 50.8% of RPNs.
In the community sector, 66.7% of RNs and 50.0% of RPNs were less than 30
years of age. In the LTC sector, 64.8% of RNs were younger than 30 years of age
compared to 40.4% of RPNs. In each of these sectors, the percentage of RNs and
RPNs under 30 has decreased since the previous year.
36
Table 10. New Graduate (RN/RPN) Survey Respondents' Age Group by Sector of
Employment 2012
Nurse Group
Sector
Age Group (%)
<19 20–24 25–29 30–34 35–39 >40 Total
Registered Nurse Hospital 0 52.8 26.3 11.1 5.3 4.4 100
Community 0 47.1 19.6 11.8 7.8 13.7 100
Long-Term Care 0 40.5 24.3 18.9 8.1 8.1 100
Other 0 45.5 45.5 0 0 9.1 100
Total 0 51.6 26 11.4 5.6 5.4 100
Registered
Practical Nurse
Hospital 0.8 24.6 25.4 13.5 12.7 23 100
Community 0 26.7 23.3 16.7 13.3 20 100
Long-Term Care 0.8 20.6 19 17.5 15.1 27 100
Other 0 31.6 21.1 10.5 10.5 26.3 100
Total 0.7 23.6 22.3 15.3 13.6 24.6 100
Source: New Graduate Evaluation of the Nursing Graduate Guarantee Survey 2012–2013.
Distribution of Nursing Graduates by Primary Area of Practice
The main areas of practice for RNs in 2012 were medicine (16.5%), surgery
(11.2%) and critical care (9.1%). These areas, primarily based in hospitals,
employed over a third (36.8%) of 2012 RN new graduate survey respondents. The
main areas for RPNs in 2012 were geriatrics (39.5%), complex continuing care
(9.6%) and medicine (8.6%). These areas employed over half (57.7%) of the 2012
RPN graduates. Data are generally consistent with previous years. See Appendix
G for a comparison of graduates' primary areas of practice from 2007 to 2012.
Distribution of Nursing Graduates by Employment Status
Table 11 shows the employment status of new graduate RN survey respondents
from 2004 to 2012. In 2012, 59% of RN new graduate survey respondents were
employed FT, 32% were employed PT and 5% were employed in casual
The main areas of
practice for RNs in
2012 were medicine
and surgery,
followed by
emergency and
critical care.
37
positions. Pre-policy (2004) survey employment data showed 44% of new
graduate RNs employed in FT positions. A chi-square test was conducted to
compare 2004 baseline employment data to each cohort of new graduate RNs
beginning in 2005. In each year, the percentage of FT employment was
significantly higher than the pre-policy level.
Table 11. RN New Graduate Survey Respondents Employment Status 2004–2012
Employment
Status
Year of Graduation N(%)
2004 2005 2007 2008 2009 2010 2011 2012
Full-Time±
225(44) 175(58)* 771(85)* 549(83)* 522(67)* 360(52)* 443(63)* 390(59)*
Part-Time 146(29) 80(27) 97(11)* 70(10)* 157(20)* 196(28) 193(27) 209(32)
Casual 83(16) 20(7)* 32(3)* 25(4) 61(8) 75(11)* 32(5)* 34(5)*
Other (multiple;
temporary part-
time)
57(11) 26(9) 12(1)* 21(3)* 41(5)* 65(9) 37(5)* 29(4)*
Total 511(100) 301(100) 912(100) 665(100) 781(100) 696(100) 705(100) 622(100)
Note. New graduate survey data was not collected in 2006.
±Full-time includes the categories of temporary FT and beginning in 2007–2012 supernumerary
FT Nursing Graduate Guarantee positions.
*Significant at p<.05 level based on chi-square. All testing in reference to 2004 pre-policy survey
employment data.
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
In 2005 and 2006, the MOHLTC invested pilot funding for new graduate RN
employment. The impact of this investment is evident in the initial increase in the
percentage of FT employment for RNs in 2005. During the years of the NGG
(2007–2012), the percentage of FT employment for RNs continued to be
significantly higher than the pre-policy level of 2004.
For RPNs, 36% of 2012 new graduate survey respondents were employed FT,
36% were employed PT and 23% were employed in casual positions (see Table
12). Survey data collection on RPN employment did not begin until 2005. In
addition, RPNs were not part of the MOHLTC pilot funding available between
In 2005 and
2006, the
MOHLTC
invested pilot
funding
targeting new
graduate RN
employment.
38
During the years of
the NGG (2007– 2012), the
percentage of FT
employment
continued to be
significantly higher
than the pre-policy
level of 2004.
2004 and 2006. Pre-policy (2005) RPN survey employment data showed 26% of
new graduate RPNs employed in FT positions. In each year of the NGG (2007–
2012), the percentage of FT employment for RPNs was significantly higher
compared to the pre-policy level.
Table 12. RPN New Graduate Survey Respondents Employment Status 2005–2012
Working
Status
Year of Graduation N(%)
2005 2007 2008 2009 2010 2011 2012
Full-Time±
67(26) 325(61)* 130(56)* 178(49)* 150(41)* 147(40)* 107(36)*
Part-Time 98(39) 99(18)* 54(23)* 97(27)* 108(29)* 121(33) 107(36)
Casual 48(19) 74(14) 24(10)* 44(12)* 57(15) 45(12)* 69(23)
Other (multiple;
temporary part-time) 40(16) 37(7)* 26(11) 41(11) 55(15) 58(16) 16(5)*
Total 253(100) 535(100) 234(100) 360(100) 370(100) 371(100) 299(100)
Note. New graduate survey data was not collected in 2006.
±Full-time in 2007–2012 includes the categories of temporary full-time and supernumerary full-
time Nursing Graduate Guarantee positions.
*Statistically significant at p<.05 level based on chi-square. All testing in reference to 2005 pre-
policy survey employment data.
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
Comparison to CNO New Member Employment Data
The following sections compare new graduate survey results to the CNO
registration database of general class new member RNs and RPNs. It is important
to note that comparisons do not represent similar points in time. New graduate
data are leading (i.e., 2012 data is collected in 2013), while CNO employment
data on new members are lagging (i.e., 2013 data is collected in
2012).
The CNO (2013) new member RN employment data shows a similar trend to
survey data (see Table 13). According to CNO pre-policy (2005) data, 39% of
new member RNs were employed in FT positions. In each year following (2006–
2013), the percentage of FT employment was significantly higher than the pre-
New graduate
data are leading
(i.e., 2012 data
is collected in
2013), while
CNO
employment
data on new
members are
lagging (i.e.,
2013 data is
collected in
2012).
39
Although this
analysis indicates
that the percentage
of FT employment
increased during
the period of
incentive funding,
it does not
demonstrate a
causal
relationship.
policy level. In 2013, FT employment for new member RNs was 56%, a 5%
decrease compared to the previous year.
Table 13. CNO RN New Member Working Status 2005–2012
±First cohort of NGG new member RNs.
*Statistically significant at p<.05 level based on chi-square. All testing in reference to 2005 pre-
policy survey employment data.
Source: Baumann et al., 2012c; College of Nurses of Ontario, 2012c, 2013.
For new member RPNs, pre-policy employment data (2007) showed 24% were
employed in FT positions (see Table 14). In each year of the NGG (2008–2012),
there was a significant increase in the percentage of FT employment compared to
the pre-policy level. In 2013, FT employment for new member RPNs was 30%, a
5% decrease compared to the previous year.
Although analysis indicates that the percentage of FT employment increased
during the period of incentive funding, it does not demonstrate a causal
relationship. It is recognized that other factors can influence employment. For
example, changes in the economy can affect the availability of FT jobs. However,
the NGG has been successful in mitigating the effects of a weakening economy
on FT employment for NGNs. Survey findings revealed that new graduates who
participated in the NGG obtained FT employment at a higher rate than those who
did not participate.
Working
Status
N(%)
2005 2006 2007 2008±
2009 2010 2011 2012 2013
Full-
Time
1700(39) 1116(47)* 1231(59)* 2294(76)* 2456(79)* 2236(71)* 1644(58)* 2010(61)* 2049(56)*
Part-
Time
1947(44) 966(40)* 702(34)* 624(21)* 509(16)* 706(23)* 948(33)* 1041(32)* 1343(37)*
Casual 773(17) 318(13)* 158(8)* 114(4)* 133(4)* 196(6)* 254(9)* 245(7)* 287(8)*
Total
4420(100) 2400(100) 2091(100) 3032(100) 3098(100) 3138(100) 2846(100) 3296(100) 3679(100)
40
Table 14. CNO RPN New Member Working Status 2005–2012
±First NGG cohort of new member RPNs.
*Statistically significant at p<.05 level based on chi-square.
All testing in reference to 2005 pre-policy survey employment data.
Source: Baumann et al., 2012c; College of Nurses of Ontario, 2012c, 2013.
As shown in Figure 5, RNs who participated in the NGG had significantly higher
rates of FT employment than those who did not. Rates were similar between
participants and non-participants in 2008. However, the economic decline in
2008–2009 had a substantial impact on FT employment for non-participants.
From 2008–2012, FT employment of participants decreased 20.4% (82.2% to
61.8%) compared to a decrease of 38.9% (76.3% to 38.3%) for non-participants.
In 2012, 61.8% of participants were able to secure FT positions compared to
38.3% of non-participants.
Similarly, RPNs who participated in the NGG had significantly higher rates of FT
employment than those who did not for all years between 2008 and 2012 (see
Figure 6). From 2008–2012, FT employment for non-participants decreased
12.1% (29.0% to 16.9%). Conversely, FT employment for participants remained
at or above 50%. In 2012, 50% of participants were able to find FT positions
compared to 16.9% of non-participants.
Working
Status
N(%)
2005 2006 2007 2008±
2009 2010 2011 2012 2013
Full-
Time
255(23) 335(21) 439(24) 623(34)* 896(41)* 883(36)* 780(36)* 971(35)* 919(30)*
Part-
Time
630(56) 914(59) 1034(57) 905(49)* 1018(46)* 1208(49)* 1006(47)* 1311(48)* 1568(51)*
Casual 238(21) 313(20) 347(19) 303(17) 294(13)* 371(15)* 358(17) 477(17)* 596(19)
Total 1123(100) 1562(100) 1820(100) 1831(100) 2208(100) 2462(100) 2144(100) 2759(100) 3083(100)
41
Figure 5. Full-Time Employment Rates for Participant and Non-Participant New
Graduate RNs
Note: Changes in the NGN survey in 2008 prevented similar comparisons from being made using
2007 data.
Rates exclude respondents in multiple positions and temporary, supernumerary NGG positions.
Source: Nursing Health Services Research Unit, 2008, 2009, 2010, 2011, 2012 [Unpublished raw
data].
Figure 6. Full-Time Employment Rates for Participant and Non-Participant New
Graduate RPNs
Note: Changes in the NGN survey in 2008 prevented similar comparisons from being made using
2007 data.
Rates exclude respondents in multiple positions and temporary, supernumerary NGG positions.
Source: Nursing Health Services Research Unit, 2008, 2009, 2010, 2011, 2012 [Unpublished raw
data].
0%
20%
40%
60%
80%
100%
2008 2009 2010 2011 2012
Pe
rce
nt
FT E
mp
loym
en
t
Year
RN non-NGG RN NGG
0%
20%
40%
60%
80%
100%
2008 2009 2010 2011 2012
Pe
rce
nt
FT E
mp
loym
en
t
Year
RPN non-NGG RPN NGG
42
Thirty-one percent
of new graduate
survey respondents
who indicated they
were employed in
the community
sector were
employed in FT
permanent
positions.
Distribution of Nurse Graduates by Work Status and Type of Employer
As shown in Table 15, there were sector differences in employment status among
NGNs. Thirty-one percent of new graduate RN and RPN survey respondents who
indicated they were employed in the community sector were employed in FT
permanent positions. Similarly, 31.3% of respondents who indicated they were
employed in the hospital sector were employed in FT permanent positions.
However, only 11.8% of respondents who worked in LTC were employed in
permanent FT positions. When examined by nurse group, the most common
employment status for RNs in all sectors was FT permanent.
Table 15. New Graduate Survey Respondents' Employment Status by Sector of
Employment 2012
Nurse
Category
Sector Employment Status N(%)
Perm FT Temp* FT Perm PT Casual Other Total
Registered
Nurse
Hospital 195(35) 136(24) 158(28) 22(4) 54(10) 565(100)
Community 17(34) 13(26) 9(18) 4(8) 7(14) 50(100)
Long-Term Care 12(33) 8(22) 6(17) 8(22) 2(6) 36(100)
Other 6(55) 3(27) 1(9) 0(0) 1(9) 11(100)
Total 230(35) 160(24) 174(26) 34(5) 64(10) 662(100)
Registered
Practical
Nurse
Hospital 21(17) 29(23) 40(32) 20(16) 16(13) 126(100)
Community 8(27) 3(10) 6(20) 8(27) 5(17) 30(100)
Long-Term Care 7(6) 31(25) 35(28) 37(30) 15(12) 125(100)
Other 6(33) 2(11) 2(11) 4(22) 4(22) 18(100)
Total 42(14) 65(22) 83(28) 69(23) 40(13) 299(100)
Total Hospital 216(31) 165(24) 198(29) 42(6) 70(10) 691(100)
Community 25(31) 16(20) 15(19) 12(15) 12(15) 80(100)
Long-Term Care 19(12) 39(24) 41(25) 45(28) 17(11) 161(100)
Other 12(41) 5(17) 3(10) 4(14) 5(17) 29(100)
Total 272(28) 225(23) 257(27) 103(11) 104(11) 961(100)
*Includes supernumerary temporary FT NGG positions.
Source: New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
43
Of the employed
new graduate
nurse survey
respondents,
almost all
indicated that they
were working in
Ontario.
For RPN new graduate survey respondents working in the hospital sector, the
largest percentage was employed in permanent PT positions. For those working in
the community sector, the largest percentage was employed in FT permanent or
casual positions. For those working in the LTC sector, the largest percentage was
employed in casual positions. Appendix H provides a breakdown of the
percentage of RN and RPN graduates by employment status and sector of
employment over time.
Mobility and Migration: RNs and RPNs
Of the employed new graduate nurse survey respondents, almost all (98.2% of
RNs and 99.7% of RPNs) indicated they were working in Ontario (see Appendix
I). In 2012, the Canadian Institute for Health Information released an updated
summary on the geography and migration patterns of Canada's nursing workforce.
According to the report, slightly more than 10.5% of the RN workforce was
employed in rural or remote areas. The majority (88.7%) of RN graduates from
Canadian nursing programs were employed in their jurisdiction of graduation.
Licensed practical nurses (LPNs) had a higher rate of non-migratory patterns.
Most (95%) LPNs remained in or returned to their jurisdiction of graduation. In
2012, 93.6% of graduates from an Ontario nursing school were employed within
the province.
EMPLOYMENT PREFERENCES OF RN AND RPN GRADUATES
This section reports survey findings from two subsamples of new graduate RNs
and RPNs. The first includes nurses who were employed but were not in their
preferred position regarding employment status, primary area of practice and
geographic region (i.e., LHINs). The second includes new graduates who were
not employed at the time of questionnaire completion but were seeking nursing
employment (9.5% of RN and 31.9% of RPN survey respondents) and indicated
their preference for employment.
44
Since 2005,
preference for FT
employment has
increased for RNs
and RPNs
Survey results
showed that 66.6%
of RN and 43.8% of
RPN graduates in
2011 indicated
their current
employment status
was by choice.
Preferences for Full-Time Work Status
Since 2005, there has been an 11.8% increase in the percentage of RNs and a
7.7% increase in the percentage of RPNs who prefer FT employment (see Figure
7). The majority of RN (82.5%) and RPN (67.8%) 2012 graduates indicated a
preference for FT employment status. However, compared to 2011 graduates,
preference for FT work decreased 3.1% for RNs and 3.4% for RPNs.
Survey results showed that 66.6% of RN and 43.8% of RPN graduates in 2012
indicated their current employment status was by choice. As shown in Figure 8,
the percentage of NGNs who indicated they were in their preferred employment
status has decreased from 2007 to 2010 for RNs and from 2007 to 2011 for RPNs.
However, the percentage of NGNs in preferred employment increased in 2011
and 2012 for RNs and increased in 2012 for RPNs.
Figure 7. New Graduates' Preference for Full-Time Employment 2005–2012
Note. Preference data calculated based on respondents who indicated they were not employed in
their preferred employment status and those seeking employment.
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
45
To assess new
graduate
employment
preferences,
respondents were
asked to rank their
top three choices
for employment
location, sector
and area of
practice.
Figure 8. Percentage of New Graduates Working in Employment Status of Choice
2007–2012
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
The majority of employed NGNs not working in a preferred position wanted
permanent FT status (91.0% of RN and 86.9% of RPNs). Only 7.7% of RNs and
10.7% of RPNs wanted permanent PT status. Interestingly, since 2009 the
preference for PT work has increased for RNs (from 3.5% to 7.7%) but decreased
for RPNs (from 14.6% to 10.7%). See Appendix J for a breakdown of
employment preference from 2007 to 2012.
Respondents who were not employed in nursing (11.8% of RNs and 35.0% of
RPNs) but looking for jobs in their field were asked to identify the type of
position they were seeking. For RNs, 52.0% indicated they were looking for a
permanent FT job, 13.3% were seeking permanent PT employment and 5.3%
were seeking temporary FT. No RNs were seeking casual employment. For RPNs,
42.8% indicated they were looking for a permanent FT job, 13.2% were seeking
permanent PT employment, 3.9% were seeking temporary FT employment and
1.3% were seeking casual employment. An additional 20.0% of RNs and 29.6%
of RPNs were seeking employment from multiple employers.
46
The majority of
2012 new graduate
respondents
indicated they were
employed in a
geographic region
of choice.
Three-quarters of
2012 new graduate
survey respondents
indicated they were
working in their
preferred sector of
employment and
area of clinical
practice.
For RNs not
working in their
clinical area of
choice, the top
three preferred
clinical areas were
emergency, public
health and critical
care.
Preferences for Employment Location
To assess NGN employment preferences, respondents were asked to rank their top
three choices for employment location, sector and area of practice. The
preferences were then weighted according to their priority. The majority of 2012
NGN respondents (84.2%) indicated they were employed in a geographic region
of choice. The rate was higher for RNs (87.3%) than for RPNs (77.4%).
Compared to 2011 new graduates, there has been a 4.0% increase in the
percentage of RNs and an 8.6% decrease in the percentage of RPNs who indicated
they were working in their preferred geographic location.
Similar to last year, the three most preferred LHINs by RN survey respondents
were Toronto Central, Mississauga Halton and Central. For RPNs, the three most
preferred LHINs were Mississauga Halton, Toronto Central and Waterloo
Wellington (see Appendix K). The top three LHIN locations in which RNs and
RPNs were seeking employment were Toronto Central, Mississauga Halton and
Central (see Appendix L).
Preferences for Sector of Employment and Clinical Area of Practice
Trends in preferences for sector of employment and area of clinical practice help
inform recruitment strategies. Three-quarters of 2012 new graduate survey
respondents indicated they were working in their preferred sector of employment
(74.2%) and area of clinical practice (72.4%).
For RNs not working in their clinical area of choice, the top three preferred
clinical areas were emergency, public health and critical care. For RNs actively
seeking employment, the top three choices were medical/surgical, medicine and
maternal/newborn. For RPNs not working in their clinical area of choice, the top
three preferred clinical areas were medical/surgical, maternal-newborn and
surgery. For RPNs actively seeking employment, the top three choices were
medical/surgical, geriatrics and medicine.
Survey respondents who were not in their employment sector of choice or who
were actively seeking nursing employment at the time of survey completion were
47
For RPNs, the top
three preferred
clinical areas were
medical/surgical,
maternal-newborn
and surgery.
More than three
quarters indicated
they had
participated in past
initiatives, they had
read about the NGG
on the HFO website
and they had read
about it on the
MOHLTC website.
asked to identify their preferred sector of employment. Registered nurse
respondents preferred the community sector, followed by hospital and LTC
sectors. Registered practical nurses preferred the hospital sector, followed by the
community and LTC sectors. These findings are similar to previous years.
Preferences for Mobility and Migration
Only 1.3% of all the 2012 survey respondents reported their current location of
employment as outside Ontario. The main reasons nurses accepted positions
outside the province were better career opportunities (61.5%), inability to find a
permanent position (61.5%), unsatisfied with area of practice (30.8%) and better
salary and benefits (30.8%). Top motivators for returning to Ontario were cited as
availability of FT work (84.6%), availability of desired clinical practice area
(53.8%), better workload/work opportunities (53.8%) and better salaries (46.2%).
STAKEHOLDER PERCEPTIONS OF THE NGG 2011-2012
The following sections describe the major themes identified by the participants
and their overall perceptions of the NGG program. The themes include how the
NGG was promoted, recruiting NGNs through the employment portal, factors
affecting participation in the NGG, employer challenges in creating bridging
positions, facilitating NGN transition to work and offering permanent FT
positions. Survey results are supplemented with qualitative findings to present the
perspectives of all stakeholders.
Promotion of the NGG: How Employers and New Graduates Were Informed
Employer NGG participant survey respondents were asked how they heard about
the initiative for 2012–2013. More than three-quarters (78.7%) indicated they had
participated in past NGG initiatives, 11.0% indicated they had read about the NGG
on the HFO website and 4.4% indicated they had read about it on the MOHLTC
website. The majority of employer focus group participants thought the NGG was
an ongoing initiative and posted each year. One human resource manager
reported,
48
New graduate
survey respondents
were also asked
how they first
learned about the
NGG. The top two
ways were through
teachers or
professors at
school and through
other students.
We have been participating in the New Graduate Guarantee for about five
years now, so we just assume that it is going to be available and we would
talk to HealthForceOntario or look at the information available on the
website.
The top two ways NGNs heard about the NGG in 2012 were through
teachers/professors (52.3%) and other students (44.7%). In 2011, the top two
ways were also through other students (49.8%) and teachers/professors (47.7%).
Other ways NGNs learned of the NGG in 2012 were the HFOJobs website
(35.4%) and promotional advertisements at school (33.5%). One graduate
commented, "[I] found out about it through some people I had worked with that
had done the program and they had recommended it."
Recruiting NGNs: Evaluating the Effectiveness of the Employment Portal
(HFOJobs)
Just under half (43.4%) of all employer survey respondents indicated that
recruiting NGNs using the NGG website was the most efficient method. Other
methods included posting positions on organizational websites (60.0%), posting
positions internally (51.0%) and advertising positions in local newspapers
(32.4%). When asked if they would use the website again, 98.1% indicated they
would.
Employers continue to be successful in using the portal to recruit NGNs. Focus
group participants reported using the NGG as an extension of the clinical
placements for students. Many employers will hire clinical students when they
complete a placement in the last year of their program and place them into an
NGG position. This provides students with the extended orientation and
mentorship needed to transition from school to work. One manager explained,
We . . . try to take advantage of our consolidation students and get them
into the NGG and hire them so then they've had from January to April
with us and had some of that orientation and are comfortable. And then to
49
Survey findings
indicated that 74%
of 2012 new
graduates were
satisfied with the
job postings on
HFOJobs with
respect to their job
preferences
Although many
new graduates
reported a good
variability of job
postings, they
recognized that
they had to do
more than just
submit an
application in
order to be
successful.
provide that additional sort of advanced or more tailored training and
support in the NGG . . . they're ready to hit the ground running.
Survey findings demonstrated that 74.0% of 2012 NGNs rated the job postings on
HFOJobs as good, very good or excellent with respect to their job preferences.
New graduate interviewees indicated they had applied to a large number of
postings and received responses from some employers, but it took a lot of time to
obtain a position. One new graduate reported,
I sent my résumé . . . my cover letter, and I tried to follow up through an
email to see if they actually got my information. Some responded, but I
didn't get much of a response which, to be honest, at that point was kind of
disappointing.
Many of the new graduate interviewees had to expand their job search
geographically and look at sectors outside their preferred areas of interest. One
new graduate said, "When I realized no one was calling me after about four or
five months then I got desperate and I started applying in the nursing homes as
well."
Website Design and Functionality: Employer and New Graduate Ratings
Employer survey respondents were asked to evaluate the instructions for posting
positions on the NGG website and their overall experience using the employment
portal. Similar to previous years, 2012 employers highly rated the clarity of
instructions for posting positions; 77.8% rated the instructions as clear or very
clear compared to 82.9% in 2011.
Employer satisfaction ratings with the NGG website for 2012 are shown in Figure
9. The majority of employers (66.3%) rated their overall experience with the
website as high. These ratings were consistent with those from 2011. Almost two-
thirds (61.3%) of employers indicated that it took about the amount of time they
anticipated to register and post positions on the portal. This was a slight decrease
compared with 2011 (66.4%). In further comparison to the 2011 results, there was
50
Similar to previous
years, employers
gave high ratings
to the clarity of
instructions for
posting positions.
a 9.4% increase in the percentage of employers who said it took more time and a
4.3% decrease in the percentage of employers who said it took less time to
register and post positions.
Figure 9. Employers' Rating of Their Overall Experience with the Nursing
Graduate Guarantee Website
As shown in Figure 10, nearly two-thirds (62.3%) of new graduate survey
respondents rated their overall experience with the NGG website as positive (i.e.,
good, very good or excellent). However, over one-third (37.7%) rated their
experience as fair or poor. When compared to survey findings from 2011, the
percentage of new graduates who gave a positive rating has decreased by 4.7%.
51
At the time of
survey completion,
60.7% of 2012 new
graduate survey
respondents
indicated they were
in positions made
available through
the NGG.
Figure 10. New Graduates' Rating of Their Overall Experience with HFOJobs
Nursing Graduate Guarantee Program Website 2012–2013
Factors Affecting New Graduate Participation
At the time of survey completion, 60.7% (68.7% of RNs and 43.0% of RPNs) of
2012 new graduate survey respondents indicated they were in positions made
available through the NGG (see Figure 11). This represents a 6.1% increase since
2011 and a 17.5% increase since 2010.
Figure 11. New Graduate Survey Respondents Indicating They Obtained an NGG
Position 2007–2012
52
Source: Baumann et al., 2012c; New Graduate Nurse Evaluation of Nursing Graduate Guarantee
Survey 2012–2013.
The reasons most frequently cited by 2012 new graduates for not matching to an
employer through the NGG website are provided in Table 16. The top reason was
no response from employers (53.9%), followed by the new graduate obtaining a
position outside of the portal (20.2%). These findings are consistent with the
reasons cited by 2011 new graduates. However, there has been a 5% increase in
NGNs who indicated they did not receive a response from employers. There has
also been a 5% decrease in NGNs who obtained a nursing position outside the
portal.
Interview data supports these findings. Many new graduates searched for jobs
outside the portal. One new graduate reported, "I applied through both, I applied
through the HFO website but also through public postings they have on their
website, like the hospital website." Others searched for jobs by attending career
fairs, visiting hospitals to drop off résumés personally and word of mouth through
friends and family.
Table 16. Reasons Given by Nursing Graduates Who Did Not Match Into an NGG
Position 2011–2012 Reason Year of Graduation N(%)
2010 2011 2012
I had no response from employers 497 62% 332 49% 328 54%
I have a nursing position that I obtained outside of the portal 131 16% 166 25% 123 20%
Posted positions are not in geographic region of interest 109 14% 87 13% 70 12%
Available nursing positions posted to date on the portal are
not of interest to me
37 5% 46 7% 34 6%
Did not pass the nursing exam 25 3% 20 3% 20 3%
I am not seeking a nursing position at this time 4 0% 2 0% 4 1%
Other -- -- 19 3% 28 5%
Total 803 100% 672 100% 607 100%
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
The top reason
cited by 2012
new graduates
for not matching
to an employer
was no response
from employers.
53
Less than half of
employer survey
respondents who
participated in the
NGG in 2012–2013
indicated they had
the same number of
FT job opportunities
for new graduates
as they had in
previous years.
The main reasons
for fewer FT jobs
cited by
employers in 2012
were lack of FT
vacancies
(62.9%) and
budget
constraints
(22.9%).
EMPLOYER CHALLENGES IN CREATING BRIDGING POSITIONS
Less than half (44.6%) of employer survey respondents who participated in the
NGG in 2012–2013 had the same number of FT job opportunities for NGNs as
they had in previous years. Over thirty-nine percent (39.8%) had fewer FT job
opportunities and 15.7% had more FT job opportunities compared to previous
years.
Compared to last year, there was a 7.3% decrease in employers who had the same
number of FT job opportunities for NGNs. In addition, there was a 6.0% increase
in employers who had fewer FT job opportunities and a 1.4% increase in
employers who had more FT job opportunities. The main reasons for fewer FT
jobs cited by employers in 2012 were lack of FT vacancies (62.9%) and budget
constraints (22.9%).
Many of the employers in the focus group had participated in the NGG in
previous years and planned for annual hiring of NGNs based on their previous
experiences with the initiative. Employers reported that they hire based on
"need" and at different times in the year. They also consult with clinical
managers to ensure a FT position will be available at the six-month mark. One
manager commented,
The clinical managers do their forecasting so their staffing needs
throughout the year are based on natural attrition, who they know is
coming up for retirement, etc. . . . There is always in the back of your
mind best efforts to bridge them into the full-time jobs.
Many employers consult with the union before posting an NGN position. One
manager said,
We do have correspondence with the union at all the steps, and we have
gone beyond just the Med/Surg units into the speciality. So each time we
post in those [specialty] areas, they want to know how many [positions
will be posted before we actually go ahead.
54
For smaller
organizations, the
issue of budget
was a barrier to
hiring NGNs.
Nearly three
quarters (73.3%) of
the 2012
participating
employers gave
high ratings to the
mentoring provided
by their
organization.
For smaller organizations, the issue of budget was a barrier to hiring NGNs. Many
employers reported that they could not afford to absorb the additional six weeks if
they were unable to transition the new graduate into a FT position. One Director
of Care from a LTC facility acknowledged that "the financial aspect of the six-
week full-time commitment is always a bit of a concern; so [hiring] one [new
graduate] has been our limit." In other sectors such as the community and long-
term care, employers indicated they were unable to take on many new graduates.
A LTC manager remarked,
Usually, we can't handle a lot of them [NGNs] financially because there is
that stipend at the end where you have to pay for the extra six weeks, and
financially we can't afford to do that. So we usually only take one. I have
at one point taken two, but I can't take very many.
Facilitating NGN Transition to Work: Mentoring and Support for New
Graduates
The six-month extended orientation and mentorship were viewed as advantageous
for NGNs who participated in the NGG. Employers and staff nurses indicated that
the mentorship period allowed NGNs to gain the skills, knowledge and
confidence needed to practice independently. Employer survey respondents were
asked to rate the mentoring/supervision provided during the temporary FT
supernumerary position (see Table 17). Nearly three-quarters (73.3%) of the 2012
participating employers highly rated the mentoring provided by their organization.
As shown in Table 18, approximately two-thirds (66.5%) of 2012 new graduate
survey respondents highly rated their mentorship experiences.
55
Having access to a
mentor was a key
feature identified
by both employers
and NGNs.
Table 17. Employer Survey Respondents' Ratings of Mentoring Process 2008–
2012
Rating Year of Graduation N(%)
2008 2009 2010 2011 2012
High 80(70) 75(58) 81(69) 71(68) 85(73)
Average 30(26) 47(36) 26(22) 33(31) 28(24)
Low 5(4) 7(6) 10 (9) 1(1) 3(3)
Total 115(100) 129(100) 117(100) 105(100) 116(100)
Note. Employers were not asked to rate the mentoring process in 2007.
Source: Baumann et al., 2012c; Employer Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
Table 18. New Graduate Survey Respondents Ratings of the Mentoring Process
2008–2012
Rating Year of Graduation N(%)
2008 2009 2010 2011 2012
High 379(61) 406(56) 336(64) 387(69) 366(67)
Average 140(22) 174(24) 98(19) 108(19) 116(21)
Low 109(17) 148(20) 91(17) 66(12) 68(12)
Total 627(100) 728(100) 525(100) 561(100) 550(100)
Note. New graduates were not asked to rate their experience with the mentoring process in 2007.
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
Interview data was consistent with survey findings. Having access to a mentor
was identified as important by employers and NGNs. Employer focus group
participants agreed that having a primary mentor was valuable for NGNs.
However, some emphasized the need for a secondary mentor. A manager in one
organization observed, "They [NGNs] follow their primary mentor and there may
be a secondary one as well . . . so that there is somebody else that is also very
closely involved with them and available to support them."
56
Most employers
followed a one-to-
one model of
mentoring with a
few indicating they
expose NGNs to
two mentors over
the six-month
duration.
There was a sense
of ease knowing
that someone was
there to support
them as they began
their role as a
nurse.
"It was a very good
experience . . . you
get such good
training and you
really build your
confidence. . . . It
helped me so much
transitioning into
this job."
Most employers followed a one-to-one model of mentoring with a few indicating
they expose NGNs to two mentors over the six-month duration. One manager
noted,
We usually try one person, although . . . some of the feedback we have
gotten is that it is good to have two people because you get a bit of a
different perspective on things. But you don't want it to be too widespread
because then the message gets very convoluted.
Another mentoring model was identified by employers who hired NGNs into the
Nursing Resource Team (NRT). This model involved NGNs being mentored by
three or four different nurses during their orientation. The advantage of this
approach was that NGNs were able to experience different clinical units and
styles of nursing. However, employers cautioned that this method might not work
for all nurse graduates.
As in previous years, new graduate interviewees believed mentorship helped them
transition from a student to nurse. There was a sense of ease knowing that
someone was there to support them as they began their role as a nurse. One NGN
enthused, "I loved having someone help me; someone that I always knew was
there to answer my questions. And when something happened, I always had
someone there that wasn't too busy to help me."
When asked if they felt job ready at graduation, the majority of NGNs indicated
that they did not. Having a mentor prepared them for practice. An NGN remarked,
"It was a very good experience . . . you get such good training and you really
build your confidence. . . . It helped me so much transitioning into this job." Many
NGNs highlighted the need for the NGG extended orientation and mentorship.
They also mentioned how difficult it would have been if they were given only a
few "buddy shifts" during their orientation. One NGN said, "If you have [only]
three buddy shifts, there's no way you are going to know just simple things, like
where everything is." Another commented on the stress associated with a "normal
57
Mentors used a
range of strategies
to help new
graduates become
more comfortable
with their role as a
graduate nurse.
Following the
period of
shadowing, new
graduates were
given the
responsibility to
care for patients
while being
supervised by their
mentor who
encouraged them
to take the lead in
providing total
patient care.
job and having five shifts and good luck . . . because no matter how well they get
you ready for it, you're just not there."
Mentor Perspectives
Staff nurses were interviewed about their experiences with the NGG and
mentoring a 2012 NGN. Nurses reported varying experiences. Some had been
involved with the NGG program since its inception, while others had only
recently mentored. All nurse mentors knew about the NGG and that it had been
available to NGNs for many years.
Staff nurses were asked how mentors were chosen within their organization.
Some indicated they had previous experience as a preceptor for clinical students.
Consequently, they were identified by their managers as good candidates for
mentoring NGNs. Others were chosen by the clinical educator/manager to mentor
because they had expressed an interest in doing so. One staff nurse in an acute
care facility recounted her experience:
In my case, I was approached by the educator on our floor . . . when I'd
had my performance reviews I indicated that preceptoring and mentoring
is something that I enjoy doing . . . I had sort of identified myself as
somebody that would be willing to do that. So they asked me, and I
agreed.
The method of mentoring NGNs was similar across organizations. Graduates
began by shadowing their mentor and then gradually took over the patient load
while their mentor observed. However, the process of mentoring varied by sector.
In the community, NGNs conduct home visits with their mentor for a period of
time and then transition to doing home visits on their own. Their mentor supports
them through weekly meetings and phone calls if needed. In acute care, NGNs
initially shadow their mentors and then work progressively toward independent
practice. In LTC, NGNs work in different wings of the residence and with
different mentors because they are required to gain experience across the facility.
58
Once the new
graduate felt
comfortable
enough to accept
full responsibility
for patient care,
the mentor's role
shifted from direct
supervision to
indirect
supervision.
Over half (58.8%)
of 2012 employer
survey respondents
indicated they were
not able to bridge
the new graduate
to a FT permanent
position.
The mentor interviewees agreed that NGNs were not prepared to enter the
workplace and the NGG was needed to enable their transition from school to
work. One mentor commented, "[The NGG] is a phenomenal program. . . . to get
the younger nurses feeling comfortable with their role and to try and retain them."
Another mentor believed it was her duty to support NGNs as they begin practice
and the NGG facilitated this process:
I do believe that if we want good nurses, we need to take on that
responsibility . . . we have a responsibility to participate in mentorship and
[anything] that can increase the care that we provide and our quality of
work.
Offering New Graduates Permanent Full-Time Positions
Over half (58.8%) of 2012 employer survey respondents were not able to bridge
NGNs to a FT permanent position. This was a 6.0% increase from 52.8% in 2011.
Table 19 provides the reasons for not transitioning NGNs to FT permanent
positions.
The main reason for not transitioning NGNs identified by 71.6% of employers
was a lack of FT positions. Compared to 2011, there has been an 8.6% increase in
the percentage of employers citing this reason. Six percent of employers agreed
barriers related to collective agreements prevented the transitioning of NGNs.
This percentage has decreased by 5.1% since 2011. Employers noted that posted
positions are often awarded to nurses with greater seniority, which means fewer
permanent FT positions available for NGNs.
59
When asked what
would help them
create more FT
positions for new
graduates, 61% of
employer survey
respondents
indicated more
funding.
Based on the focus
group data,
employers were
able to transition
new graduates into
FT positions easier
this year compared
to last year.
Table 19. Employer Survey Respondents' Reasons for Not Transitioning to Full-
Time 2010, 2011 and 2012
Reason Year of Graduation N(%)
2010 2011 2012
No position was available 42 65% 34 63% 48 72%
Existing employment contracts 5 8% 6 11% 4 6%
There was not a match between the nurse's interest
and the clinical area offered
1 2% 2 4% 0 0%
Lack of adequate funding 2 3% 2 4% 3 4%
Failed registration exam 1 2% 1 2% 0 0%
Nurse did not accept permanent job 3 5% 1 2% 1 1%
The performance of the nurse was not adequate 1 2% 0 0% 0 0%
Other (please specify) 10 15% 8 15% 11 16%
Total 65 100% 54 100% 67 100%
Source: Baumann et al., 2012c; Employer Evaluation of Nursing Graduate Guarantee 2012–2013.
When asked what would help them create more FT positions for NGNs, 67.6% of
employer survey respondents specified more funding. An additional 23.5%
indicated that the retirement of senior nurses would open FT permanent
opportunities for NGNs. These represent 6.5% and 5.7% increases, respectively,
since 2011.
Some employers were able to transition the majority of their NGNs into FT
positions. Employers emphasized that NGNs hired into the NRT were guaranteed
a FT position. A nurse manager in acute care acknowledged that the organization
had an NRT and was "able to accommodate all 13 new grads." Other employers
found that FT opportunities were unit specific. One human resource manager
remarked,
We find our existing nurses tend to not want to move into Emerg or ICU.
So the new grads can often get full-time in those two departments, but
60
Small and rural
organizations
struggled to offer
FT due to low
turnover among
their internal
nursing staff.
Less than half
(42.3%) of the new
graduate
respondents
indicated they were
offered and
accepted a FT
position from their
employer.
they can rarely get full-time hours in any other area of the hospital where
the more senior nurses are anxious to move.
Some employers pointed out that their collective agreement prevented new
graduates from transitioning into FT positions right away. One manager in acute
care said,
Because of our collective agreement language, especially with ONA
[Ontario Nurses Association], we need to post, and when a full-time
position gets posted, we have all the internal candidates with the seniority
that are able to move into those positions.
Employers who were unable to offer FT positions directly after the NGG reported
that NGNs are able to transition into a FT position within a couple of years of
completing their position. An HR manager commented, "Most [new graduates] go
into part-time or temp full-time, but probably within the two years they are into
full-time jobs."
Owing to a lack of capacity, small and rural organizations struggled to offer FT
employment to NGNs. This finding is similar to previous years. One HR manager
discussed the issue with new graduates who were beginning their NGG position:
We do talk a lot about that with the new grads when they come . . . and set
their expectations, so that they understand in a smaller hospital we don't
have full-time jobs every day of the week, and our hope in going through
this process is that they stay with us.
New Graduates' Experiences Following Their NGG Position
New graduate survey respondents were asked to describe what happened
following their temporary NGG position (see Table 20). Less than half (42.3%) of
respondents were offered a FT position by their employer, which they accepted.
Thirty-five percent were offered a PT position, which they accepted. Compared to
last year, the number of NGNs who were offered and who accepted a FT position
from their employers decreased 3.9%. The number of NGNs who were offered a
PT position increased 1.8%.
61
Some NGN interviewees were told they would not be guaranteed FT employment
following their NGG position. Employers advised that there would be a
permanent position for the NGNs, but it could be PT or in a different unit from
where they had been working. One NGN commented, "[The employer] never said
they guaranteed it [FT]. They said, 'We will have positions available for you, we
don't know if it's going to be full-time or part-time, but there will be some
position available for you.'"
Table 20. New Graduate Experience Following their Nursing Graduate
Guarantee Position 2010-2012
Outcome Year of Graduation N(%)
2010 2011 2012
I was offered a full-time job by my employer and I took
it
123(33) 177(46) 162(42)
I was offered a part-time job by my employer and I took
it
151(41) 127(33) 134(35)
I was not offered a full-time job by my employer, but my
position was extended for an additional six weeks
27(7) 7(2) 16(4)
I am working for a different employer 4(1) 6(2) 3(1)
I was not offered a job by my employer 2(1) 3(1) 2(1)
I was offered a full-time job by my employer but chose
to take a part-time job
6(2) 2(1) 4(1)
Other (please specify) 56(15) 61(16) 62(16)
Total 369(100) 383(100) 383(100)
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
BARGAINING UNIT AND EMPLOYER COLLABORATION: WHERE
ARE THE GAPS?
An online survey was used to examine the union perspective on the NGG
program and its effectiveness. The following sections outline the results of the
Union Representative Survey 2012–2013. Comparisons are made to previous
years where applicable.
Employers
advised that
there would be
a permanent
position for the
NGNs, but it
could be PT or
in a different
unit from where
they had been
working.
62
When asked about
communication
prior to
participation in the
NGG, over half
(59.4%) of union
representatives
indicated that
employers
communicated with
the union.
In the decision to
bridge the new
graduate, only
21.2% of union
representatives
indicated they were
involved.
Communication of Employers with the Bargaining Unit
Successful collaboration requires ongoing communication between employers and
bargaining units throughout the entire process of the NGG. Union representative
survey respondents were asked if they were consulted during the following phases
of the NGG: prior to participation, prior to posting a position on the NGG
website, in the decision to bridge the new graduate and prior to sign-off of final
report. Table 21 presents the results of the union survey for each of these phases.
When asked about communication prior to participation in the NGG, over half
(59.4%) of union representatives indicated that employers communicated with the
union. This rate has decreased 5.1% since 2011 (down from 64.5%). When asked
if employers consulted the union prior to posting a position on the NGG website,
43.9% of union representatives indicated they had. This percentage has increased
by 6.2% since 2011.
Table 21. Union Representative Survey Respondents' Collaboration with
Employers During Phases of the Nursing Graduate Guarantee 2012
Phase N(%)
Yes No Total
Prior to participation in the
NGG
41(59) 28(41) 69(100)
Prior to posting a NGG
position
29(44) 37(56) 66(100)
In the decision to bridge the
new graduate
14(21) 52(79) 66(100)
Prior to sign-off of final report 26(41) 37(59) 63(100)
Source: Union Representative Survey of Nursing Graduate Guarantee 2012–2013.
In the decision to bridge the new graduate, only 21.2% of union representatives
indicated they were involved. When asked if employers had contacted them
before the final sign-off, 41.3% of union representatives indicated they had. These
represented 2.9% and 4.2% decreases, respectively, since 2011.
63
Over half of all
union
representative
survey respondents
indicated that new
graduates never
transitioned into a
specialty position
ahead of existing
staff.
When asked how they would rate the overall efforts of employers to collaborate
with the union, 75.8% rated it as poor or fair and 13.6% rated it as very good or
excellent. These ratings have dropped since the 2011 survey, in which 59.6%
rated poor or fair and 26.3% rated very good or excellent. Although collaboration
between employers and the union is encouraged throughout the NGG process,
these findings suggest that this is not always the case at the outset. In fact, the
only time employers are required to contact the union is to sign-off on the final
report.
New Graduates in Specialty Positions: Union Concerns
Each year, union representatives are asked how frequently NGNs transition to a
specialty area position that an existing staff member wanted but lacked the
necessary experience to obtain. Table 22 shows that over half (54.7%) of all union
representative survey respondents reported that this situation never or almost
never occurred. In contrast, 17.2% indicated that it almost always or always
happened.
Table 22. Union Representatives' Perceptions that New Graduates Transitioned
to a Specialty Area Position Ahead of Existing Staff 2008–2012
Rating N(%)
2008 2009 2010 2011 2012
Never 44(49) 58(54) 40(53) 26(46) 25(39)
Almost never 15(17) 10(9) 9(12) 10(18) 10(16)
Sometimes 21(24) 31(29) 20(26) 14(25) 18(28)
Almost always 8(9) 6(6) 6(8) 6(11) 9(14)
Always 1(1) 2(2) 1(1) 1(2) 2(3)
Total 89(100) 107(100) 76(100) 57(100) 64(100)
Source: Baumann et al., 2012c; Union Representative Survey 2012–2013.
64
The majority of
union
representatives
who indicated they
were consulted
about the
reinvestment of
NGG funds were
satisfied with the
nursing initiatives
chosen by
employers.
Less than half of
employer survey
respondents were
able to reinvest
funds from their
participation in the
NGG.
Reinvestment of Funds: Who is Involved in Decisions
As shown in Figure 12, 85.1% of union representatives indicated they were not
consulted about the reinvestment of funds obtained from the NGG. This
percentage was higher than in 2011 (77.6%). Of the 14.9% of union
representatives who were consulted in 2011–2012, 83.3% were satisfied with the
nursing initiatives in which employers reinvested the funds. This was consistent
with 2011 (84.6%).
Employer survey respondents were asked if they were able to reinvest any funds
from their participation in the NGG. Less than half (45.3%) said they were. Table
23 shows the initiatives into which the funds were reinvested. Over eighty percent
(82.4%) of the employers used funds to backfill the 80/20 initiative, 52.9%
allocated funds to support interprofessional mentorship and preceptorship
programs and 11.8% used funds to provide internships for experienced nurses in
specialty areas. These data indicate that investment of surplus NGG funds into the
80/20 initiative has increased, while investment in internships for experienced
nurses has decreased compared with previous years.
Figure 12. Percentage of Union Representatives Consulted Regarding the
Reinvestment of Nursing Graduate Guarantee Funds 2012
Source: Union Representative Survey 2012–2013.
65
The Nursing
Graduate
Guarantee
Management
Module (NGGMM)
is an online system
through HFOJobs
that allows
employers to
manage the
funding,
contracting and
reporting aspects
of the NGG.
Employers were
either neutral or
satisfied with their
experience
requesting funds
through the NGG
and using the
MOHLTC transfer
payment
agreement.
Table 23. Employer Survey Respondents Reinvestment of Funds 2008–2012
Initiative
N(%)
2008 2009 2010 2011 2012
80/20 for staff nurses 33(70) 33(65) 23(61) 20(61) 28(82)
Interprofessional mentorship and
preceptorship programs
28(60) 27(53) 23(61) 18(55) 18(53)
Internships for experienced nurses in
specialty areas
16(34) 19(37) 12(32) 8(24) 4(12)
Support internationally educated
nurses and nurses re-entering the
workforce
7(15) 7(14) 6(16) 1(3) 0(0)
Other 6(13) 7(14) 4(11) -- --
Note. Numbers do not add to 100% because employers were asked to check all that apply.
Source: Baumann et al., 2012c; Employer Evaluation of Nursing Graduate Guarantee 2012–2013.
ADMINISTRATIVE AND BUDGETARY ISSUES
Evaluation of the Nursing Graduate Guarantee Management Module
The Nursing Graduate Guarantee Management Module (NGGMM) is an online
system through HFOJobs that allows employers to manage the funding,
contracting and reporting aspects of the NGG. Employer survey respondents were
asked to rate their satisfaction with accessing the NGGMM (see Table 24).
The majority of employers were either neutral or satisfied with their experience
requesting funds (69.4%) and using the MOHLTC transfer payment agreement
(73.1%). However, employer satisfaction with requesting funds and using the
transfer payment agreement have decreased when compared to previous years.
Similarly, employer satisfaction with the amount of time required for the NGG
funding process has lessened. Over half (53.3%) of the survey respondents
indicated the funding process took more time than anticipated, 46.7% indicated it
took about the amount of time anticipated and none indicated it took less time
than anticipated.
66
The majority of
employers had
called the Nursing
Secretariat or
HFOJobs for
support.
Table 24. Employer Rating of Their Experience Accessing Nursing Graduate
Guarantee Funds and Using the Ministry of Health and Long-Term Care Transfer
Payment Agreement
Rating Requesting Funds Through the Nursing
Graduate Guarantee Initiative (%)
Using the Ministry of Health and Long-
Term Care Transfer Payment
Agreement (%)
2007 2008 2009 2010 2011 2012 2007 2008 2009 2010 2011 2012
Easy or
very easy
36.1 28.3 40.8 50.4 54.1 46.3 43 31.2 26.0 36.5 36.0 20.2
Neither
easy nor
difficult
51.5 47.1 31.5 27.7 25.7 23.1 52.3 46.4 57.3 48.3 49.0 52.9
Difficult or
very
difficult
12.4 24.6 27.7 21.8 20.1 30.6 4.7 22.5 16.8 15.3 15.0 26.9
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Source: Baumann et al., 2012c; Employer Evaluation of Nursing Graduate Guarantee Survey
2012–2013.
Ministry Response to Employer Challenges
Employer survey respondents were asked how they learned about using the
NGGMM. The majority (93.3%) called the Nursing Secretariat or HFOJobs for
support (see Table 25). Other methods included online help pages, trial and error
and webinars produced by the Nursing Secretariat. Only 7.5% of employers said
they had no difficulty with the NGGMM.
67
The response of all
stakeholders to the
NGG was very
positive.
Since its inception,
employers and new
graduates reported
on the effectiveness
of the NGG in
integrating NGNs
into Ontario's
workforce.
Table 25. Methods Employers Used to Obtain Help With the NGGMM 2012–2013
Method Used to Obtain Help N(%)
Phone calls to Nursing Secretariat/HFOJobs Support Office 112(93)
Help pages 61(51)
Trial and error 65(54)
Information webinars 43(36)
Had no difficulty learning the NGGMM 9(8)
Other 6(5)
Note. Numbers do not add to 100% because employers were asked to check all that apply.
Source: Employer Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
OVERALL IMPACT OF THE NURSING GRADUATE GUARANTEE
The response of all stakeholders to the NGG was very positive. As shown in
Table 26, the majority of employers rated the responsiveness of stakeholders in
their organizations to be receptive or very receptive for both clinical staff (89.2%)
and administrators (92.4%). However, results from 2012 indicate that a greater
percentage of clinical staff was unreceptive or very unreceptive and a greater
percentage of administrative staff was neither receptive nor unreceptive to the
NGG when compared with recent years.
Employers provided their views regarding differences between NGG participants
and non-participants. Many employers reported the initiative helps NGNs
improve their team engagement and nursing skills and identify gaps in their
practice. It also builds their confidence and allows them to grow and develop. One
employer noted that the initiative gives NGNs "a platform." Overall, employers
believed that the NGG produced better quality NGNs. One employer remarked,
The new grad that goes through the New Grad Initiative has a broader
understanding of the patient's experience . . . I think that they are better
critical thinkers and I think that they understand the continuum of care for
the patients, not just that small little wedge on their unit. So they go way
68
NGG "makes a
better nurse because
you're not busy just
trying to be task
focused, you can
actually learn."
The year 2012– 2013 marks the
sixth anniversary of
the NGG initiative.
beyond that in their thinking, as well as to be able to manage and lead on
the unit in a different way. There is that confidence that they have in
partnering with the patient as well.
Table 26. Employer Rating of Clinical and Administrative Staff Responses to the
Nursing Graduate Guarantee Initiative
Rating Clinical Staff (%) Administrative Staff (%)
2007 2008 2009 2010 2011 2012 2007 2008 2009 2010 2011 2012
Receptive or very
receptive
84.6 97.7 89.3 94.1 92.4 89.8 95.9 96.6 93.7 94.9 96.2 92.4
Neither receptive
nor unreceptive
13.2 1.6 10.7 3.4 6.7 5.1 2.7 2.7 5.6 3.4 1.9 5.9
Unreceptive or
very unreceptive
2.2 0.8 0.0 2.5 1.0 5.1 1.4 0.7 0.8 1.7 2.0 1.7
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Source: Baumann et al., 2012c; Employer Evaluation of Nursing Graduate Guarantee 2012–2013.
Additionally, employers indicated that NGG participants would get a job sooner
than non-participants would because they have additional experience. A public
health manager observed that the NGG also allows employers "to kind of check
them [NGNs] out and for them to check us out."
New graduate interviewees believed that the NGG was extremely beneficial. One
NGN commented that it "makes a better nurse because you're not busy just trying
to be task focused, you can actually learn." Many NGNs mentioned being "very
frightened" to be on their own and reported that having someone there to help
them manage the first few months of practice was invaluable. All the NGN
interviewees indicated they would recommend the NGG to others and believed
that the government should continue to support the program.
CONCLUSION
The NGG was launched in 2007 to encourage FT employment for RN and RPN
graduates in Ontario. This provincial government initiative was created in
69
Longitudinal trend
data from the
College of Nurses
of Ontario FT
employment of new
members has
increased since the
introduction of the
NGG.
As a result of the
ongoing NGG
investment, there
has been a change
in employer
practices and
employment
strategies
pertaining to
NGNs.
response to an increasing trend towards casualization of the nursing workforce,
particularly NGNs. The NGG funds six months of supernumerary FT employment
for NGNs.
In 2012, there were 6648 nursing graduates (3383 RNs and 3265 RPNs); 2249
participated in the NGG (1813 RNs and 436 RPNs). Additionally, 214 employers
participated. Hospitals hired the majority of new graduates (85%), followed by
LTC facilities (10%) and community organizations (5%). During the past six
years, 14,395 NGNs participated in the NGG. An average of 200 healthcare
employers per year also participated.
Survey data demonstrate that NGNs who participated in the NGG obtained FT
employment at a higher rate than those who did not participate. In 2012, 62% of
RNs and 50% of RPNs who participated in the NGG secured FT positions
compared to 38% of RNs and 17% of RPNs who did not participate. According to
the College of Nurses of Ontario new registrant data, there has been an overall 5%
decrease in FT employment for RNs (61% to 56%) and RPNs (35% to 30%).
However, there has been a 9% increase in FT employment for both RNs (47% to
56%) and RPNs (21% to 30%) over the six years of the NGG.
Limitations
Any evaluation of this type uses a point-in-time approach. The data gathering
spans a six-month period and the numbers can vary depending on the time data is
collected. For example, both the number of employed graduates and the number
of available positions changed as the months progressed. What is important in
evaluating the overall initiative is the change in employment trends of NGNs.
Surveys were administered via email and were on a voluntary basis. Survey
results are subject to volunteer bias and may not reflect the experience of all
NGNs, employers and union representatives.
Recommendations
1. Improve access to employment-level data following the six-month
supernumerary period.
70
2. Encourage participation across sectors and regions.
3. Monitor nursing employment trends and assess the outcome of the NGG on
new graduates' FT employment, retention and professionalism.
4. Invest in developing, managing and digitizing longitudinal data repositories of
nurse employment and employing agencies.
5. Examine overall labour trends such as the impact of employment saturation on
the hiring of NGNs in Ontario.
6. Measure the effectiveness of the Nursing Career OrIENtation initiative on the
employment of internationally educated nurses.
7. Determine the feasibility of extending the NGG to include nurses transferring
to Ontario from other provinces and territories in Canada.
8. Examine RPN workforce to get a better understanding of participation.
9. Calculate the FT rates of employment outside the Greater Toronto Area to
estimate job availability and proportion of FT to PT.
10. Identify best practices to integrate and retain new graduates in the nursing
workforce.
71
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77
APPENDIX A. NURSING GRADUATE GUARANTEE APPLICATION PROCESS
78
APPENDIX B. BRIEFING NOTE – FEBRUARY 1, 2013
The Nursing Graduate Guarantee (NGG) initiative completed its fifth year in 2011–2012. Over
the five years, there has been a total of 26,617 new graduates, of which 12,146 (46%) were hired
through the NGG. The participation rate differed over time. The percentage of new graduates
hired into the NGG each year ranged from 32% to 59%. The percentage for the registered nurse
(RN) category ranged from 46% to 83%. Variations across the years were due to several factors,
including the number of nurses produced each year, the number of jobs available and sector-
specific involvement in the NGG. See Table 1 for the number of new graduates entering the
system each year.
Table 1. Total Number and Percentage of New Graduates by Nurse Category 2007-2011
Source: Ministry of Training, Colleges and Universities (MTCU), 2007–2011.
The supply of new nurses has been increasing since the NGG began. Across the five years, more
than half of all new graduates were RNs. Of the 26,617 new graduates 14,643 (55%) were RNs
and 11,974 (45%) were registered practical nurses (RPNs). Table 2 presents the total number of
new graduates and the percentage of those hired into the NGG for each nurse category.
Table 2. Total Number of New Graduates and Percentage Hired into NGG by Nurse Category
2007–2008 to 2011–2012 Note. *New Graduate;
±Number hired into NGG
Source: MTCU, 2007–2011; Ministry of Health and Long-Term Care, 2007–2011.
Year of Graduation
Nurse
Category
2007 2008 2009 2010 2011 Total
Count % Count % Count % Count % Count % Count %
RN 2776 60 2681 56 2910 55 2989 54 3287 51 14643 55
RPN 1837 40 2126 44 2346 45 2566 46 3099 49 11974 45
Total 4613 100 4807 100 5256 100 5555 100 6386 100 26617 100
Nurse
Category
Year of NGG
2007–2008 2008–2009 2009–2010 2010–2011 2011–2012 Total
NG* NGG± % NG NGG % NG NGG % NG NGG % NG NGG % NG NGG %
RN 2776 2013 73 2681 2213 83 2910 2023 70 2989 1378 46 3287 1692 51 14643 9319 64
RPN 1837 648 35 2126 626 29 2346 581 25 2566 422 16 3099 550 18 11974 2827 24
Total 4613 2661 58 4807 2839 59 5256 2604 50 5555 1800 32 6386 2242 35 26617 12146 46
79
Of the 14,643 new graduate RNs, 9319 (64%) were hired through the NGG and of the 11,974
RPNs, 2827 (24%) were hired through the NGG. Table 3 shows the number of new graduates
hired into the NGG by year. Consistently across the years, more than three-quarters of those
hired into the NGG were RNs. Of the 12,146, a higher percentage were in the registered nurse
(RN) category (77%; N=9319) compared to the registered practical nurse (RPN) category (23%;
N=2827).
Table 3. Total Number and Percentage of NGG Hires by Nurse Category 2007–2008 to 2011–
2012
Source: Ministry of Health and Long-Term Care NGG Program Data, 2007-2011.
Nurse
Category Year of NGG
2007–2008 2008–2009 2009–2010 2010–2011 2011–2012 Total
Count % Count % Count % Count % Count % Count %
RN 2013 76% 2213 78% 2023 78% 1378 77% 1692 76% 9319 77%
RPN 648 24% 626 22% 581 22% 422 23% 550 24% 2827 23%
Total 2661 100% 2839 100% 2604 100% 1800 100% 2242 100% 12146 100%
80
APPENDIX C. DATA COLLECTION AND REFINEMENT OF THE NURSING
GRADUATE GUARANTEE 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*
1376 1345 1292 808 484 24% 23%
Note. *Total number of Nursing Graduate Guarantee portal registrants was 5669.
Source: New Graduate Nurse Survey (English and French) 2012–2013.
81
APPENDIX D. PERCENT DISTRIBUTION OF NURSING GRADUATES BY NURSE
CATEGORY AND LOCAL HEALTH INTEGRATION NETWORK REGION 2012–2013
Local Health Integration
Network Region
Registered Nurse Registered Practical
Nurse
Total
Count % Count % Count %
LHIN 1 - Erie St. Claire 25 4 7 2 32 3
LHIN 2 - South West 32 5 26 9 58 6
LHIN 3 - Waterloo
Wellington
43 6 19 6 62 6
LHIN 4 - Hamilton,
Niagara, Haldimand, Brant
72 11 39 13 111 11
LHIN 5 - Central West 13 2 12 4 25 3
LHIN 6 - Mississauga
Halton
44 7 31 10 75 8
LHIN 7 - Toronto Central 147 22 30 10 177 18
LHIN 8 - Central 39 6 27 9 66 7
LHIN 9 - Central East 40 6 27 9 67 7
LHIN 10 - South East 27 4 12 4 39 4
LHIN 11 - Champlain 87 13 25 8 112 11
LHIN 12 - North Simcoe
Muskoka
19 3 23 8 42 4
LHIN 13 - North East 68 10 18 6 86 9
LHIN 14 - North West 14 2 9 3 23 2
Total 670 100 305 100 975 100
Note. The majority of graduate registered nurses (87%) and registered practical nurses (77%) indicated they were
employed in their geographic region of choice.
Source: New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
82
APPENDIX E. PARTICIPATING EMPLOYER SURVEY RESPONDENTS BY LOCAL
HEALTH INTEGRATION NETWORK REGION
Local Health Integration Network Region Participating Employers
Count %
LHIN 1 - Erie St. Claire 7 5
LHIN 2 - South West 13 10
LHIN 3 - Waterloo Wellington 12 9
LHIN 4 - Hamilton, Niagara, Haldimand, Brant 6 4
LHIN 5 - Central West 2 1
LHIN 6 - Mississauga Halton 5 4
LHIN 7 -Toronto Central 9 7
LHIN 8 - Central 12 9
LHIN 9 - Central East 9 7
LHIN 10 - South East 12 9
LHIN 11 - Champlain 17 12
LHIN 12 - North Simcoe Muskoka 4 3
LHIN 13 - North East 20 15
LHIN - 14 - North West 8 6
Total 136 101
Source: Participating Employer Survey 2012–2013.
83
APPENDIX F. DISTRIBUTION OF NURSING GRADUATES BY SECTOR OF
EMPLOYMENT
Table 1. New Graduate RNs Sector of Employment 2007–2012
Sector 2007 2008 2009 2010 2011 2012
Count % Count % Count % Count % Count % Count %
Acute Care
Hospital
758.0 83.2 558.0 84.4 615.0 78.2 496.0 71.3 526.0 74.1 518 77.7
Addiction and
Mental Health/
Psychiatric
16.0 1.8 19.0 2.9 16.0 2.0 22.0 3.2 33.0 4.6 26 3.9
Community
Employers*
70.0 7.7 51.0 7.7 72.0 9.2 71.0 10.2 60.0 8.5 51 7.6
Continuing
Complex Care/
Rehabilitation
24.0 2.6 13.0 2.0 17.0 2.2 34.0 4.9 32.0 4.5 24 3.6
Long-Term Care
Facility
11.0 1.2 6.0 0.9 38.0 4.8 49.0 7.0 39.0 5.5 37 5.5
Other 32.0 3.5 14.0 2.1 28.0 3.6 24.0 3.4 20.0 2.8 11 1.6
Total 911.0 100.0 661.0 100.0 786.0 100.0 696.0 100.0 710.0±
100.0 667 100.0
*Includes public health. ±Missing value=4.
Source: Baumann et al., 2012c; New Graduate Evaluation of the Nursing Graduate Guarantee Survey 2012–2013.
Table 2. New Graduate RPNs Sector of Employment 2007–2012
Sector 2007 2008 2009 2010 2011 2012
Count % Count % Count % Count % Count % Count %
Acute Care
Hospital
175.0 32.7 91.0 39.1 97.0 26.9 76.0 20.5 100.0 26.6 86 28.4
Addiction and
Mental Health/
Psychiatric
27.0 5.0 6.0 2.6 6.0 1.7 13.0 3.5 26.0 6.9 10 3.3
Community
Employers
63.0 11.8 24.0 10.3 45.0 12.5 49.0 13.2 48.0 12.8 30 9.9
Continuing
Complex Care/
Rehabilitation
70.0 13.1 36.0 15.5 54.0 15.0 46.0 12.4 34.0 9.0 31 10.2
Long-Term Care
Facility
179.0 33.5 64.0 27.5 144.0 40.0 172.0 46.5 147.0 39.1 127 41.9
Other 21.0 3.9 12.0 5.2 14.0 3.9 14.0 3.8 21.0 5.6 19 6.3
Total 535.0 100.0 233.0 100.0 360.0 100.0 370.0 100.0 376.0±
100.0 303 100
*Includes public health. ±Missing values=2.
Source: Baumann et al., 2012c; New Graduate Evaluation of the Nursing Graduate Guarantee Survey 2012–2013.
84
APPENDIX G. DISTRIBUTION OF NURSING GRADUATES BY PRIMARY AREA OF
PRACTICE
Table 1. RN New Graduate Survey Respondents Primary Area of Practice 2007–2012
Clinical Area 2007 2008 2009 2010 2011 2012
Count % Count % Count % Count % Count % Count %
Administration 0.0 0.0 1.0 0.1 0.0 0.0 0.0 0.0 3.0 0.4 1 0.2
Ambulatory/
Outpatient
9.0 1.0 4.0 0.6 2.0 0.3 6.0 0.9 1.0 0.1 9 1.4
Case
Management
4.0 0.4 3.0 0.4 1.0 0.1 7.0 1.0 5.0 0.7 6 0.9
Complex
Continuing Care
11.0 1.2 5.0 0.7 13.0 1.7 17.0 2.4 22.0 3.1 16 2.4
Critical Care 58.0 6.4 57.0 8.5 82.0 10.4 39.0 5.6 48.0 6.8 60 9.1
Education 1.0 0.1 2.0 0.3 2.0 0.3 0.0 0.0 3.0 0.4 1 0.2
Emergency 101.0 11.1 74.0 11.1 77.0 9.8 54.0 7.8 50.0 7.1 55 8.3
Geriatrics 18.0 2.0 7.0 1.0 40.0 5.1 50.0 7.2 37.0 5.2 36 5.4
Informatics 0.0 0.0 0.0 0.0 2.0 0.3 2.0 0.3 0.0 0.0 2 0.3
Maternal/
Newborn
85.0 9.3 58.0 8.7 57.0 7.3 49.0 7.0 38.0 5.4 30 4.5
Medicine 161.0 17.7 124.0 18.6 122.0 15.5 120.0 17.2 126.0 17.8 109 16.5
Addiction and
Mental Health/
Psychiatric
36.0 4.0 36.0 5.4 39.0 5.0 41.0 5.9 42.0 5.9 45 6.8
Occupational
Health
2.0 0.2 1.0 0.1 0.0 0.0 2.0 0.3 0.0 0.0 1 0.2
Palliative Care 7.0 0.8 3.0 0.4 11.0 1.4 9.0 1.3 2.0 0.3 4 0.6
Paediatrics 77.0 8.5 54.0 8.1 33.0 4.2 40.0 5.7 41.0 5.8 46 6.9
Perioperative
Care
20.0 2.2 15.0 2.2 7.0 0.9 5.0 0.7 7.0 1.0 14 2.1
Policy 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.1 0.0 0.0 0 0
Primary Care 16.0 1.8 5.0 0.7 16.0 2.0 21.0 3.0 16.0 2.3 11 1.7
Public Health 31.0 3.4 22.0 3.3 28.0 3.6 10.0 1.4 23.0 3.3 11 1.7
Rehabilitation 13.0 1.4 8.0 1.2 10.0 1.3 15.0 2.2 16.0 2.3 16 2.4
Surgery 157.0 17.3 103.0 15.4 119.0 15.1 66.0 9.5 95.0 13.4 74 11.2
85
Clinical Area 2007 2008 2009 2010 2011 2012
Count % Count % Count % Count % Count % Count %
Visiting Nurse 17.0 1.9 9.0 1.3 20.0 2.5 28.0 4.0 9.0 1.3 12 1.8
Other 86.0 9.5 76.0 11.4 105.0 13.4 114.0 16.4 123.0 17.4 103 15.6
Total 910.0 100.0 667.0 100.0 786.0 100.0 696.0 100.0 707.0 100.0 662.0 100.0
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
86
Table 2. RPN New Graduate Survey Respondents Primary Area of Practice 2007–2012
Clinical Area 2007 2008 2009 2010 2011 2012
Count % Count % Count % Count % Count % Count %
Administration 1.0 0.2 0.0 0.0 1.0 0.3 4.0 1.1 2.0 0.5 0 0
Ambulatory/
Outpatient
5.0 0.9 6.0 2.6 2.0 0.6 5.0 1.4 5.0 1.3 3 1
Case
Management
1.0 0.2 1.0 0.4 1.0 0.3 2.0 0.5 0.0 0.0 0 0
Complex
Continuing Care
68.0 12.7 26.0 11.1 44.0 12.2 40.0 10.8 24.0 6.4 29 9.6
Critical Care 1.0 0.2 1.0 0.4 0.0 0.0 2.0 0.5 1.0 0.3 0 0
Education 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.3 1 0.3
Emergency 6.0 1.1 2.0 0.9 2.0 0.6 2.0 0.5 5.0 1.3 0 0
Geriatrics 163.0 30.4 65.0 27.7 127.0 35.3 152.0 41.1 143.0 38.3 119 39.5
Informatics 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1 0.3
Maternal/
Newborn
6.0 1.1 2.0 0.9 8.0 2.2 4.0 1.1 2.0 0.5 5 1.7
Medicine 60.0 11.2 44.0 18.7 43.0 11.9 25.0 6.8 38.0 10.2 26 8.6
Addiction and
Mental Health/
Psychiatric
41.0 7.6 8.0 3.4 14.0 3.9 17.0 4.6 32.0 8.6 23 7.6
Occupational
Health
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.3 1 0.3
Palliative Care 9.0 1.7 5.0 2.1 7.0 1.9 13.0 3.5 7.0 1.9 6 2
Paediatrics 8.0 1.5 4.0 1.7 7.0 1.9 7.0 1.9 4.0 1.1 8 2.7
Perioperative
Care
3.0 0.6 0.0 0.0 3.0 0.8 5.0 1.4 2.0 0.5 4 1.3
Policy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0
Primary Care 25.0 4.7 2.0 0.9 7.0 1.9 11.0 3.0 13.0 3.5 7 2.3
Public Health 3.0 0.6 0.0 0.0 4.0 1.1 4.0 1.1 3.0 0.8 3 1
Rehabilitation 27.0 5.0 13.0 5.5 21.0 5.8 20.0 5.4 10.0 2.7 11 3.7
Surgery 48.0 9.0 14.0 6.0 19.0 5.3 8.0 2.2 20.0 5.4 14 4.7
87
Clinical Area 2007 2008 2009 2010 2011 2012
Count % Count % Count % Count % Count % Count %
Visiting Nurse 31.0 5.8 20.0 8.5 24.0 6.7 22.0 5.9 27.0 7.2 12 4
Other 30.0 5.6 22.0 9.4 26.0 7.2 27.0 7.3 33.0 8.8 28 9.3
Total 536.0 100.0 235.0 100.0 360.0 100.0 370.0 100.0 373.0 100.0 301.0 100.0
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
88
APPENDIX H. NURSING GRADUATES BY NURSE CATEGORY, EMPLOYMENT
STATUS AND SECTOR OF EMPLOYMENT 2007–2012
Table 1. New Graduate Nurses Employment Status by Sector of Employment 2012
Note. RN = registered nurse; RPN = registered practical nurse.
Source: New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
Nurse
Group
Sector of
Employment
Permanent
Full-Time
Temporary
Full-Time
Permanent
Part-Time
Casual Other Total
RN
Hospital 195 136 158 22 54 565
34.5% 24.1% 28.0% 3.9% 9.6% 100.1%
Community 17 13 9 4 7 50
34.0% 26.0% 18.0% 8.0% 14.0% 100.0%
Long-Term Care 12 8 6 8 2 36
33.3% 22.2% 16.7% 22.2% 5.6% 100.0%
Other 6 3 1 0 1 11
54.5% 27.3% 9.1% 0.0% 9.1% 100.0%
Total
230 160 174 34 64 662
34.7% 24.2% 26.3% 5.1% 9.7% 100.0%
RPN
Hospital 21 29 40 20 16 126
16.7% 23.0% 31.7% 15.9% 12.7% 100.0%
Community 8 3 6 8 5 30
26.7% 10.0% 20.0% 26.7% 16.7% 100.1%
Long-Term Care 7 31 35 37 15 125
5.6% 24.8% 28.0% 29.6% 12.0% 100.0%
Other 6 2 2 4 4 18
33.3% 11.1% 11.1% 22.2% 22.2% 99.9%
Total
42 65 83 69 40 299
14.0% 21.7% 27.8% 23.1% 13.4% 100.0%
89
Table 2. New Graduate Nurses Employment Status by Sector of Employment 2011
Nurse
Group
Sector of
Employment
Permanent
Full-Time
Temporary
Full-Time
Permanent
Part-Time
Casual Other Total
RN
Hospital 214.0 146.0 164.0 21.0 39.0 584.0
36.6% 25.0% 28.1% 3.6% 6.7% 100.0%
Community 18.0 20.0 9.0 6.0 5.0 58.0
31.0% 34.5% 15.5% 10.3% 8.6% 100.0%
Long-Term Care 8.0 10.0 12.0 4.0 3.0 37.0
21.6% 27.0% 32.4% 10.8% 8.1% 100.0%
Other 7.0 3.0 6.0 1.0 3.0 20.0
35.0% 15.0% 30.0% 5.0% 15.0% 100.0%
Total 247.0 179.0 191.0 32.0 50.0 699.0
35.3% 25.6% 27.3% 4.6% 7.2% 100.0%
RPN
Hospital 26.0 29.0 56.0 16.0 27.0 154.0
16.9% 18.8% 36.4% 10.4% 17.5% 100.0%
Community 16.0 5.0 14.0 4.0 6.0 45.0
35.6% 11.1% 31.1% 8.9% 13.3% 100.0%
Long-Term Care 21.0 30.0 46.0 23.0 26.0 146.0
14.4% 20.5% 31.5% 15.8% 17.8% 100.0%
Other 3.0 7.0 3.0 1.0 5.0 19.0
15.8% 36.8% 15.8% 5.3% 26.3% 100.0%
Total 66.0 71.0 119.0 44.0 64.0 364.0
18.1% 19.5% 32.7% 12.1% 17.6% 100.0%
Note. RN = registered nurse; RPN = registered practical nurse.
90
Table 3. New Graduate Nurses Employment Status by Sector of Employment 2010
Nurse
Group
Sector of
Employment
Permanent
Full-Time
Temporary
Full-Time
Permanent
Part-Time
Casual Other Total
RN
Hospital 137 151 162 51 51 552
24.8% 27.4% 29.3% 9.2% 9.2% 100.0%
Community 24 9 17 12 9 71
33.8% 12.7% 23.9% 16.9% 12.7% 100.0%
Long-Term Care 9 15 15 6 4 49
18.4% 30.6% 30.6% 12.2% 8.2% 100.0%
Other 11 4 2 6 1 24
45.8% 16.7% 8.3% 25.0% 4.2% 100.0%
Total 181 179 196 75 65 696
26.0% 25.7% 28.2% 10.8% 9.3% 100.0%
RPN
Hospital 22 43 35 18 17 135
16.3% 31.9% 25.9% 13.3% 12.6% 100.0%
Community 9 5 20 10 5 49
18.4% 10.2% 40.8% 20.41% 10.2% 100.0%
Long-Term Care 24 41 50 27 30 172
14.0% 23.8% 29.1% 15.7% 17.4% 100.0%
Other 3 3 3 2 3 14
21.4% 21.4% 21.4% 14.3% 21.4% 100.0%
Total 58 92 108 57 55 370
15.7% 24.9% 29.2% 15.4% 14.9% 100.0%
Note. RN = registered nurse; RPN = registered practical nurse.
Source: Baumann et al., 2012c.
91
Table 4. New Graduate Nurses Employment Status by Sector of Employment 2009
Nurse
Group
Sector of
Employment
Permanent
Full-Time
Temporary
Full-Time
Permanent
Part-Time
Casual Other Total
RN
Hospital 263 173 132 47 30 645
40.8% 26.8% 20.5% 7.3% 4.7% 100.0%
Community 12 26 6 4 4 52
23.1% 50.0% 11.5% 7.7% 7.7% 100.0%
Long-Term Care 11 5 15 4 3 38
28.9% 13.2% 39.5% 10.5% 7.9% 100.0%
Other 20 12 4 6 4 46
43.5% 26.1% 8.7% 13.0% 8.7% 100.0%
Total 306 216 157 61 41 781
39.2% 27.7% 20.1% 7.8% 5.2% 100.0%
RPN
Hospital 27 54 39 19 18 157
17.2% 34.4% 24.8% 12.1% 11.5% 100.0%
Community 5 7 8 3 1 24
20.8% 29.2% 33.3% 12.5% 4.2% 100.0%
Long-Term Care 29 38 41 17 19 144
20.1% 26.4% 28.5% 11.8% 13.2% 100.0%
Other 12 6 9 5 3 35
34.3% 17.1% 25.7% 14.3% 8.6% 100.0%
Total 73 105 97 44 41 360
20.3% 29.2% 26.9% 12.2% 11.4% 100.0%
Note. RN = registered nurse; RPN = registered practical nurse.
Source: Baumann et al., 2012c.
92
Table 5. New Graduate Nurses Employment Status by Sector of Employment 2008
Nurse
Group
Sector of
Employment
Permanent
Full-Time
Temporary
Full-Time
Permanent
Part-Time
Casual Other Total
RN Hospital 356 133 67 20 17 593
60.0% 22.4% 11.3% 3.4% 2.9% 100.0%
Community 8 26 1 0 3 38
21.1% 68.4% 2.6% 0.0% 7.9% 100.0%
Long-Term Care 1 0 1 2 2 6
16.7% 0.0% 16.7% 33.3% 33.3% 100.0%
Other 7 2 0 2 3 14
50.0% 14.3% 0.0% 14.3% 21.4% 100%
Total 372 161 69 24 25 651
57.1% 24.7% 10.6% 3.7% 3.8% 100.0%
RPN Hospital 20 52 25 18 19 134
14.9% 38.8% 18.7% 13.4% 14.2% 100.0%
Community 7 3 3 0 0 13
53.8% 23.1% 23.1% 0.0% 0.0% 100.0%
Long-Term Care 10 24 20 4 7 65
15.4% 36.9% 30.8% 6.2% 10.8% 100.0%
Other 2 1 4 1 2 10
20.0% 10.0% 40.0% 10.0% 20.0% 100.0%
Total 39 80 52 23 28 222
17.6% 36.0% 23.4% 10.4% 12.6% 100.0%
Note. RN = registered nurse; RPN = registered practical nurse.
Source: Baumann et al., 2012c.
93
Table 6. New Graduate Nurses Employment Status by Sector of Employment 2007
Nurse
Group
Sector of
Employment
Permanent
Full-Time
Temporary
Full-Time
Permanent
Part-Time
Casual Other Total
RN Hospital 531 143 90 22 9 795
66.8% 18.0% 11.3% 2.8% 1.1% 100.0%
Community 32 27 3 6 1 69
46.4% 39.1% 4.3% 8.7% 1.4% 100.0%
Long-Term Care 6 1 2 1 1 11
54.5% 9.1% 18.2% 9.1% 9.1% 100.0%
Other 17 10 1 3 1 32
53.1% 31.2% 3.1% 9.4% 3.1% 100.0%
Total 586 181 96 32 12 907
64.6% 20.0% 10.6% 3.5% 1.3% 100.0%
RPN Hospital 52 115 47 37 20 271
19.2% 42.4% 17.3% 13.7% 7.4% 100.0%
Community 23 13 12 10 5 63
36.5% 20.6% 19.0% 15.9% 7.9% 100.0%
Long-Term Care 35 69 36 24 12 176
19.9% 39.2% 20.5% 13.6% 6.8% 100.0%
Other 11 5 3 2 0 21
52.4% 23.8% 14.3% 9.5% .0% 100.0%
Total 121 202 98 73 37 531
22.8% 38.0% 18.5% 13.7% 7.0% 100.0%
Note. RN = registered nurse; RPN = registered practical nurse.
Source: Baumann et al., 2012c.
94
APPENDIX I. DISTRIBUTION OF NURSING GRADUATES BY EMPLOYMENT
LOCATION AND NURSE GROUP
Employment Location N(%)
RN RPN Total
Employed in Ontario 671(98.2) 305(99.7) 976(98.7)
Employed in another Canadian
province
8(1.2) 1(0.3) 9(0.9)
Employed in the United States 3(0.4) 0(0) 3(0.3)
Employed outside Canada 1(0.1) 0(0) 1(0.1)
Total 683(99.9) 306(100) 989(100)
Source: New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
95
APPENDIX J. COMPARISON OF EMPLOYMENT PREFERENCES OF NURSING
GRADUATES BY NURSE CATEGORY 2007–2012
Table 1. Percentage of Nurse Graduates Indicating Current Employment Status was by Choice,
2007–2012
Nurse Category Employment Status is by Choice
2007 2008 2009 2010 2011 2012
Registered Nurse 76.5% 78.0% 60.0% 50.7% 60.5% 66.6%
Registered Practical Nurse 51.9% 58.2% 54.3% 49.3% 39.6% 43.8%
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
Table 2. Percentage of Nurse Graduates Indicating Preference for FT and PT Work Status by
Nurse Category, 2007–2012
Employment
Status
RN RPN
2007 2008 2009 2010 2011 2012 2007 2008 2009 2010 2011 2012
Prefer
permanent FT
85.5% 89.4% 92.7% 91.4% 91.0% 91.0% 88.5% 72.7% 81.0% 83.1% 85.5% 86.9%
Prefer
permanent PT 10.0% 5.7% 3.5% 6.0% 6.6% 7.7% 10.3% 14.3% 14.6% 12.6% 11.5% 10.7%
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
96
APPENDIX K. EMPLOYMENT PREFERENCES OF NURSING GRADUATES BY
GROUP
Table 1. Percentage of Nurses Working in Region of Choice
Preferred Region of
Employed New
Graduates
Graduation Year
2008 2009 2010 2011 2012
RN RPN RN RPN RN RPN RN RPN RN RPN
Employment is in region
of choice
96% 91% 87% 86% 78% 87% 83% 86% 87% 77%
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
Table 2. Preferences of Nursing Graduates Not Working in Region of Choice
Local Health Integration
Network Location
Weighted Value
2008 2009 2010 2011 2012
RN RPN RN RPN RN RPN RN RPN RN RPN
Erie St. Clair 132 77 42 47 27 46 26 19 25 8
South West 73 56 54 51 46 52 44 21 19 17
Waterloo Wellington 34 45 32 38 29 37 30 69 34 25
Hamilton Niagara
Haldimand Brant
31 26 43 21 46 37 26 46 20 33
Central West 36 22 30 63 27 41 33 68 28 32
Mississauga Halton 70 53 75 80 78 92 82 118 83 61
Toronto Central 73 98 159 119 152 103 157 110 124 71
Central 39 81 72 66 59 77 66 38 41 44
Central East 17 79 53 39 49 26 58 52 27 26
South East 11 19 3 18 15 15 17 24 4 5
Champlain 35 30 6 24 38 18 18 9 5 5
North Simcoe Muskoka 14 0 5 21 14 32 19 12 20 4
North East 22 15 6 11 10 21 16 13 2 4
North West 14 0 5 0 10 4 8 3
3 7
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
97
APPENDIX L. LOCAL HEALTH INTEGRATION LOCATIONS WHERE NURSING
GRADUATES SEEK EMPLOYMENT
Seekers Graduation Year
2008 2009 2010 2011 2012
RN RPN RN RPN RN RPN RN RPN RN RPN
Percentage seeking
employment
5% 14% 11% 20% 18% 27% 9% 24% 12% 35%
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
Local Health
Integration
Network Location
Weighted Value
2008 2009 2010 2011 2012
RN RPN RN RPN RN RPN RN RPN RN RPN
Erie St. Clair 15 22 25 20 17 27 12 33 29 31
South West 43 24 36 25 32 21 16 29 25 30
Waterloo Wellington 0 16 12 22 13 26 29 32 21 60
Hamilton Niagara
Haldimand Brant
15 30 33 19 26 46 36 28 30 67
Central West 32 47 20 63 29 57 54 61 28 105
Mississauga Halton 72 87 82 99 93 111 106 121 56 174
Toronto Central 192 126 157 150 204 136 176 118 100 171
Central 107 109 71 78 84 54 60 71 46 108
Central East 82 42 73 52 74 54 54 45 35 125
South East 0 7 17 14 4 17 10 10 10 27
Champlain 15 34 28 29 11 27 20 18 21 32
North Simcoe
Muskoka
0 27 15 7 8 12 7 21 17 54
North East 13 18 17 10 3 9 14 6 13 26
North West 15 11 13 8 2 4 5 6 3 17
Source: Baumann et al., 2012c; New Graduate Evaluation of Nursing Graduate Guarantee Survey 2012–2013.
