Evaluation of a Provincial Policy Strategy Nursing ...fhs.mcmaster.ca/nhsru/documents/Series...2 Employment Integration of Nursing Graduates: Evaluation of a Provincial Strategy, November

Title Page

Health Human Resource Series Andrea Baumann

Series Number #19 Mabel Hunsberger

Dina Idriss-Wheeler

Mary Crea-Arsenio

Employment Integration of Nursing Graduates:

Evaluation of a Provincial Policy Strategy

Nursing Graduate Guarantee 2008-2009

November 2009

2

Employment Integration of Nursing Graduates: Evaluation of a Provincial Strategy, November 2009 Number #19

Andrea Baumann, RN, PhD, Associate Vice President, International Health,

& Director, Nursing Health Services Research Unit (McMaster University site)

Mabel Hunsberger, RN, PhD, Associate Professor, Nursing Health Services Research Unit (McMaster University site)

Dina Idriss-Wheeler, MSc, MHA, Research Coordinator, Nursing Health Services Research Unit (McMaster University site)

Mary Crea-Arsenio, MSc, Research Coordinator, Nursing Health Services Research Unit (McMaster University site)

Contact Andrea Baumann Phone (905) 525-9140, ext. 22581 E-mail [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.

mailto:[email protected]�

http://www.nhsru.com/�

3

TABLE OF CONTENTS

EXECUTIVE SUMMARY ....................................................................................................... 8 Employment Trends: Status, Location, Sector and Preferences............................................ 8 NGG Evaluation: Posting and Matching on the HealthForceOntario Portal ...................... 8 NGG Evaluation: Online Budget Reporting .......................................................................... 9 NGG Evaluation: Orientation/Mentorship Phase ................................................................. 9 NGG Evaluation: Offering Full-Time Permanent Positions ................................................. 9 Bargaining Units and Employer Collaboration .................................................................... 9 Overall Impact of the Initiative ............................................................................................ 10

RECOMMENDATIONS ......................................................................................................... 10 INTRODUCTION ................................................................................................................... 12 OVERVIEW OF LABOUR MARKET TRENDS .................................................................. 12

Historical Trends in Nurse Employment ............................................................................. 14 Workforce Planning in the New Millennium ....................................................................... 15 New Graduate Initiative 2004-2008 .................................................................................... 16 Factors Affecting Integration of New Graduates Into the Workplace ................................. 17 Markets Change ................................................................................................................... 18

THE NEW SUPPLY: REGISTERED NURSES AND REGISTERED PRACTICAL NURSES IN ONTARIO .......................................................................................................... 19

Nurse Education in Ontario................................................................................................. 19 Data Gaps ............................................................................................................................ 21 Data on Graduating Nurses ................................................................................................. 21 Recent Trends in RN and RPN Graduation ......................................................................... 22

Figure 1. First Year Intake and Supply of Ontario Registered Nurse Graduates ........... 23 Figure 2. First Year Intake and Supply of Ontario Registered Practical Nurse Graduates ......................................................................................................................................... 23

INTEGRATION OF NEW GRADUATES INTO THE WORKFORCE ............................... 24 Nursing Graduate Guarantee Initiative: Background and Description .............................. 24 Nursing Graduate Portal – HealthForceOntario ................................................................ 25 Evaluation of Nursing Employment in Ontario 2008 .......................................................... 25 Methods ................................................................................................................................ 26

Box 1. Triangulation Design............................................................................................ 26 Sample .................................................................................................................................. 26

Table 1. Quantitative Survey Response Rates ................................................................. 27 Analysis ................................................................................................................................ 27

DEMOGRAPHIC CHARACTERISTICS OF SURVEY RESPONDENTS .......................... 28 RN and RPN New Graduates ............................................................................................... 28

EMPLOYER PROFILE AND PARTICIPATION .................................................................. 29 Registered Employers ...................................................................................................... 29 Table 2. Percentage of Registered Employer Survey Respondents by Type of Organization .................................................................................................................... 29 Table 3. Percentage of Non-Registered Employer Survey Respondents by Type of Organization .................................................................................................................... 30 Union Representatives ..................................................................................................... 31

ACTUAL EMPLOYMENT OF REGISTERED NURSES AND REGISTERED PRACTICAL NURSES ........................................................................................................... 31

4

Distribution of Nursing Graduates by Type of Employer .................................................... 31 Table 4. Distribution of Registered Nurse and Registered Practical Nurse Graduates by Type of Employer for 2007 and 2008-2009 ..................................................................... 32

Distribution of Nursing Graduates by Age and Sector of Employment............................... 33 Table 5. Percentage Distribution of New Nurse Graduate Survey Respondents by Nurse Group, Age Group and Sector of Employment ................................................................ 34

Distribution of Nursing Graduates by Primary Area of Practice ....................................... 34 Distribution of Nursing Graduates by Employment Status ................................................. 35

Table 6. Comparison of Employment Status of Registered Nurse and Registered Practical Nurse Graduands 2005 to 2008 ....................................................................... 35

Distribution of Nurse Graduates by Work Status and Type of Employer............................ 37 Table 7. Proportion of Nurse Graduates by Employment Status and Sector of Employer ......................................................................................................................................... 37

Mobility and Migration: RNs and RPNs ............................................................................. 37 EMPLOYMENT PREFERENCES OF REGISTERED NURSE AND REGISTERED PRACTICAL NURSE GRADUATES .................................................................................... 38

Preferences for Full-Time/Part-Time Work Status: RNs and RPNs ................................... 38 Table 8. Preferences for Full-Time Employment Status .................................................. 38 Table 9. Percent Distribution of Employment Preference by Nurse Group 2008 ........... 39

Preferences for Employment Location: RNs and RPNs ...................................................... 39 Preferences for Sector of Employment and Clinical Area of Practice: RNs and RPNs ...... 40 Preferences for Mobility and Migration: RNs and RPNs .................................................... 41

PROVINCIAL AND CANADIAN COMPARISON .............................................................. 41 Comparison to College of Nurses of Ontario General Class New Members ...................... 42

Figure 4. Comparison of Employment Status Between Registered Practical Nurse Graduates 2007-2008 and College of Nurses of Ontario Registered Practical Nurse New General Class Members 2005-2007 ................................................................................ 43 Table 10. Portal Survey Employment Status 2007-2008 Compared to the College of Nurses of Ontario New General Class Members 2005-2007 .......................................... 44

Comparison to Canadian Institute for Health Information Work Status Figures for Ontario 2004-2006 ............................................................................................................................ 44

Figure 5. Comparison of Employment Status Between Registered Nurse Graduates 2007-2008 and the Canadian Institute for Health Information Registered Nurses in Ontario 2004-2006 .......................................................................................................... 45 Figure 6. Comparison of Employment Status Between Registered Practical Nurse Graduates 2007-2008 and Canadian Institute for Health Information Registered Practical Nurses in Ontario 2004-2006 .......................................................................... 46

Comparison to Canadian Institute for Health Information Work Status Figures for Canada 2004-2006 ............................................................................................................................ 46

Figure 7. Comparison of Employment Status Between Registered Nurse Graduates 2007-2008 and Canadian Institute for Health Information Registered Nurses in Canada 2004-2006 ........................................................................................................................ 47

EVALUATION OF THE NURSING GRADUATE GUARANTEE ..................................... 48 Launching of the Nursing Graduate Guarantee: How Information Was Received ............. 49 Is the Nursing Graduate Portal an Efficient Matching Tool? ............................................. 49

Employer Experience Using the Portal ............................................................................ 49

5

Figure 9. Employers’ Rating of Their Overall Experience With the Nursing Graduate Portal ............................................................................................................................... 50 The Time Factor for Employers ...................................................................................... 51 New Graduate Experience Using the Portal .................................................................... 52 Figure 10. New Graduates’ Rating of Their Overall Experience With the Nursing Graduate Portal ............................................................................................................... 52 Table 11. Registered Nurse and Registered Practical Nurse Evaluation of the Employment Portal Dimensions ...................................................................................... 53 Using the Nursing Graduate Portal Help Line ................................................................. 54

THE CHALLENGE OF MATCHING FOR SUPERNUMERARY POSITIONS: WHAT WERE THE BARRIERS? ....................................................................................................... 54

Are There Gaps: How Matched are the Applicants and Available Jobs? ........................... 55 New Graduate Behaviours and Job Searching: The Need for Immediate Full-Time Job Security ................................................................................................................................ 56 Reasons for Not Offering Supernumerary Positions ........................................................... 56

Table 12. Reasons Given by Employers for not Offering a Temporary Full-Time Position ......................................................................................................................................... 57

New Graduate Reasons for not Matching Through the Portal............................................ 57 Table 13. Reasons Given by Nursing Graduates for not Matching Into a Temporary Full-Time Position Through the Portal ........................................................................... 58

CREATING SUPERNUMERARY POSITIONS FOR NEW GRADUATES: BENEFITS OUTWEIGH THE CHALLENGES ........................................................................................ 58

Staff Shortages and RN Graduation .................................................................................... 58 License and Exams issues: Challenges and Strategies ........................................................ 59 Orientation Benefits: Mentoring and Support For New Graduates .................................... 59

Table 14. Employer and New Graduate Ratings of the Mentoring Process ................... 60 Mentoring Model Used During Bridging ............................................................................ 61 Creating and Sustaining Mentoring Resources: Educational and Administrative Challenges ........................................................................................................................... 62 The Challenge of Integrating New Graduates: The Tension of Workload and Learning ... 62

OFFERING PERMANENT FULL-TIME POSITIONS WITHIN THE REALITY OF THE WORKPLACE ........................................................................................................................ 63

Reasons Why New Graduates Were Not Offered Permanent Full-Time Positions ............. 63 Table 15. Reasons Given by Employers for not Bridging a New Graduate into a Permanent Full-Time Position ........................................................................................ 64

Sector Variables: Maximizing the Creation of Full-Time Positions ................................... 64 New Graduate Preferences: A Variable in Transitioning to Regular Full-Time Positions 66 Employee Seniority and Bargaining Unit Contracts ........................................................... 66

BARGAINING UNIT AND EMPLOYER COLLABORATION: WHERE ARE THE GAPS? ................................................................................................................................................. 67

Communication of Employers With the Bargaining Unit .................................................... 67 Figure 11. Percentage of Union Representatives Consulted Prior to Employer Participation in the Nursing Graduate Guarantee .......................................................... 67 Figure 12. Percentage of Union Representatives Consulted Prior to Employer Posting on Nursing Graduate Guarantee Portal .......................................................................... 68

New Graduates in Specialty Positions: What are the Issues for the Bargaining Unit ........ 68

6

Table 16. Percent Distribution of Union Representatives' Perceptions that New Graduates Transitioned into a Specialty Area Position Ahead of Existing Staff ............ 69

Reinvestment of Funds: Who is Involved in Decisions ........................................................ 69 Figure 13. Percentage of Union Representatives Consulted Regarding the Reinvestment of Nursing Graduate Guarantee Funds ........................................................................... 70

Decisions About Bridging Into Full-Time Position ............................................................. 70 OVERALL IMPACT OF THE NURSING GRADUATE GUARANTEE ............................ 70

Stakeholder Response .......................................................................................................... 70 Table 17. Employer Rating of Clinical and Administrative Staff Responses to the Nursing Graduate Guarantee Initiative........................................................................... 71

Workplace Improvements to Promote Recruitment and Retention ...................................... 71 Reinvestment of Funds: How are They Used and Who Benefits? ....................................... 72

Table 18. Percent Distribution of Initiatives Employers Chose to Reinvest Funds ........ 72 ADMINISTRATIVE AND BUDGETARY ISSUES ............................................................. 73

Employer Communication with the Ministry of Health and Long-Term Care .................... 73 Table 19. Employer Rating of Their Experience Accessing Nursing Graduate Guarantee Funds and Using the Ministry of Health and Long-Term Care Service Level Agreement ......................................................................................................................................... 74

ORGANIZATIONAL BENEFITS AND FINANCIAL RESTRAINTS ................................ 75 Would There be Employer Support for the Initiative at Level IV Clinical? ........................ 76

Preference for More Advanced Skills and Temporary License ....................................... 76 University Semester is too Short ..................................................................................... 77 Impact of Variation in Clinical Placement Experiences .................................................. 77 Support Mixed With Ambivalence .................................................................................. 78

How can Nurses be Recruited into Long Term Care: Employer Perspective From all Sectors .................................................................................................................................. 78

Issue of Differences in Remuneration ............................................................................. 78 A Different Emphasis on Long-Term Care in School ..................................................... 78

CONCLUSION........................................................................................................................ 79 Employment Trends: Status, Location, Sector and Preferences.......................................... 79 NGG Evaluation: Posting and Matching on the HealthForceOntario Portal .................... 79 NGG Evaluation: Online Budget Reporting ........................................................................ 79 NGG Evaluation: Orientation/Mentorship Phase ............................................................... 80 NGG Evaluation: Offering Full-time Permanent Positions ................................................ 80 Bargaining Units and Employer Collaboration .................................................................. 80 Overall Impact of the Initiative ............................................................................................ 81

LIMITATIONS ........................................................................................................................ 81 RECOMMENDATIONS ......................................................................................................... 82 REFERENCES ........................................................................................................................ 83

Appendix A. Nursing Graduate Guarantee Application Process ........................................ 88 Appendix B. Nursing Graduate Guarantee Initiative .......................................................... 89 Appendix C. Data Collection and Refinement of the Nursing Graduate Portal Evaluation Survey .................................................................................................................................. 90 Appendix D. Percent Distribution of Nursing Graduates by Nurse Type and Local Health Integration Network Region ................................................................................................ 91 Appendix E. Data Collection and Refinement of the Employer Portal Evaluation Survey . 92

7

Appendix F. Percent Distribution of Employer Survey Respondents by Registration Status and Local Health Integration Network ................................................................................ 93 Appendix G. Percent Distribution of Nursing Graduates by Primary Area of Practice and Nurse Group 2007 to 2008 .................................................................................................. 94 Appendix H. Number and Proportion of Nurse Graduates by Nurse Group, Employment Status and Sector of Employment 2007 and 2008 ............................................................... 95 Appendix I. Distribution of Nursing Graduates by Employment Location and Nurse Group ............................................................................................................................................. 97 Appendix J. A comparison of Employment Preferences of Nursing Graduates by Nurse Group 2007-2008 ................................................................................................................. 98 Appendix K. Employment Region Preference of Nursing Graduates by Nurse Group ....... 99 Appendix L. Local Health Integration Locations Where New Graduates Seek Employment by Nurse Group .................................................................................................................. 100 Appendix M. Employers’ Rating of Their Satisfaction With the Employment Portal ....... 101 Appendix N. New Nursing Graduate and Employer Recommendations for the Improvement of Nursing Graduate Employment Portal .......................................................................... 102

8

EXECUTIVE SUMMARY

This report presents the results of an evaluation of the Ontario provincial strategy for hiring

new graduates, the Nursing Graduate Guarantee (NGG), for the year 2008-2009. Over the

past 10 years, there has been a dramatic improvement in the employment status for nurses in

Ontario. In 1998, over 60% of nurses were part-time (PT) or casual. Today, 64% of all nurses

and 76% of new graduates are employed full-time (FT).

EMPLOYMENT TRENDS: STATUS, LOCATION, SECTOR AND PREFERENCES

Since 2005, FT employment has increased 24% for new graduate registered nurses (RNs) and

29% for new graduate registered practical nurses (RPNs). The Toronto Central Local Health

Integration Network employs the largest percentage of new graduates, and 75% of all new

graduates are employed in the acute care sector. Overall, the community and long-term care

sectors hired fewer new graduates in 2008 compared to 2007. The majority of RNs (88%) and

RPNs (73%) surveyed indicated they were working in their preferred area of clinical practice.

The primary areas of practice for RNs were medicine, surgery, emergency and maternal-

newborn. The primary areas of practice for RPNs were geriatrics, medicine and complex

continuing care.

NGG EVALUATION: POSTING AND MATCHING ON THE HEALTHFORCEONTARIO PORTAL

The NGG uses an online employment portal (HealthForceOntario or HFO) to link new

nursing graduates with employers who are interested in hiring them (HFO, 2009). Compared

to last year, employers and new graduates found the portal easier to use; however, employers

reported that new graduates required assistance from them to apply on the portal. The

applicant pool was found to be smaller for certain sectors and locations (e.g., long-term care

and rural areas). Some new graduate portal registrants (34%) said they secured a position

outside the portal (compared to 43% last year). The portal was viewed positively in regard to

posting and matching, but employers expressed frustration with the online budget reporting

and found the E-signatures to be labour intensive.

9

NGG EVALUATION: ONLINE BUDGET REPORTING

Although not all employers had difficulty, a substantial number indicated the online budget

reporting method is an area that they would like to see improved. Obtaining E-signatures was

the most reported problem area. Those who had difficulty also indicated that the help line was

not sufficiently available during the week of the report deadline and felt it was likely due to

an overwhelming number of calls to the Ministry of Health and Long-Term Care.

NGG EVALUATION: ORIENTATION/MENTORSHIP PHASE

Experienced nurses were supportive and willing to provide the mentorship needed for the

new graduates, although some employers expressed concern about mentor and preceptor

burnout. Some of the employers in public health and community reported that one-to-one

supervision can interfere with client load demands. The overall response to this phase of the

NGG was overwhelmingly positive. However, the experience was not positive for a small

percentage of the new graduates in acute care and long-term care.

NGG EVALUATION: OFFERING FULL-TIME PERMANENT POSITIONS

Some long-term care, community and rural organizations had difficulty offering FT positions.

Larger acute care centres could more readily access the additional funds made available when

the new graduate was transitioned into a FT position at three months. Barriers to offering FT

positions included lack of available FT jobs, nurse rejection of offer, failure of licensure

exam, seniority/union agreements and lack of funding. Rejection of FT offers by new

graduates occurred less often this year than last year.

BARGAINING UNITS AND EMPLOYER COLLABORATION

This year, in addition to interviews with two union leaders, a survey was sent to union

representatives. The union leaders recommended that collaboration between employers and

the union begin early and continue throughout the initiative. Communication did occur

between employers and the unions prior to NGG participation, but 80% of the union

representatives surveyed said there was no communication with them about reinvestment of

the extra funds. Union leaders were concerned that new graduates who were mentored in

specialty units could have a clinical advantage over existing staff when FT opportunities

10

arose. However, 66% of respondents in the union survey indicated that new graduates "never

or almost never" transitioned into specialty area positions ahead of existing staff.

Nonetheless, this continues to be an area that should be monitored in the future.

OVERALL IMPACT OF THE INITIATIVE

The overall response to the initiative was very positive. The NGG is viewed as a major

benefit for the recruitment and retention of nurses into the profession. All stakeholders

applauded the integration of new graduates into the workplace through extended orientation

and mentoring. The reinvestment of funds into other nursing priorities within organizations is

also a major benefit, although some sectors benefit more than others. During the current

unprecedented economic recession, the NGG afforded an opportunity for employment and

mentorship to new graduates, thus making it an attractive recruitment strategy in the 2008

hiring cycle. In conclusion, employers, new graduates, mentors and union representatives

provided valuable information about their perspectives on the NGG initiative. All groups are

in support of the NGG and provided excellent suggestions for future initiatives.

RECOMMENDATIONS

These targeted recommendations are intended to increase FT employment of newly graduated

nurses and facilitate their integration into the workforce. They are based on feedback from

the stakeholders and are categorized into four sections:

Overall Employment Trends and Issues

• Retain an employment initiative for new graduates for 2010

• Focus on employment strategies for RPNs

• Conduct a needs-based analysis in the long-term care and community sectors to identify

barriers to offering FT employment to new graduates and retain mentored new graduates

• Focus on strategies to enhance FT employment in rural areas

Posting and Matching on the Portal

• Develop more educational strategies to ensure new graduates become self-sufficient on

the website, ensure there are clear instructions on all aspects of the application process

• More consistent advertising and promotion of the NGG in educational institutions

11

• Revisit job search page to enhance job search engine and posting to give more options

and flexibility, including save functions, posting medical-surgical separately and search

by clinical specialty

Orientation and Mentorship

• Retain an orientation and mentorship component of the NGG for all new graduates

• Enhance advertising and supportive materials to mentors to ensure their understanding of

the NGG guidelines and the intent of the supernumerary status

• Re-evaluate NGG guidelines to create mentoring models more suitable for the public

health and community sectors (adapt 1:1 models of supervision)

Administrative Issues

• Restudy the online budget and reporting process and make adjustments to increase

efficiency and availability of assistance to meet deadline (e-signatures particularly)

• Consider giving more flexibility to organizations in the March 31 deadline for use of

extra funding

• Enlarge evaluation parameters to include employer survey on real time job vacancies.

12

INTRODUCTION

This report focuses on the supply and employment of nursing graduates in Ontario and their

integration into the workforce. It presents the results of an evaluation of the Ontario

provincial strategy for hiring new graduates, the Nursing Graduate Guarantee (NGG), for the

year 2008-2009. It begins with a review of labour market trends in the health care sector and

discusses nursing supply, mobility and cross-border migration in the recent past. The major

repositories of data on nurse education are identified and an overview of the entry of new

nurses into the workforce is provided. In addition, the employment market for newly

graduated nurses across Canada is discussed. The NGG is described and the results of the

evaluation of the initiative for 2008-2009 are compared to a previous study in 2007-2008 and

a two-year study covering 2003-2004 and 2004-2005. Conclusions and recommendations are

presented.

OVERVIEW OF LABOUR MARKET TRENDS

Economic insecurity and global casualization have negative implications for workers, both

nationally and internationally (Standing, 2008). During times of recession, 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). Unlike

the mild to moderate recession of the late 1990s, economists today have projected a more

severe and longer lasting recession (Buerhaus, Auerbach, & Staiger, 2009). The greatest

impact of this modern recession can be seen in the loss of jobs in the manufacturing sector

and the shift from a predominantly male labour force to an increasing female labour force

(Salam, 2009). A less visible impact is evident in the poor labour market conditions for

younger workers compared to their older counterparts (Borbely, 2009). As employment

contracts dwindle, so do opportunities for young adults to enter and remain in the workforce.

Labour markets are also affected by escalating costs, reduced supply, job substitution and

growth or decline in particular sub sectors, resulting in a dramatic change in employment

patterns and conditions for workers. Prior to recent changes in the economic climate,

stakeholders voiced concerns about the growing shortage of health care providers in general

13

and nurses in particular (Fraher, Carpenter, & Broome, 2009). The current economic “bust”

will affect health care as budget constraints and fiscal accountabilities mount (Batch,

Bernard, & Windsor, 2009). As seen before, the most notable change in employment patterns

is the increased use of part-time (PT) and casual staff.

During recent decades, there has been a movement towards flexible, non-standardized work

and a shift towards what is commonly called “casualization” (Baumann & Blythe, 2003).

This 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). Historically, contingent employment in the private sector has been well

documented (Zeytinoglu, 1999). Between 1984 and 1987, the percentage of employees in

full-time (FT) or permanent employment decreased and various forms of non-standard

employment increased (Heery & Salmon, 2000, p. 13; Usalcas, 2008).

In Canada, casualization of the workforce has affected both 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

(Heery & Salmon, 2000). The large and predominantly female nursing workforce followed

these trends with increasing proportions of PT and casual nurses. Some PT nurses voluntarily

choose their PT status and prefer it, but research evidence suggests many favour FT over PT

status (Blythe, Baumann, Zeytinoglu, Denton, & Higgins, 2005; Grinspun, 2003).

Grinspun (2002) reviewed the evidence on the impact of the flexible nursing workforce and

found that casualization in nursing has had a negative effect on patient care and nurses’

organizational involvement and commitment. Recent studies have explored the impact of new

types of work arrangements on employee health and the effects of atypical forms of

employment and the decline of standard FT jobs (Benach & Muntaner, 2007). Authors

generally argue the importance of maintaining a workforce that is more stable (Burke &

Cooper, 2006; Cherry, 2006; Cummings & Kreiss, 2008).

In recent decades, there has been a movement towards flexible, non-standardized work and a shift towards what is commonly called “casualization.”

More research is needed on the impact of casualization on patient outcomes.

14

HISTORICAL TRENDS IN NURSE EMPLOYMENT

During the 1990s, an economic downturn led to a dramatic decrease in nursing employment.

Between 1993 and 1999, there was a loss of 5,765 registered nurses (RNs) and 1,510

registered practical nurses (RPNs) from Ontario’s labour market. This loss was most

pronounced in hospitals and long-term care facilities, which lost 10.0% of their nursing

workforce. The loss was finally recouped by 2003 due to an influx of nurses to hospitals and

other sectors (Alameddine et al., 2006a, 2006b). As a result of health care restructuring,

casual employment and the use of agency nurses increased. Between 1998 and 2007, the

College of Nurses of Ontario (CNO) reported a net gain of 3,886 RN members and a net loss

of 1,650 RPN members. Between 1998 and 2001, there was an accumulative loss of 4,055

RNs, contrasted by an accumulative net gain of 8,011 RNs from 2002 to 2006. There was no

appreciable difference in RN net loss or gain in 2006 and 2007. However, in 2008, gains

outstripped losses, resulting in a net gain of 950 RNs (CNO, 2008). For RPNs, there was an

accumulative net loss of 3,322 members between 1998 and 2005, followed by a net gain of

1,672 RPNs from 2006 to 2007 (CNO, 2007). In 2008, the CNO reported a significant gain in

RPN membership, resulting in a net gain of 1050.

In 2000, anecdotal evidence of acute nursing shortages in large urban hospitals surfaced.

Although it was difficult to ascertain true vacancy rates, there were clear indications of

shortages in intensive care, cardiac care and emergency units (Baumann, Fisher, Blythe, &

Oreschina, 2003). Shortages were also reported in community hospitals and hospitals in rural

areas. In addition, several reports highlighted a potential crisis due to aging health care

workforces, including nursing. Three seminal reports documented the maturing workforce

and warned of potential shortages as nurses retired (O’Brien-Pallas, Duffield, & Alksnis,

2004; Ryten, 1997, 2002). In 2006, the average age of RNs in the Canadian hospital sector

was 43.4 years, compared to 46.4 years for those in the community health sector and 48.0

years for those in the nursing home/long-term care sector (Canadian Institute for Health

Information [CIHI], 2007). The government began to focus on strategies to increase and

expand employment opportunities in health care.

In 2008, there was a net gain of RNs and RPNs in Ontario.

Shortages still exist in specialty units.

15

WORKFORCE PLANNING IN THE NEW MILLENNIUM

As early as 1999, a Nursing Task Force (NTF) was established by the Ministry of Health

and Long-Term Care (MOHLTC, 2006b). Two of the key recommendations made by the

NTF were as follows:

1. Immediately enhance health care delivery through nursing services by stabilizing the

workforce and improving retention of currently employed nurses.

2. Provide ongoing structured opportunities for RNs and RPNs to participate in a

meaningful way in decisions that affect patient care on both a corporate and

operational level.

The MOHLTC (1999) announced several funding initiatives to enhance and increase

permanent FT nursing positions province wide in two sectors (acute care and long-term

care).

In 1999, the MOHLTC introduced the Nursing Enhancement Fund as part of the Ontario

Nursing Strategy to create new permanent FT and PT nursing positions. This was in response

to the recommendation of the NTF to enhance health care delivery through stabilization and

retention efforts (Haygroup, 2001). The government targeted $50 million annually for the

creation and maintenance of FT positions for nurses in the province. In 2004, the MOHLTC

announced a policy for hospitals to increase the FT employment of nurses towards a goal of

70% FT. The government’s commitment to creating new nursing positions in hospitals and in

the acute care sector includes the following (MOHLTC, 2004b, 2004c):

• 1999-2000: $130 million new base funding annually to hospitals to create 3,300 new

nursing positions

• 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

In May 2004, the provincial government announced an additional investment of $191 million

to hire 2000 new staff, including 600 new nurses. The main objective was to ensure all long-

The MOHLTC continues to invest in employment integration and workforce stability for nurses.

16

term 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, 2004a).

A two-year study covering 2003-2004 and 2004-2005 showed high rates of PT employment

for nurses in Ontario (Baumann, Blythe, Cleverly, & Grinspun, 2006). In response, the

government and granting agencies commissioned various reports to lay the groundwork for

policy change. Some reports recommended strategies to increase workforce numbers. Others

focused on retention initiatives such as healthy work environments, strategies for older

workers and incentives for FT employment for new graduates (Baumann et al., 2001;

MOHLTC, 2004a). These multifaceted strategies were designed to influence work

satisfaction and increase workforce participation. In order to meet the demand for nurses,

there has also been an increase in the employment of internationally educated nurses (Blythe

et al., 2008; Blythe, Baumann, Rheaume, & McIntosh, 2006). According to the CIHI (2007),

12.5% of RNs in Ontario in 2006 were internationally educated.

NEW GRADUATE INITIATIVE 2004-2008

Since 2004, the MOHLTC has been investing in the support of new nursing graduates.

Between 2004 and 2006, the total funding for the new graduate initiative was $30.4 million

(MOHTLC, 2006a); $17.7 million was invested in fiscal year 2004-2005 (MOHLTC, 2006c),

$12.7 million was invested in fiscal year 2005-2006 and an additional $26.7 million was

invested in fiscal year 2006-2007 (D. Torres, personal communication, July 11, 2008). These

investments were followed by the major Nursing Graduate Guarantee (NGG) initiative,

which was launched in 2007 with $89.9 million (MOHLTC, 2007) and $90 million in 2008-

2009 (Ministry of Finance, 2008)

The objectives of this initiative were to promote the availability of permanent employment

opportunities for new nursing graduates, improve integration of new nursing graduates into

the workforce, promote retention among the province’s new nursing graduates and increase

the total supply of nurses in Ontario by providing FT employment to nurses who might

otherwise seek work in other jurisdictions. According to Baumann, Blythe et al. (2006), 75%

of new registered nursing graduates surveyed in 2005 indicated their preferences for FT

employment, but only 43% had FT jobs six months after graduation. Nurses in general and

Multifaceted strategies were designed to influence work satisfaction and increase workforce participation.

Major investments have been made to increase permanent employment opportunities.

Registered nursing graduates prefer full-time employment.

17

new graduates in particular were finding it difficult to secure FT permanent employment.

Recent MOHLTC initiatives have been directed at addressing this issue.

FACTORS AFFECTING INTEGRATION OF NEW GRADUATES INTO THE WORKPLACE

The chief employer is the hospital sector with 24/7 service and over 31,000 patient beds. The

overall number of nursing employer organizations is 1,198 and includes 159 (13.3%)

hospitals and 606 (50.6%) long-term care facilities. The remaining 433 (36.1%) organizations

include public health, community and other (A. Ferretti, personal communication, October

27, 2009). There are a total of 91,965 RNs and 27,432 RPNs employed in nursing in Ontario

(CNO, 2008). Typically, there are high rates of job turnover in large acute care hospitals and

lower rates in community and rural facilities (Hayes et al., 2006).

The ability for organizations to provide employment for new nurses changes over time and is

affected by numerous variables. Identifying and quantifying their capacity to employ new

graduates is a challenge for researchers because availability of jobs cannot be estimated by

counting vacancies or job postings. Organizations define vacancies in various ways. Some

organizations do not differentiate internal vacancies from external vacancies. Internal

vacancies are created by workers transferring within an organization, whereas external

vacancies are created when workers leave an organization. Internal vacancies do not

represent employment opportunities for new applicants.

Vacancies that are posted are not necessarily related to new job opportunities. Vacancies are

not always associated with funded positions and often remain unfilled because related work

hours are covered by overtime or casual hours (Baumann, Keatings, Holmes, Oreschina, &

Fortier, 2006). Part-time and casual jobs are not always advertised; consequently, jobs exist

but not specific positions. Even posted jobs representing funded positions may not be

available for new graduates because they are not suited to a new nurse or seniority within the

organization precludes new nurses from being offered the job. This is particularly the case

with FT employment. In a recent study on vacancies, the term has been redefined with the

recognition that “organizational flexibility strategies have altered nurse utilization and

rendered data on vacancy statistics inaccurate measures of nursing shortage” (Fisher,

The chief nursing employer is the hospital sector.

The definition of vacancies is not standardized across the province.

18

Baumann, & Blythe, 2007). Additional difficulties occur when statistical reports do not

distinguish FT status from FT hours. For example, the Ministry of Training, Colleges and

Universities (MTCU; 2005) considers nursing graduates to have FT employment if they work

more than 30 hours per week. However, nurses with casual or PT status may work FT hours.

Factors that influence where a nurse seeks employment include the number of potential

employers in the area. Nurses graduating from schools in Toronto, for example, have more

employment opportunities than those educated in Windsor. Lack of local employment

opportunities encourages graduate mobility. Hiring cycles are another factor. An organization

that hires heavily in one year will not do so in the next, unless it has a low rate of retention or

is expanding its services. Smaller organizations are likely to have more unpredictable hiring

cycles than larger ones. The role of timing also bears consideration. For example, what is the

relationship between new job hires and an organization’s financial position? Is there a

relationship between when nurses graduate and the ease with which they find jobs? An

additional factor is the effect that unionized environments and certain employment policies

have on the availability of FT employment for graduating nurses.

MARKETS CHANGE

There is no doubt that the balance between the supply and demand for nurses has fluctuated

in recent years. Important factors in nurse recruitment include market conditions and the

availability of employers to hire new graduates and integrate them into the workforce.

Growth in the health sector increases employment opportunities. Organizations should have

sufficient annual turnover and a relatively large system to absorb new employees (Baumann,

Keatings et al., 2006). The turnover of nurses is affected by retirement, job changes and

personnel leaving the profession or moving between sectors (e.g., hospital to community).

There has been a dearth of research examining changes in nursing employment opportunities

over time in relation to macro economic indicators such as labour market trends.

Nursing labour markets are sensitive to government investments and policy decisions.

Starting in 1999, in an attempt to reverse the attrition of nurses from Ontario’s labour market,

the provincial government led multiple initiatives aimed at increasing the FT equivalents of

nurses working in acute care hospitals and long-term care facilities. This was done through

The number of potential employers/ employment opportunities at any one time is difficult to assess.

Important factors in nurse recruitment include market conditions and the availability of employers to hire new graduates.

Nursing labour markets are sensitive to government investments and policy decisions.

19

baseline funding to these organizations to support the hiring of new nurses and/or convert

casual and PT nurses into FT staff. The ultimate investment was in 2007, when the MOHLTC

first announced $89 million to support every new Ontario nursing graduate (RN and RPN) in

finding FT employment upon graduation through the NGG.

THE NEW SUPPLY: REGISTERED NURSES AND REGISTERED PRACTICAL NURSES IN ONTARIO

Each year the nursing workforce is augmented by newly graduating nurses, internationally

educated nurses and nurses who re-enter the workforce (Blythe et al., 2008; Simoens,

Villeneuve, & Hurst, 2005). This report focuses on 2008 new graduates. It is essential to

develop a profile of new graduates that includes an overview of both nurse education and

demographics and clarifies how well nurses are integrated into the workforce. Little is known

about the distribution of new graduates across sectors, areas of practice and geographical

location. Recent restructuring of nurse education (e.g., combining community college and

university education) continues to have an impact on the number of nurse graduates and

where they seek employment upon graduation. Consequently, it is important to describe the

characteristics of the educational system and employment possibilities for new entrants into

the profession.

NURSE EDUCATION IN ONTARIO

In Ontario, the MTCU is responsible for education at the community college and university

levels. The MOHLTC shares the responsibility for health care and is interested in the

education of health care workers to supply and maintain the system. However, the

responsibility for funding nurse education, with the exception of a few targeted areas (e.g.,

nurse practitioner education and recent investments in clinical simulation equipment), lies

with the MTCU.

Three historical events temporarily or permanently affected the supply of new graduates.

First, in 2003, secondary education in Ontario was reduced to four years, temporarily

increasing the number of potential applicants to nursing programs. Second, on January 1,

2005, the CNO changed its educational requirements for registration in the general class to a

degree for RNs and a diploma for RPNs. The new requirements resulted in changes to RN

A profile of annual graduates is essential to understand how well nurses are integrated into the workforce.

It is necessary to track changes in educational programs.

20

and RPN nursing education in Ontario. As a result, there was an influx of students into RN

nursing diploma programs in the last year they were offered (2001). New entry to practice

legislation specifying baccalaureate degrees for RNs encouraged community colleges and

universities to enter into college-university collaborative programs leading to a degree from

the university partner. The upshot was a new educational way of delivering the four-year

basic nursing program through partnerships between the 13 universities and 22 colleges

offering nursing.

To facilitate the transition to all baccalaureate nursing, the MTCU made funding available to

support enrolment growth in the new collaborative programs. It also provided funding for

compressed degree programs in universities and the final intake of diploma students to the

colleges. The intention was to boost the number of graduates in 2003-2004, the year in which

reduced numbers were anticipated due to the elimination of the three-year college diploma.

Third, in 2001, RPN programs altered their curricula and increased their lengths to two years

to produce graduates capable of expanded practice roles. In addition, the MTCU announced

that effective January 2001, enrolment quotas on RPN programs were lifted.

The number of nurses entering the workforce has traditionally been supply driven. With the

introduction of the baccalaureate entry to practice requirement, the government of Ontario

committed to funding an intake of 4,000 first-year collaborative nursing degree students per

annum for potential RNs (B. Gough, personal communication, May 2, 2005). The overall

annual intake of RN students has almost reached this target of 4,000 (3,515 RN admissions in

2008). Capital funding for physical plant infrastructure dedicated to nursing education has

been sporadic in most educational institutions, although there have been government

strategies in targeted areas to help educational institutions increase enrolment. For example,

from 2004 to 2006, there was a $20 million investment by the MOHLTC in clinical

simulation equipment for schools of nursing. The MTCU also increased Basic Income Unit

funding for growth in RN nursing programs. As a sequel to the time-limited funding for

compressed degrees announced in 2001, the MTCU approved new Second-Entry Programs,

which began in 2005-2006. These programs are geared to students with previous post

secondary education, including diploma-prepared RPNs wishing to upgrade to a degree. The

initiative was intended to increase the intake of nursing students.

Ontario moved to baccalaureate education for all RNs in 2001.

In 2001, RPN programs altered their curricula and increased their programs to two years.

21

DATA GAPS

According to the 2005 Data Quality Report: The State of Data Quality in Ontario

(MOHLTC, 2005),

Producing better data is a key objective of the province’s Information Management

Strategy. Sound health care planning decisions require accurate, timely and accessible

data. Quality information is essential to making effective evidence-based decisions,

which ultimately impact on the province’s ability to adequately meet the health care

needs of Ontarians.

To link the supply of new nursing graduates to the needs of the provincial health care system,

good data about the supply of new graduates and information about market requirements are

essential. Gaps currently exist in relation to the supply of new nurses and their uptake into the

workforce. However, Statistics Canada has decided to include a health human resources

survey of new graduates on its agenda. A recent report by Statistics Canada includes a

detailed outline of key data that should be collected (Allen, Ceolin, Ouellette, Plante, &

Vaillancourt, 2006).

DATA ON GRADUATING NURSES

National educational data is currently stored by two organizations: the Canadian Nurses

Association (CNA) and the Canadian Association of Schools of Nursing (CASN). Data on

enrolment and graduation from schools of nursing is collected yearly. In addition, Statistics

Canada collects annual degree statistics from registrars of the educational institutions.

However, recent changes to Statistics Canada data-sharing policies meant that after 2002,

Statistics Canada was no longer able to share the data with the MTCU. Since 2003, the

MTCU has collected data on degrees granted directly from the colleges and universities. This

is to be used in conjunction with nursing school enrolment data to track nurse supply. Data

collection has been a challenge because of various factors such as differing graduation times,

FT and PT student counts and the capacity of individual institutions to create and maintain

adequate databases.

In addition, the creation of college-university collaborative programs has resulted in data

integration challenges related to applications, registration and enrolment. For example, in

There was a $20 million investment by the MOHLTC in clinical simulation equipment for schools of nursing.

Statistics Canada has decided to include a health human resources survey of new graduates on its agenda.

The MTCU has collected data on degrees granted directly from the colleges and universities.

22

some college-university partnerships, applicants apply to the Ontario College Application

Service and the Ontario Universities’ Application Centre. The CNO data on new registrants is

also used to analyze the supply of nurses because enrolment and graduation data do not

capture graduates who never register with the CNO.

Student employment upon graduation is not well measured. Some schools of nursing may

survey their alumni sporadically to gain information about their absorption into the

workforce. Yet there is no mandatory reporting of alumni employment data at the provincial

or national level. In its statistics on new members, the CNO differentiates nurses educated in

Ontario from those educated abroad or in other provinces. While this group is mainly

composed of new graduates, it also includes reinstated members. Furthermore, the CNO

reports only the age, gender and place of initial education of new members, not their

employment status. The employment status is rolled up in the totals of the proceeding year’s

release of the Annual Membership Statistics report.

RECENT TRENDS IN RN AND RPN GRADUATION

As shown in Figure 1, the number of nurses graduating each year varies over time and there

is no consistent pattern. In the year of interest (2008), there were 4,902 graduates (2,776 RNs

and 2,126 RPNs). These numbers can vary depending on the point in time they are collected.

The “ebbs and flows” of the number of RN graduates have been affected by the

implementation of the baccalaureate degree as entry to practice in 2004 (Baumann, Blythe et

al., 2006). The overall numbers for RPNs are steadily increasing (see Figure 2). This reflects

the 2001 provincial government strategy to lift caps on enrolment in programs.

Student employment upon graduation is not well measured.

The overall number of RPN graduates is steadily increasing.

23

Figure 1. First Year Intake and Supply of Ontario Registered Nurse Graduates

Note. First year intake and graduation numbers are based on full-time students entering the first year of the

baccalaureate program (includes Second-Entry Programs but excludes post RN programs).

2001-2002 – Last intake of diploma programs; first intake for collaborative programs; first intake of compressed

baccalaureate.

2004 – Graduates of last intake of diploma + compressed + part-time and diploma and baccalaureate graduates

(not collaborative).

Source: Individual university and college reports, 2008.

Figure 2. First Year Intake and Supply of Ontario Registered Practical Nurse Graduates

Source: Ministry of Training, Colleges and Universities 2008; Individual university and college reports, 2008.

The intake and graduation numbers of RNs fluctuate but are on an upward trend.

The intake and graduation numbers of RPNs are on a continual upward trend.

24

INTEGRATION OF NEW GRADUATES INTO THE WORKFORCE

Recognizing the prevalence of PT and casual employment in the provincial nursing

workforce, the government has made major policy changes to support every new Ontario

nursing graduate (RN and RPN) to find FT employment upon graduation. A targeted

employer incentive was launched to build capacity within the health care system for the

planning and management of the nursing workforce. The NGG was designed by the

MOHLTC to increase FT employment and to improve integration of new graduate nurses

into the workforce. A goal of the initiative is to provide FT positions to nurses who may

otherwise seek employment in other jurisdictions or professions. The overall intent is to

increase the total supply of nurses in Ontario (MOHLTC, 2008).

NURSING GRADUATE GUARANTEE INITIATIVE: BACKGROUND AND DESCRIPTION

In 2007, the MOHLTC announced $89.9 million to fund the NGG. The purpose of the

initiative is to finance FT six-month supernumerary (above staff complement) nursing

positions for all new nursing graduates. As part of the MOHLTC Health Human Resource

Strategy, the NGG is intended to ensure that every new RN and RPN nursing graduate who

wishes to work FT in Ontario will have that opportunity (MOHLTC, 2007).

According to the guidelines of the NGG initiative, the MOHLTC provides funding for

temporary FT supernumerary positions for six months for new nursing graduates who have

secured their position by using the online nursing graduate portal. The intent is to provide

employers with the time to build capacity within their organizations, so that they might be

able to offer permanent FT employment to the new graduate nurses. After a minimum period

of three months but within six months, the MOHLTC expects employers to use their best

efforts to hire new graduate nurses into a permanent FT position, unless there are outstanding

reasons not to continue the employment. Employers must commit to providing an additional

six weeks of FT supernumerary time and funding for the new graduate nurses if they are

unable to offer them a permanent FT position within the six-month period. The NGG has

completed its second year of funding (2008-2009) and is continuing for the graduates of

2009-2010.

A targeted employer incentive was launched to build capacity within the health care system.

The NGG funds provide temporary Full-time supernumerary positions for six months for new nursing graduates.

25

NURSING GRADUATE PORTAL – HEALTHFORCEONTARIO

The NGG uses an online employment portal (HealthForceOntario or HFO) to link new

nursing graduates with employers who are interested in hiring them (HFO, 2009). Both

nursing students and employers must register on the portal to participate. Appendix A

clarifies the NGG application process via the nursing graduate portal.

EVALUATION OF NURSING EMPLOYMENT IN ONTARIO 2008

This report is the second year evaluation of the NGG. Appendix B outlines the strategies,

methodology and participants involved in the study. There are four target populations: new

nursing graduates, employers, mentors and union representatives. The objectives of the NGG

initiative, as outlined by the MOHLTC (2008), are as follows:

• Provide every new graduate with the opportunity for FT employment in Ontario

• Promote the availability of permanent FT positions for new graduates

• Facilitate “matching” between new graduates and employers

• Create bridging positions for new graduates

• Support Ontario’s new graduates as they transition into practice

• Improve integration of new graduates into the workforce

• Promote retention among Ontario’s nurse graduates

• Facilitate recruitment to all sectors

• Transform employer practices to maximize availability of FT nursing positions for all

nurses

• Increase the total supply of nurses in Ontario by providing FT employment to nurses who

may otherwise seek employment in other jurisdictions or professions

An online employment portal links new nursing graduates with employers who are interested in hiring them.

Both nursing students and employers must register on the portal to participate.

26

METHODS

A triangulation design (see Box 1) was used to assess the employment status of 2008

graduating nurses in Ontario and evaluate the NGG.

Box 1. Triangulation Design

Data was collected by administering surveys to new graduates (RNs and RPNs), employers

(registered and non-registered) and union representatives. The surveys were designed to

evaluate users' experiences with the nursing graduate portal and during extended orientation

and transition into employment, employment status and area of practice, new graduate

preferences and collaboration with bargaining units. Data was also collected through focus

groups with select employers and key informant interviews with new graduates, nurse

mentors and union representatives. A comparison was made to other existing databases (CIHI

and CNO). The data reported in this study identifies both the source and the relevant

respondents.

SAMPLE

The overall sample included new graduates, employers, mentors and union representatives.

Information was obtained using the three surveys outlined above and the stakeholder analysis

(employers, new graduates, nurse mentors and union representatives). The surveys and

guidelines for the focus groups and interviews were developed with input from expert senior

researchers at the Nursing Health Services Research Unit (NHSRU) and senior policy

analysts from the MOHLTC. A grey literature search of media releases and news bulletins

Surveys • New Graduate Evaluation of the Nursing Graduate Guarantee 2008-2009 • Employer Evaluation of the Nursing Graduate Guarantee 2008-2009 • Union Representative Evaluation of the Nursing Graduate Guarantee 2008-2009

Focus Groups • Employer Focus Groups – acute care (large, medium, small, and rural), long-term

care, public health and community

Key Informant Interviews • New Graduates of 2008 Key Informant Interview Guide • Nurse Mentor Key Informant Interview Guide • Union Representative Key Informant Interview Guide

The evaluation of a policy requires a variety of research approaches.

Findings were compared to secondary databases (CIHI and CNO).

27

was conducted to collect all information related to the initiative. Content and face validity

testing were performed.

Participation in the qualitative stakeholder analysis included (i) 7 employer focus groups with

54 participants from acute care (large, medium, small and rural), long-term-care, public

health and community and (ii) key informant interviews with 16 new graduates (9 RNs and 7

RPNs), 4 frontline/experienced nurse mentors and 2 nursing union representatives. All survey

participants were directed to an information page that outlined the rationale of the study and

asked each person to consent to participate.

For the interviews and focus groups, the purpose of the study was explained to all participants

before the interview process began. All research instruments underwent the necessary ethics

review process and received final approval from the Hamilton Health Sciences Research

Ethics Board. The research team and the MOHLTC obtained the participants’ consent to

publish the survey and interview findings. Participants were guaranteed anonymity and

assured that no personal identifiers would be associated with responses to the questions.

Response rates for the quantitative survey are outlined in Table 1.

Table 1. Quantitative Survey Response Rates

New Graduate Evaluation of Nursing Graduate Guarantee 2008-2009 There were 998 respondents out of 3,550 NGP registrants (28%) • 715 RNs and 283 RPNs

Employer Evaluation of Nursing Graduate Guarantee 2008-2009 There were 435 respondents out of 1,300* employers (34%)

• 254 (58%) of the survey respondents were registered on the NGP • 181(42%) of the survey respondents were not registered on the NGP

Union Representative Survey 2008-2009 There were 144 respondents out of 413 representatives (35%) Note. NGP = nursing graduate portal; RNs = registered nurses; RPNs = registered practical nurses.

*This number includes registered and non-registered employers (contacted through Local Health Integration

Network CEOs).

ANALYSIS

Surveys were analyzed through SPSS (version 17.0). Responses to the interview and focus

group questions were taped during the time of the interview and subsequently transcribed.

28

Thematic analysis of the major issues was carried out. Upon detailed examination of the

interview results, major themes were highlighted and key findings were grouped

appropriately under each thematic heading. Recommendations were then developed from the

interview and focus group themes and survey findings.

DEMOGRAPHIC CHARACTERISTICS OF SURVEY RESPONDENTS

RN AND RPN NEW GRADUATES

The new graduate evaluation survey was sent to 3,550 new nurse graduates who were

registered on the nursing graduate portal (D. Torres, personal communication, May 20,

2009). Data collection took place between January 2009 and May 2009. Upon completion of

data collection, cleaning and refinement, a total of 998 valid responses remained in the

database; 715 from RNs and 283 from RPNs (see Appendix C).

Data analysis revealed that RN and RPN nursing graduates were comparable in gender

distribution but differed in age distribution. The ratio of females to males was 92:8 for RNs

and 90:10 for RPNs. Similar to last year’s findings, RN nursing graduates were younger

compared to their RPN counterparts; 68% of new graduate RPNs were older than 25 years of

age compared to only 49% of new graduate RNs. This age difference is important when

comparing the two nursing groups because age influences the worklife span of nurse

graduates as well as their work preferences and career mobility (Blythe et al., 2008).

According to the survey, the majority of RN (96%) and RPN (85%) new graduates were

working as nurses at the time of questionnaire completion. Almost all RN (98.9%) and RPN

(99.6%) new graduates who were working indicated that Ontario was their main employment

location. In terms of geographical location, the Toronto Central Local Health Integration

Network (LHIN) employed the largest percentage of RN (33%) and RPN (13%) new

graduates, followed by the Champlain LHIN (11% for both RNs and RPNs) and the

Hamilton, Niagara, Haldimand, Brant LHIN (9% for RNs and 12% for RPNs). Appendix D

shows the breakdown by LHIN for RNs and RPNs. According to the CNO (2008), general

class new RN and RPN member statistics were consistent with survey data in that the largest

percentage of RNs and RPNs were employed in the Toronto Central LHIN (26% and 12%

respectively) and the Champlain LHIN (13% and 12% respectively).

New graduate RPNs were older than new graduate RNs.

The CNO (2008), general class new RN and RPN member statistics were consistent with survey data.

29

EMPLOYER PROFILE AND PARTICIPATION

The employer evaluation survey was sent to all nursing employer organizations in Ontario

(1,300). In an effort to understand the underlying causes for not using the nursing graduate

portal, the evaluation included employers who did not register. Data collection was carried

out between January 2009 and April 2009. Upon completion of data collection, cleaning and

refinement, the final employer database had 435 valid responses; 254 (58%) from employers

who posted positions on the employment portal in 2008 and 181 (42%) from employers who

did not (see Appendix E). Of the employers surveyed, 449 (35%) registered on the

employment portal. Of those who registered, 301 (67%) matched employment positions with

new nurse graduates (D. Torres, personal communication, May 20, 2009). The following

section provides a demographic profile of employer survey respondents broken down by

registration status (i.e., employer registrants versus employer non-registrants).

Registered Employers

The majority of registered employers who responded to the survey fell into two main

organizational categories: acute care hospitals (41%) and long-term care facilities (36%).

Table 2 provides the full breakdown of employer survey respondents registered on the portal.

These percentages represent the number of employers who responded to the survey and are

not reflective of the number of jobs posted or nurses hired by each sector.

Table 2. Percentage of Registered Employer Survey Respondents by Type of Organization

Type of Organization Percentage (%)

Acute Care Hospital 40.6

Long-Term Care Facility 35.8

Public Health 5.5

Community (Community Health Centre, Community Care Access Centre, Mental Health, Physician Offices, Nursing Agency, Hospice)

4.7

Other Hospitals (Continuing Complex Care/Rehabilitation, Addiction and Mental Health)

4.3

Other (Family Health Team, Combined Acute and Long-Term Care, College/University)

9.0

Total 100.0

Source: Employer Evaluation of Employment Portal Survey, 2008-2009.

The main nurse employers in the province of Ontario are acute care hospitals and long-term care facilities.

30

In comparing the sector breakdown of portal registrants to the sector breakdown in the

province, an inverse relationship exists. Thirteen percent (13%) of nurse employers in

Ontario are acute care, 51% are long-term care and 36% are found in other sectors. However,

the opposite is true for the 449 portal registrants, 53% (238) of which were acute care

hospitals, 15% (67) were long-term care and 32% (144) were in other sectors. Based on the

data, there are many long-term care facilities in Ontario that are not registered on the portal.

Despite this, however, long-term care facilities provided a good response to the survey.

Half of the employer survey respondents were located in the following four LHIN regions:

North East (15%), Toronto Central (12%), Hamilton, Niagara, Haldimand, Brant (11%) and

Champlain (11%). The remaining organizations were distributed among the other nine LHINs

(on average 5% per LHIN). Appendix F provides a full breakdown of employer respondents

by LHIN.

Non-Registered Employers

Community organizations (35.8%) and long-term care facilities (32.0%) comprised the

majority of non-registered survey respondents. Table 3 provides the full breakdown of

organizational categories among non-registered employers.

Table 3. Percentage of Non-Registered Employer Survey Respondents by Type of Organization

Type of Organization Percentage (%)

Community (Community Health Centre, Community Care Access Centre, Mental Health, Physician Offices, Nursing Agency, Hospice)

35.8

Long-Term Care 32.1

Public Health 4.3

Other Hospitals (Continuing Complex Care/Rehabilitation, Addiction and Mental Health)

4.3

Acute Care Hospital 3.7

Other (Government, Association, Regulatory Body, Union, College/University, Retirement Home, Family Health Team)

19.8

Total 100.0


Large acute care hospitals have more postings on the portal compared to other sectors.

The highest percentage of non-participating employers was found in the community sector.

31

Over 60% of non-registered employers were found in the following five LHIN regions: North

East (16%), Hamilton, Niagara, Haldimand, Brant (14%), Toronto Central (13%), Champlain

(9%) and North West (9%). The remaining organizations were distributed across the other

nine LHINs (4% per LHIN on average). Additional information about the non-registered

employers can be found in the companion series report, Employer Engagement in a Policy

Initiative: Uptake of the New Graduate Guarantee.

Union Representatives

The union survey was sent to approximately 413 union representatives across the province.

This was the first wave of data collected from union representatives. Data collection took

place during March 2009. Upon completion of data collection, cleaning and refinement, a

total of 144 valid responses remained in the database.

ACTUAL EMPLOYMENT OF REGISTERED NURSES AND REGISTERED PRACTICAL NURSES

The New Graduate Evaluation of Nursing Graduate 2008 Portal Survey is the source for the

actual employment figures and results reported below. Comparisons are made with other

sources as indicated.

DISTRIBUTION OF NURSING GRADUATES BY TYPE OF EMPLOYER

As shown in Table 4, acute care hospitals were the largest employer of nursing graduates in

2008 (74.5%), with 86.1% for RNs and 40.8% for RPNs. By comparison, in 2007, there were

64.5% new graduates (83.2% for RNs and 32.7% for RPNs) employed by acute care hospitals

(Baumann, Hunsberger, Idriss, & Alameddine, 2007).

Acute care hospitals are increasing their involvement in the NGG.

32

Table 4. Distribution of Registered Nurse and Registered Practical Nurse Graduates by Type

of Employer for 2007 and 2008-2009

Note. RN = registered nurse; RPN = registered practical nurse.

*In 2007, 4.1% of RNs and 0.2% of RPNs were employed in public health.

**In 2008, 3.5% of RNs and 0% of RPNs were employed in public health.

Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.

The remaining RNs worked in the community (5.8%), addiction and mental health centres

(3.1%), continuing complex care/rehabilitation (2.0%) or were dispersed across other types of

employers. Note that the distribution of RN graduates by employer is comparable to that

reported by the CNO (2008) for general class new RN members for hospital (88.3%) and

community (7.3%). There is a lower percentage of new graduates in long-term care (0.9%)

compared to CNO new members (2.4%).

In addition to acute care hospitals, RPNs were working in long-term care facilities (29.1%),

continuing complex care/rehabilitation (16.6%), community organizations (6.3%) and

addiction and mental health centres (2.7%), or they were dispersed across other employers

(4.5%). In comparison to 2007 portal survey data, there have been gains in the proportion of

RPNs working in acute care hospitals (an increase of 8.1%) and continuing complex

care/rehabilitation (an increase of 3.5%) and losses in the proportion of RPNs working in

long-term care facilities (a decrease of 4.3%) and community employers (a decrease of 4%).

Comparison of these percentages with those reported by the CNO for general class new RPN

Type of Employer 2007 2008-2009

RN RPN Total (%) RN RPN Total (%)

Acute Care Hospital 83.2 32.7 64.5 86.1 40.8 74.5

Addiction and Mental Health/Psychiatric

1.8 5.0 3.0 3.1 2.7 3.0

Community Employers 7.0* 10.3* 9.7 5.8** 6.3** 5.9

Continuing Complex Care/Rehabilitation

2.6 13.1 6.5 2.0 16.6 5.7

Long-Term Care Facility 1.2 33.4 11.7 0.9 29.1 8.1

Other 4.2 5.5 4.6 2.1 4.5 2.7

Total 100.0 100.0 100.0 100.0 100.0 100.0

There has been an increase in the percentage of RPNs working in acute care hospitals.

33

members in 2008 shows a similar distribution in acute care hospitals (41.0% compared to

40.8% of 2008 new graduates) but a larger proportion in long-term care facilities (45.1%

compared to 29.1% of new graduates).

DISTRIBUTION OF NURSING GRADUATES BY AGE AND SECTOR OF EMPLOYMENT

In alignment with the CNO’s classification, employer categories have been further refined

into four major sectors of employment: hospital, community, long-term care and other.

Registered nurse survey respondents were younger compared to RPN survey respondents

across all sectors of employment (i.e., hospital, community and other), except long-term care.

The age difference was most pronounced in the hospital sector where 78.5% of RNs versus

52.2% of RPNs were less than 30 years of age. In the community sector, 63.1% of RNs and

50.0% of RPNs were less than 30 years of age. Conversely, in the long-term care sector, 40%

of RPNs were younger than 30 years of age compared to 33.4% of RNs (see Table 5).

In examining the distribution of RNs, the percentage working in long-term care has decreased

since 2007. Eleven out of 910 (1.2%) respondents in 2007 and 6 out of 650 (.9%) respondents

in 2008 were working in long-term care. Of these, 9 out of 11 (81.8%) and 2 out 6 (33.3%)

were under the age of 30 at the time of survey. There was only a slight change for RPNs. In

2007, 179 out 535 (33.5%) respondents were working in long-term care compared to 60 out

of 223 (26.9%) in 2008. Of these, 77 out of 179 (43%) and 24 out of 60 (40%) were under the

age of 30 at the time of survey.

The percentage of RNs working in long-term care has decreased slightly since 2007.

34

Table 5. Percentage Distribution of New Nurse Graduate Survey Respondents by Nurse

Group, Age Group and Sector of Employment


DISTRIBUTION OF NURSING GRADUATES BY PRIMARY AREA OF PRACTICE

The five main areas of practice for RNs were medicine (18.5%), surgery (15.3%), emergency

(11.1%), maternal-new born (8.7%) and critical care (8.5%). These areas, primarily based in

hospitals, employed nearly two-thirds (62.4%) of RN graduates in 2008. The five main areas

for RPNs were geriatrics (27.7%), medicine (18.6%), complex continuing care (11.1%),

visiting nurse (8.5%) and surgery (5.9%). These areas employed almost three-quarters

(72.0%) of RPN graduates in Ontario in 2008. This distribution was comparable to that

observed in 2007, especially for RN graduates (Baumann, Hunsberger et al., 2007). For

RPNs, a greater proportion was employed in medicine in 2008 than in 2007 (18.6% versus

11.2%). See Appendix G for a full comparison between 2007 and 2008.

Nurse Group

Employment

Sector

Age Group (%)

Under 19

20-24 25-29 30-34 35-39 More Than 40

Total

RN

Hospital 0.2 53.5 24.8 8.1 6.9 6.4 100.0

Community -- 36.8 26.3 15.8 5.3 15.8 100.0

Long-Term Care -- 16.7 16.7 16.7 16.7 33.3 100.0

Other -- 35.7 35.7 -- 28.6 0.0 100.0

Total 0.2 51.8 25.1 8.5 7.4 7.1 100.0

RPN

Hospital -- 37.3 14.9 17.9 9.0 20.9 100.0

Community -- 28.6 21.4 21.4 14.3 14.3 100.0

Long-Term Care -- 29.2 10.8 13.8 7.7 38.5 100.0

Other -- 20.0 10.0 20.0 10.0 40.0 100.0

Total 0 33.6 13.9 17.0 9.0 26.5 100.0

The top area of practice for RNs was medicine.

The top area of practice for RPNs was geriatrics.

35

DISTRIBUTION OF NURSING GRADUATES BY EMPLOYMENT STATUS

At the time the portal survey was completed, 56.5% of RN graduates and 18.8% of RPN

graduates were employed on a permanent FT basis. Note that 16.8% of RN graduates and

25.2% of RPN graduates were still completing their supernumerary FT employment period in

the NGG, and thus could potentially be bridged into permanent FT jobs over the next few

months. Another 9.3% of RNs and 11.5% of RPNs were employed in other types of

temporary FT positions. Compared to RNs, a higher percentage of RPN graduates were

working on a PT or casual basis (see Table 6).

Table 6. Comparison of Employment Status of Registered Nurse and Registered Practical

Nurse Graduands 2005, 2007, 2008

Employment Status

Registered Nurse (%) Registered Practical Nurse (%)

2005 2007 Portal

2008 Portal

2005 2007 Portal

2008 Portal

Full-Time 42.5 64.7 56.5 14.2 22.6 18.8 Temporary Full-Time* 15.7 19.8 26.1 12.2 38.1 36.7 Part-Time 26.6 10.6 10.5 38.7 18.5 23.1 Casual 6.6 3.5 3.8 19 13.8 10.3 Other (including multiple and temporary part-time)

8.6 1.3 3.0 15.8 6.9 11.1

* Temporary full-time for 2007 and 2008 includes new graduates in supernumerary full-time Nursing Graduate

Guarantee positions.

Note. Full-time employment for all new graduate portal survey respondents is 75.5% (82.6% for 665 RNs and

55.5% for 234 RPNs). Part-time employment for all new graduate portal survey respondents is 13.8% (10.5%

for 665 RNs and 23.1% for 234 RPNs).

Source: 2005 data – Nursing Graduand Survey: RN and RPN Programs, 2005.

Source: 2007 and 2008 data – New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.

The overall employment rates for new nursing graduates (RNs and RPNs) in 2008 are 75.5%

FT and 13.8% PT. Trend analysis across the three years of data (2005, 2007 and 2008) shows

an increase of 24% in FT employment for RNs (from 58.2% to 82.6%). Full-time

employment for RPNs has also increased 29% since 2005 (from 26.4% to 55.5%). Full-time

rate calculations include temporary FT positions for both RNs and RPNs.

The full-time employment trend remained stable for both RNs and RPNs

36

In 2005, the overall FT employment rate for RNs was 58% (42.5% permanent FT + 15.7%

temporary FT). In 2007, the first year of the NGG, this rate increased to 85% (64.7%

permanent FT + 19.8% temporary FT). The rate remained steady in 2008 at 83% (56.5%

permanent FT + 26.1% temporary FT). There has been a 16% decrease in overall PT rates

and a 3% decrease in casual rates for new graduate RNs since 2005. In 2005, PT employment

for RNs was 27%; had dropped to 11% in 2007 and remained at 11% in 2008. Similarly, in

2005, casual employment for RNs was 7%; it had dropped to 4% in 2007 and remained at 4%

in 2008.

A similar trend can be seen for new graduate RPNs. There has been a 29% increase in the

overall FT employment rate of RPNs since 2005. In 2005, the overall FT employment rate for

RPNs was 26% (14.2% permanent FT + 12.2% temporary FT). In 2007, this rate had more

than doubled at 61% (22.6% permanent FT + 38.1% temporary FT). In 2008, however, it had

dropped slightly to 56% (18.8% permanent FT + 36.7% temporary FT). Overall PT and

casual employment rates for RPNs have also decreased since 2005 (a decrease of 16% for PT

and 9% for casual). In 2005, PT employment for RPNs was 39%; it had dropped to 19% in

2007 and increased slightly to 23% in 2008. Similarly, in 2005, casual employment for RPNs

was 19%; it had dropped to 14% in 2007 and dropped to 10% in 2008.

This data demonstrates the effectiveness of the NGG initiative as a major contributing factor

in reversing the trend of casualization of nurses in Ontario. In spite of a current economic

recession and the reticence of employers to guarantee FT employment, the overall FT

employment rate for new graduate RNs and RPNs in Ontario remains high at 76%. In

evaluating the long-term impact of this initiative, the upward trend in FT rates proves

promising.

RPNs have a more difficult time getting full-time status.

The NGG initiative is a major contributing factor in reversing the trend of casualization of nurses in Ontario.

37

DISTRIBUTION OF NURSE GRADUATES BY WORK STATUS AND TYPE OF EMPLOYER

At the time of survey completion, acute care hospitals employed the largest percentage of

2008 nursing graduates (51.7%) in permanent FT positions. This percentage was lower for

community employers (29.4%) and the lowest for long-term care facilities (15.5%). In

contrast, community had the highest percentage of nurse graduates employed on a temporary

FT basis (56.9%), followed by long-term care facilities (33.8%) and acute care hospitals

(25.4%). The low percentage of permanent FT employment for nursing graduates in long-

term care facilities could be attributed to the RPN majority workforce at these facilities (see

Table 7). Appendix H provides a detailed breakdown of the proportion of RN and RPN

graduates by employment status and sector of employer.

Table 7. Proportion of Nurse Graduates by Employment Status and Sector of Employer

Employment Status (%)

Employment Sector

2007 2008

Perm FT

Temp FT

Perm PT

Casual Perm FT

Temp FT

Perm PT

Casual

Hospital 54.7 24.2 12.9 5.5 51.7 25.4 12.7 5.2

Community (includes Public Health)

41.7 30.3 11.4 12.1 29.4 56.9 7.8 0.0

Long-Term Care 21.9 37.4 20.3 13.4 15.5 33.8 29.6 8.5

Other 52.8 28.3 7.5 9.4 37.5 12.5 16.7 12.5

Total 49.2 26.6 13.5 7.3 47.1 27.6 13.9 5.4

MOBILITY AND MIGRATION: RNS AND RPNS

The vast majority of employed RNs and RPNs who responded to the survey indicated that

they were working in Ontario (see Appendix I). The 2006 CIHI workforce trends used 2001

census data to track RN mobility. The CIHI reports that 83.2% of RNs in Ontario were non-

movers (i.e., they stayed within the same community). The nurse movers were distributed as

follows: 12.6% moved within Ontario, 1.8% moved inter-provincially and 2.4% moved

internationally. In 2006, the CIHI also reported that 91.4% of Canadian graduate nurses

employed in Ontario were graduates from an Ontario nursing program, the second best

percentage nationally after Quebec (94.1%).

RNs and RPNs tend to stay within their

38

EMPLOYMENT PREFERENCES OF REGISTERED NURSE AND REGISTERED PRACTICAL NURSE GRADUATES

This section reports on survey findings from two sub-samples of new graduates (RNs and

RPNs): (i) nurses who were employed but were not in their preferred position regarding

employment status, primary area of practice and geographic region (i.e., LHINs) and (ii) new

graduates who were not employed at the time of questionnaire completion but were seeking

nursing employment and indicated their preference for employment.

PREFERENCES FOR FULL-TIME/PART-TIME WORK STATUS: RNS AND RPNS

Since 2005, preference for FT employment has been increasing for both RNs and RPNs.

Table 8 provides a summary of preference for FT work by nurse group and presents the

available data for four of the five years in which surveys were conducted. The majority of

RNs (85%) and RPNs (65%) in 2008 indicated a preference for FT employment status. These

percentages include both sub-samples of new graduates. From 2005 to 2008, there was a 14%

increase in the number of RNs (from 70.7% to 85%) and a 5% increase in the number of

RPNs (60.2% to 65%) who preferred FT employment.

Table 8. Preferences for Full-Time Employment Status

Nursing Type 2004 2005 2007 2008 Registered Nurses 79.3 70.7 81.3 85

Registered Practical Nurses -- 60.2 63.9 65 Source: RN Nurse Graduand Survey, 2004, 2005; RPN Nurse Graduand Survey, 2005; New Graduate

Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009. According to the New Graduate Evaluation of Nursing Graduate Portal Survey, 78% of RN

and 58% of RPN respondents indicated that their current employment status was by choice.

For nursing graduates who are not in a preferred employment status, the majority of RNs

(89.4%) and RPNs (72.7%) indicated that they preferred permanent FT positions. These rates

are higher than those reported by Ontario RN (75%) and RPN (60.5%) nursing graduates in

2005 (Baumann, Blythe et al., 2006). An additional 5.7% of RNs and 14.3% of RPNs

indicated preference for permanent PT employment in the 2008 portal survey (see Table 9).

Interestingly, this trend in preference for PT work has continued to decrease for RNs (from

The overall preference for full-time continues to increase.

The full-time employment trend continues in an upward direction.

39

10.0% in 2007 to 5.7% in 2008) but increase for RPNs (from 10.3% in 2007 to 14.3% in

2008). See Appendix J for a full breakdown of employment preference.

Table 9. Percent Distribution of Employment Preference by Nurse Group 2008

Nurse Group

Is Employment Status by Choice? Employment Status is not by Choice

Yes

No

Would Prefer Permanent Full-Time

Would Prefer Permanent Part-Time

Registered Nurses

78.0% (432)

22.0% (123)

89.4% (108)

5.7% (7)

Registered Practical Nurses

58.2% (106)

42.8% (76)

72.7% (57)

14.3% (11)

Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009. Respondents who were not currently employed in nursing (4% of RNs and 15% of RPNs) but

who were looking for jobs in their field were asked to identify the type of position they were

looking for. Overall, 50% of new graduates (57% of RNs and 45% of RPNs) indicated that

they were looking for a permanent FT job. In addition, 13% (9% of RNs and 17% of RPNs)

were seeking permanent PT employment, 2% were seeking temporary PT (4% of RNs and

0% of RPNs) and 6% (4% of RNs and 7% of RPNs) were seeking casual employment. The

remaining 29% of new graduates indicated they were seeking multiple employment. This rate

was higher for RPNs than RNs (31% and 26% respectively).

PREFERENCES FOR EMPLOYMENT LOCATION: RNS AND RPNS

The majority of New Graduate Evaluation of Nursing Graduate Portal Survey respondents

indicated that they were employed in a geographic region of choice. This rate was higher for

RNs (96.3%) than RPNs (91.4%) and has increased for both groups since 2007. In previous

years, respondents were asked to select "all that apply" when giving preferences for

employment. This year, respondents were asked to prioritize their preferences for

employment location, sector and area of practice by selecting only their top three choices.

This method was used to obtain a more accurate view of nurse preferences. The preferences

were then weighted according to their priority and given a weighted value. A total of 3.7% of

RNs and 8.6% of RPNs were not employed in their geographic region of choice. The three

most preferred LHINs for RNs were Erie St. Clair, Toronto Central and South West. The

The majority of respondents indicated that they were employed in a geographic region of choice.

The regions of choice for RNs are Central and Southern Ontario.

40

three most preferred LHINs for RPNs were Toronto Central, Central and Central East. See

Appendix K for a full list of LHINs ranked by preferred employment location.

It is difficult to make a valid comparison between 2007 and 2008 because of the difference in

data collection methods used for employment location preferences. However, some trends

may be noted. In 2007, 18.4% of RN respondents preferred to work in the Mississauga

Halton and Central East LHINs, followed by 16.4% in the Toronto Central LHIN and 14.3%

in the Central West LHIN. In contrast, 21.5% of RPN respondents preferred to work in the

Toronto Central LHIN, followed by 13.9% in the Mississauga Halton LHIN and 11.4% in the

Erie St. Clair LHIN.

Respondents who were not currently employed (4% of RNs and 15% of RPNs) in nursing but

who were looking for jobs in their field were asked to identify the top three LHIN locations

where they were seeking employment. Using a similar weighting system as described above,

it was found that RN new graduates were seeking employment in the Toronto Central,

Central and Central East LHINs. They were not looking for employment in the Waterloo

Wellington, South East or North Simcoe Muskoka LHINs (all received a zero rating by RNs).

The top three locations for RPN new graduates were the Toronto Central, Central and

Mississauga Halton LHINs. See Appendix L for full breakdown of the LHIN locations where

new graduates seek employment.

PREFERENCES FOR SECTOR OF EMPLOYMENT AND CLINICAL AREA OF PRACTICE: RNS AND RPNS

Trends in preferences for sector of employment and area of clinical practice help to inform

recruitment strategies. The majority of respondents indicated that they were working in their

preferred area of practice (88% for RNs and 73% for RPNs). For RNs not working in their

clinical area of choice, almost three-quarters (73%) preferred to be working in the following

five areas of practice: maternal-newborn (18%), public health (15%), surgery (15%), critical

care (14%) and emergency (11%). For RPNs, almost two-thirds (60%) preferred to be

working in the following five areas of practice: medicine (14%) maternal-newborn (13%),

surgery (13%), emergency (11%) and mental health/psychiatric/addiction (9%).

The top regions of choice for RPNs were in the Greater Toronto Area.

The majority of nurses work in their preferred area of practice.

41

Respondents who were not currently employed (4% of RNs and 15% of RPNs) in nursing but

who were looking for jobs in their field were asked to identify the type of employer being

sought. Registered nurses rated acute care (weighted value of 216) as the top sector (weighted

value of 216), followed by community (124), public health (85) and long-term care (34).

Acute care (177) was the sector most sought by RPNs, followed by long-term care (104),

community (76) and public health (27).

In terms of clinical area of practice, RNs were seeking employment in emergency (89),

closely followed by medical-surgical (83) and maternal-new born (82). Registered practical

nurses were seeking employment in geriatrics (105), followed by medical-surgical (68) and

complex continuing care (53). These findings are similar to previous years. The primary areas

of practice sought by RNs who graduated in 2005 and 2007 were medical-surgical units in

acute care hospitals and emergency. The primary areas of practice sought by RPNs in 2007

were geriatrics and complex continuing care.

PREFERENCES FOR MOBILITY AND MIGRATION: RNS AND RPNS

In 2008, 5.9% of survey respondents indicated that they did not want or were not seeking

employment in Ontario. Compared to the results from the 2007 RN and RPN surveys, this

percentage is substantially lower. According to the earlier survey, 33% of RNs and 22% of

RPNs were interested in seeking employment outside Ontario. In addition, 0.9% of all 2008

survey respondents reported their current location of employment as outside Ontario but

within Canada. The top three reasons why nurses chose to accept a position in nursing outside

Ontario were better salary and benefits (21.7%), the belief that better career opportunities

existed (17.4%) and personal (17.4%). Payment of relocation expenses (13.2%), better

scheduling practices (13.2%) and education and training (13.2%) would motivate these

nurses to return to Ontario.

PROVINCIAL AND CANADIAN COMPARISON

To further analyze the change in employment status for Ontario nursing graduates, the

following section presents comparisons of two sets of employment data publications (CNO

new members, 2008 and CIHI, 2006) to the 2007 and 2008 new graduate portal data findings.

Five comparisons are drawn with the 2007 and 2008 portal findings:

The percentage of nurses seeking employment outside Ontario is small.

42

(i) CNO general class new members for years 2005-2007

(ii) CIHI Ontario work status numbers for RNs for years 2004-2006

(iii) CIHI Canadian work status average for RNs for years 2004-2006

(iv) CIHI Ontario work status average for RPNs for years 2004-2006

(v) CIHI Canadian work status average for RPNs for years 2004-2006

COMPARISON TO COLLEGE OF NURSES OF ONTARIO GENERAL CLASS NEW MEMBERS

Full-time employment status of 2007 CNO RN new members (76%) compared to the 2008

RN new graduates (83%) shows a similarly high proportion of RNs working on a FT basis in

Ontario. This trend can be seen across the three years of CNO data and the two years of

portal data presented here. As shown in Figure 3, there has been an increase in the proportion

of CNO RN new members working FT since 2005 (from 47% in 2005 to 76% in 2007). For

portal data, the trend across the two years shows a slight drop in the proportion of RNs

working FT (from 85% in 2007 to 83% in 2008), but the rate of FT status remains high. This

is coupled with a drop in the proportion of RNs working on a PT basis over the same time

period. In 2005, 40% of CNO RN general new class members were working PT. By 2007,

however, this rate had dropped to 21%. For new graduates, no change was seen across the

two years (2007 and 2008).

Figure 3. Comparison of Employment Status Between Registered Nurse Graduates 2007-2008

and College of Nurses of Ontario Registered Nurse New General Class Members 2005-2007

46.5%58.9%

75.7%64.7%

56.5%

19.8%*26.1%*40.3%

33.6%

20.6% 10.6% 10.5%13.3% 7.6% 3.8% 3.5% 3.8%

0%

20%

40%

60%

80%

100%

CNO 2005 CNO 2006 CNO 2007 Portal 2007 Portal 2008

Perc

enta

ge o

f new

RN

s

Data Source and YearFull-time * Temp FT Part-time Casual Other

College of Nurses data supports the full-time employment trend.

43

*Temporary full-time includes new graduates in supernumerary Nursing Graduate Guarantee positions.

Source: CNO Membership Statistics Report 2008; New Graduate Evaluation of Nursing Graduate Portal Survey,

2007, 2008-2009.

An increase in FT rates and a decrease in PT rates can also be seen with RPNs. Compared to

2005 and 2006 CNO new members, the FT employment status of 2007 CNO RPN new

members (34%) and the 2008 portal RPN new graduates (56%) shows a greater proportion of

RPNs working on a FT basis (see Figure 4). In 2005, 21% of CNO RPN new members were

working FT compared to 34% in 2007. There has also been a decrease in the proportion of

CNO RPN new members working on a PT basis (59% in 2005 to 49% in 2007). For portal

data, the rate of FT employment has shown a slight drop across the two years (from 61% in

2007 to 56% in 2008). Conversely, PT rates have increased from 18.5% in 2007 to 23.1 in

2008 but remain much lower than the PT rate reported for 2007 CNO RPN new members

(49%).

Figure 4. Comparison of Employment Status Between Registered Practical Nurse Graduates

2007-2008 and College of Nurses of Ontario Registered Practical Nurse New General Class

Members 2005-2007


Source: College of Nurses of Ontario Membership Statistics Report 2008; New Graduate Evaluation of Nursing

Graduate Portal Survey, 2007, 2008-2009.

21.4% 24.1%34.0%

22.6% 18.8%

38.1%* 36.7%*

58.5% 56.8%49.4%

18.5% 23.1%

20.0% 19.1% 16.5%13.8% 10.3%

6.9% 11.1%

0%10%20%30%40%50%60%70%80%90%

100%

CNO 2005 CNO 2006 CNO 2007 Portal 2007 Portal 2008

Perc

enta

ge

Year and Data Source

Full-time * Temp FT Part-time Casual other

44

The comparison of data across nurse groups is promising because it confirms an increase in

the rate of RN and RPN graduates working on a FT basis since 2005. This increase is coupled

with a decrease in casualization for both nursing groups, as shown by the significant drop in

the rates of RN and RPN graduates working on a PT and casual basis (see Table 10).

Table 10. Portal Survey Employment Status 2007-2008 Compared to the College of Nurses of

Ontario New General Class Members 2005-2007

Year

Employment Status* (%) Full-Time Part-Time Casual Temporary Full-

Time RN RPN RN RPN RN RPN RN RPN

College of Nurses of Ontario Data 2005 46.5 21.4 40.3 58.5 13.3 20.0 n/a n/a 2006 58.9 24.1 33.6 56.8 7.6 19.1 n/a n/a

2007 75.7 34.0 20.6 49.4 3.8 16.5 n/a n/a

Portal Data 2007 64.7 22.6 10.6 18.5 3.5 13.8 19.8± 38.1± 2008 56.5 18.8 10.5 23.1 3.8 10.3 26.1 36.7 Note. RN = registered nurse; RPN = registered practical nurse.

*Employment status figures in a particular year reflect those of RNs and RPNs joining the College of Nurses of Ontario.

Thus 2007 figures are for 2006 new members.

±Temporary full-time includes new graduates in supernumerary Nursing Graduate Guarantee positions.

Source: College of Nurses of Ontario Membership Statistics Report 2008; New Graduate Evaluation of Nursing

Graduate Portal Survey, 2007, 2008-2009.

COMPARISON TO CANADIAN INSTITUTE FOR HEALTH INFORMATION WORK STATUS FIGURES FOR ONTARIO 2004-2006

The FT employment rate of 2008 RN new graduates (including temporary FT and

supernumerary) was 83%. The FT employment rate of the 2006 Ontario RN workforce, as

reported by the CIHI, was 62%. Compared to the general RN population in Ontario, a greater

percentage of RN new graduates were employed on a FT basis (see Figure 5). In addition, PT

rates for RN new graduates (10.5%) were significantly lower than the rates for the general

RN workforce in Ontario (30%). Similarly, the casual rate for RN new graduates (4%) was

half of that reported for the Ontario RN workforce (8%).

The casualization of nurses is decreasing.

The CIHI trend data supports the findings of this evaluation study.

45

Figure 5. Comparison of Employment Status Between Registered Nurse Graduates 2007-

2008 and the Canadian Institute for Health Information Registered Nurses in Ontario 2004-

2006


Source: Canadian Institute for Health Information Workforce Trends of Registered Nurses in Canada (2006);

New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.

As shown in Figure 6, the percentage of 2008 RPN new graduates (56%) working FT was

similar to that of the general RPN workforce in Ontario (55%), as reported by the CIHI. A

comparison of casual rates yields an analogous trend across the two data repositories: 10% of

RPN new graduates and 9% of general RPNs were employed on a casual basis. However,

fewer RPN new graduates were working on a PT basis (23%) compared to the general RPN

workforce (36%).

0%

10%

20%

30%

40%

50%

60%

70%

80%

CIHI2004 CIHI2005 CIHI2006 Portal data 2007 Portal data 2008

Perc

enta

ge

Year

Full-time Part-time Casual Temp FT

Fewer RPN new graduates were working on a PT basis compared to the CIHI general RPN workforce.

46


2007-2008 and Canadian Institute for Health Information Registered Practical Nurses in

Ontario 2004-2006


Source: Canadian Institute for Health Information Workforce Trends of Licensed Practical Nurses in Canada

(2006); New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.

COMPARISON TO CANADIAN INSTITUTE FOR HEALTH INFORMATION WORK STATUS FIGURES FOR CANADA 2004-2006

Comparison between the 2008 RN new graduates and the average RN in Canada in 2006, as

reported by CIHI, reveals some interesting findings (see Figure 7). For example, more RN

new graduates than average RNs were employed on a FT basis (83% versus 56%). However,

fewer RN new graduates than average RNs were employed on a PT basis (11% versus 33%)

or a casual basis (4% versus 11%).

0%

10%

20%

30%

40%

50%

60%


Perc

enta

ge o

f RPN

s

Data Source and Year


47

Figure 7. Comparison of Employment Status Between Registered Nurse Graduates 2007-

2008 and Canadian Institute for Health Information Registered Nurses in Canada 2004-2006


Source: Canadian Institute for Health Information Workforce Trends of Registered Nurses in Canada (2006);

New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.

Comparison between the 2008 RPN new graduates and the average RPN in Canada in 2006,

as reported by CIHI, reveals that a greater percentage of RPN new graduates were working

FT (56% versus 47%). However, as shown in Figure 8, fewer RPN new graduates than

average RPNs were working on a PT basis (23% versus 36%) or casual basis (10% versus

17%).

0%

10%

20%

30%

40%

50%

60%

70%


Perc

enta

ge

YearFull-time Part-time Casual Temp FT

48


2007-2008 and Canadian Institute for Health Information Registered Practical Nurses in

Canada 2004-2006


Source: Canadian Institute for Health Information Workforce Trends of Licensed Practical Nurses in Canada

(2006); New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.

These findings indicate that new nursing graduates (RNs and RPNs) are obtaining FT

employment upon graduation. This is encouraging, particularly during times of recession

when employers are reticent to commit to FT employment. The NGG initiative is achieving

success in improving the rate of FT employment for new graduates in Ontario.

EVALUATION OF THE NURSING GRADUATE GUARANTEE

This section reports on the evaluation of the NGG that includes the nursing graduate portal

data from the surveys, focus groups and interviews. Data collected from key stakeholders

(employers, new graduates, nurse mentors and union representatives) are triangulated to

compare and contrast the responses. The integration of data from these sources serves to

validate the findings.

0%

10%

20%

30%

40%

50%


Perc

enta

ge o

f RPN

s

Data Source and Year


New nursing graduates are obtaining FT employment upon graduation.

49

LAUNCHING OF THE NURSING GRADUATE GUARANTEE: HOW INFORMATION WAS RECEIVED

Employers who participated in the focus groups were well informed about the NGG. No

issues were raised pertaining to the receipt of information. However, employers did say that

the NGG should be advertised to students earlier. One acute care employer noted: "[The]

Ministry doesn’t start promoting it to the students until January, and a lot of us are looking to

hire before Christmas."

New graduates received information from various sources and most felt they received the

information in sufficient time. They heard about the NGG from the Nursing Secretariat at

their school, faculty within the schools of nursing, managers and nurses in the hospitals

where they had their fourth-year clinical placement, email updates from the Registered

Nurses' Association of Ontario and media reports. Many new graduates mentioned that they

received an information package about the NGG from their school or the hospital that hired

them. A few new graduates reported that they heard nothing about the NGG in their school,

but that they were told about it by a friend who had participated in the NGG in the previous

year.

The frontline nurses who mentored the new graduates reported that they heard about the

NGG from administrators and managers in their organization at a meeting. They received

information about their role as a mentor and generally understood the timelines of the

program. Mentors also reported that most staff nurses in their organization were aware of the

NGG and were supportive of the initiative. While most mentors seemed to be aware of their

role, they had few details about how the overall program operates with respect to benefits to

the organization. They were unaware of the monetary benefits that occur when a new

graduate is able to transition out of the temporary FT position prior to six months.

IS THE NURSING GRADUATE PORTAL AN EFFICIENT MATCHING TOOL?

Employer Experience Using the Portal

In 2008, employer ratings of their experience using the portal were higher compared to

ratings in 2007. Nearly three-quarters of the employers surveyed in 2008 gave a high rating

for the clarity of instructions for the portal, compared to two-thirds of employers in 2007. The

Employers asked that the NGG be advertised to students earlier.

New graduates were satisfied with the information they received about the NGG.

50

ratings from 2007 to 2008 increased in each of the following categories: portal registration

(from 69.1% to 73.2%), posting (from 63.2% to 75.2%) and matching (from 66.7% to

70.5%). In addition, employers in 2008 rated the portal as more user-friendly, with over 40%

rating it as high or very high on user-friendliness. The area that did not improve over the two

years was the design of the portal, which was rated as fair or poor by 33.3% of employers in

2007 and 37.6% in 2008. See Appendix M for specific employer satisfaction with the

employment portal. As shown in Figure 9, satisfaction ratings in 2008 for the overall

experience in using the portal are similar across the three categories of high, average and low;

however, a greater percentage of employers (75% in 2008 compared to 66% in 2007) rated

their overall experience as either average or high.

Figure 9. Employers’ Rating of Their Overall Experience With the Nursing Graduate Portal

Employers who participated in focus groups this year identified that the portal had improved

compared to the previous year. Responses of employers in focus groups across sectors and

LHINs supported the survey data indicating that the portal is more user-friendly than last

year. They identified some specific features that they like. One employer stated that it "was

definitely an improvement from the previous year . . . a great feature is you are able to

publish and unpublish the postings . . . [and] can hold them in abeyance for future use." The

general theme reflected in the employer focus groups was that they found it to be easy to use,

are very comfortable with using it and that it is easy to post jobs.

Employers also reported a few difficulties related to the portal. They felt it would be helpful

to split the medical-surgical choice in larger organizations and to have the opportunity to post

Overall employer participation in the portal is increasing.

Employers noted a marked improvement in the portal.

51

specific areas of specialization such as step-down rather than the broad category of critical

care. They would like a résumé database where they could search who has applied by area

and interest, instead of having "to sit and wait" for applications. They also noted that "there is

a lag time when dates are posted and profiles are not updated" and wanted to know if there

was "a way to have the updates appear in real time." Recommendations to improve portal

design were also made on the employer survey and are reported in Table 1 of Appendix N.

The Time Factor for Employers

Similar to last year’s survey, just over one-half of employers (58% in 2007 and 52% in 2008)

indicated that it took about the amount of time they anticipated to register and post positions

on the portal. The percentage of employers who indicated that it took more time than

anticipated decreased from 44% in 2007 to 33% in 2008. Interestingly, the percentage of

employers who indicated that it took less time than anticipated was the same in both years

(3%). When employers compared the efficiency of recruiting through the portal compared to

their usual way of recruiting, findings were similar across the two years, with 31% in 2007

and 33% in 2008 reporting that the portal was more efficient. The proportion of employers

who reported there was no notable difference between the portal and recruitment outside of

the portal was also similar across the two years: 37.6% in 2007 and 38.7% in 2008. A notable

difference reported was that the 2008 employers were more positive about the efficiency of

the portal. Compared to 30.9% of employers in 2007, only 17.4% of employers in 2008 found

the portal to be less efficient than usual recruitment methods.

The time factor of using the portal was validated with more detailed information from the

focus groups. As was reported in 2007, employers in 2008 again reported that they need to

educate the new graduate candidates about the site. New graduates applied to employers

directly, who would then direct the candidates to the site. Employers across the sectors and

LHINs reported that new graduates were not well informed about navigating the website and

reported that they "actually give them [the graduates] the step-by-step guide . . . [and] had to

explain a lot . . . [some graduates] just felt someone should be helping them with it."

Employers from all sectors reported that new graduates needed more clarity on how to follow

the steps. They reported that they struggle with the technology and "tend not to contact the

Employers continue to see a need for orienting new graduates to using the portal.

52

Ministry that manages this . . . instead [they] contact the employer who then spends quite a

bit of time with them on the phone." Additionally, graduates do not seem to know that they

have to go online to accept the position. One employer recounted having to call applicants

and "tell them its going to expire tomorrow, please accept it." One employer stated in a focus

group, "I concur with the rest of the group that we see the need for absolutely more training

on the new grad side." This sentiment about new graduates needing more training and that

better marketing is required was a predominant theme. However, some employers reported

that new graduates know how to get registered on the portal but need assistance with the

application steps. These issues were also mentioned by employers in the survey, and

recommendations were made to provide more training for new graduates.

New Graduate Experience Using the Portal

Compared to survey findings from 2007, evaluation of the portal by new graduates was even

more positive than that of employers. For example, in 2007, 74% of new graduates gave the

portal an overall positive rating compared to 83% in 2008. As shown in Figure 10, the

percentages for the overall rating by new graduates in 2008 were good (39%), very good

(30%) and excellent (14%).

Figure 10. New Graduates’ Rating of Their Overall Experience With the Nursing Graduate

Portal

Overall new graduate satisfaction with the portal was high.

53

Survey findings indicated that RNs and RPNs expressed satisfaction with the ease of use

(RNs 78%; RPNs 67%) and utility of support services (RNs 66%; RPNs 75%). They were

also satisfied with the appropriateness of posted jobs to need (RNs 72%; RPNs 64%) and

matching of posted jobs with job requests (RNs 79%; RPNs 74%). Table 11 shows the exact

percentage in each category. These percentages across all categories are slightly higher in

2008 compared to 2007, demonstrating that the portal has improved over the past year. The

greatest change was in the matching of portal jobs and requests, which increased from 67%

(2007) to 79% (2008) for RNs and from 55% (2007) to 74% for RPNs.

Table 11. Registered Nurse and Registered Practical Nurse Evaluation of the Employment

Portal Dimensions

Rating

Nurse Type

Ease of Use (%) Utility of Support

Services * (%)

Appropriateness of Posted Job to Need

(%)

Portal Job Match to

Request (%)

2007 2008 2007 2008 2007 2008 2007 2008

High or Very High

RN 65.1 78.0 56.9 66.0 67.9 71.7 67.3 78.8

RPN 67.3 66.7 63.1 74.5 61.2 63.7 55.2 74.1

Neutral RN 22.5 17.4 26.4 18.5 22.9 19.8 21.6 9.7

RPN 24.6 26.7 22.9 13.2 23.1 21.6 25.2 15.0

Low or Very Low

RN 12.4 4.6 16.7 15.5 9.2 8.5 11.1 11.6

RPN 8.1 6.6 14.0 12.3 15.7 14.7 19.6 10.9 Note. RN = registered nurse; RPN = registered practical nurse.

*30% of RNs and 20% of RPNs indicated that they did not use the portal support services. The % breakdown is

for those that used the services.

Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009.

Data from the new graduate interviews validated the survey findings in regard to user-

friendliness of the portal. Most new graduates reported no difficulty with the technical

aspects of the portal, even though employers reported spending time teaching new graduates

how to use it. Both RNs and RPNs from across the sectors commented that they "found it

very straightforward" and that it was "very easy to use." Difficulties that new graduates

encountered were related to the résumé uploading and accepting the offer. One graduate

noted that "it is tricky to find the accept button" and "I couldn’t get the website to recognize

that the résumé was uploaded." Another indicated that she helped many of her friends who

The matching of portal jobs to new graduate requests has increased.

54

were having problems with the résumé and were "submitting incomplete applications . . .

[and] did not upload [their] résumé prior to submitting." Additional difficulties and

recommendations are listed in Appendix N. For analogous comments from employers and

new graduates, see Appendix N, Table 1.

Using the Nursing Graduate Portal Help Line

Employer survey responses were similar across the two years, with 75% of employers in both

years reporting that the technical assistance provided for the portal was either helpful or

exceeded their expectations. Some (15% in 2007 and 11% in 2008) did not feel that

assistance was necessary, only a few (6.6% in 2007 and 6.4% in 2008) reported that

assistance was not adequate and even fewer (2.0% in 2007 and 2.6% in 2008) reported that

they did not know assistance was available. The only comment employers made about the

help line with respect to posting positions was that when students needed help, they called the

help line for the students and the problem was solved. The major difficulty experienced by

employers using the help line was in relation to the online reporting (see Appendix N, Table

1: Employer Specific Recommendations, Administrative Issues, Improve Online Reporting).

New graduates were aware of the support services, but many (30% of RNs and 20% of

RPNs) who answered the survey did not use them. New graduates generally did not use the

online technical support services. Those who needed help contacted a classmate or someone

in human resources at the site where they were applying. This is consistent with the employer

reports that new graduates ask them for help with the portal when they apply. One new

graduate did express frustration about the confusion in trying to get help: "If you call the help

desk, they tell you it is not their problem [and to] call the Nursing Secretariat. You call the

Nursing Secretariat and they say, 'It's technical, call HFOJobs.'"

THE CHALLENGE OF MATCHING FOR SUPERNUMERARY POSITIONS: WHAT WERE THE BARRIERS?

There are numerous challenges to placing new graduates into FT supernumerary positions.

Some of these challenges are nurse related and others are employer related. Data in the

following section is reported from the perspective of both employers and new graduates.

New graduates used employers rather than the help line.

55

ARE THERE GAPS: HOW MATCHED ARE THE APPLICANTS AND AVAILABLE JOBS?

In the employer focus groups, responses to the question about adequacy of the applicant pool

varied across sectors and LHINs. Employers in acute care were generally satisfied with the

applicant pool and indicated that they get a large response on the portal. Employers in rural

areas reported having a good pool of applicants because of the tuition support program. They

indicated they had a lot of applicants for specialty areas and the usual amount for medical-

surgical, although one rural site said it posted medical-surgical sites and received no

applicants. There was some variability in the hiring of applicants in public health. Some of

the employers in this sector said they hired new graduates, but they would have liked more

applicants. One employer reported, "We interviewed a number of applicants, but before we

made the job offer they had already committed elsewhere . . . we didn’t get as many as we

had hoped for." Alternatively, other public health employers reported having positions that

they could not fill because of budget problems: "Right now there are three [positions] that

we're 'gapping' because of money." Some public health employers hire new graduates

through the NGG, even though they do not have any vacancies: "We just hire them and hope

that when the six months is up that there will be a position for them. So far we have been

very successful . . . [we] have 20 this year."

There are similarities between the community and long-term care. Both sectors are pleased

with the applicants they get, but they want more. One employer from the community sector

said, "As long as we’re competing with the hospital sector that pays a significant difference,

we’re going to be challenged . . . people leave because they can’t afford to stay." Some long-

term care employers reported that,

In urban centres they get a fair number of RN and RPN applicants . . . [which] they

take the time to interview . . . and then find out that they end up going to the hospital

because it's more money.,

One employer added that this was "fairly typical." Both the community sector and long-term

care have RPN applicants but very few RN applicants, especially in rural areas.

Community, public health and long-term care expressed the need for more applicants.

56

NEW GRADUATE BEHAVIOURS AND JOB SEARCHING: THE NEED FOR IMMEDIATE FULL-TIME JOB SECURITY

Employers reported that some of the students do not seem to be confident in the portal

process: "We get résumés through our website, in the mail, as well as on the portal. So it's

hard, you have three résumés from the same person." One employer stated,

[Students] tend to like a live person to talk to. They like to be able to email their

résumé straight to us . . . when we get [their] résumés we tell them to go on the portal,

but some may just go somewhere else and get a full-time job.

Similar to the findings from last year, there were some graduates who preferred to be hired

immediately into jobs that were available. As one employer put it,

They want to start their career . . . they want a permanent position, don’t want the

portal, don’t want to be sitting on the fence wondering if they are going to bridge into

a full-time job . . . they are willing to take anything just to get a foot in the door, even

part-time.

There continues to be an "outside of the portal process" between employers and new

graduates. As was the case last year, some new RNs and RPNs secured a job and were then

directed by the employer to go to the portal to register and apply. The practice occurred

across all sectors, particularly during fourth year clinical placements. The portal is viewed as

very helpful when a clinical placement is not a student's preferred place for employment. One

RN observed that "for those who don’t like their fourth-year placement, the need for the

portal is maximized."

REASONS FOR NOT OFFERING SUPERNUMERARY POSITIONS

Employers surveyed did not offer new graduates temporary FT positions for various reasons,

which were primarily nurse related rather than employer related. The three most often stated

reasons included a mismatch between the skills of an applicant and those needed for the

position (20.2%), a mismatch between the knowledge held by the applicant and that required

for the position (20.2%) and an applicant’s poor performance in the interview (16.7%). The

top employer-related reason for not offering a supernumerary position was a lack of available

positions (14.9%). An interesting trend is revealed when current data is compared to 2007

findings. In 2007, the top reason employers provided for not offering a supernumerary

There were multiple reasons for employers not offering supernumerary positions.

57

position was that the new graduate had rejected the offer/accepted a position elsewhere

(21%). In 2008, the proportion of employers who gave this reason had dropped significantly

to just over 6%. In 2007, a lack of available positions was indicated as a reason by only 6%

of employers; in 2008, this percentage increased to 14.9%. A percentage breakdown for all

the reasons provided by employers across the two years of evaluation is presented in Table

12.

Table 12. Reasons Given by Employers for not Offering a Temporary Full-Time Position

Reason

Percentage of Options Based on Frequency

2007 2008

New grad accepted offer elsewhere/Offer rejected 20.9 6.1

Poor performance in interview 16.5 16.7

Mismatch between nurse's skills and those needed for the position 15.7 20.2

Mismatch between nurse's knowledge and that needed for the position 13.9 20.2

Low/No applications 8.7 11.4

No positions/Resources available 6.1 14.9

Application not professional 6.1 1.8

Poor applicant 3.5 1.8

Other 8.6 7.0

Total 100.0 100.0 Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.

NEW GRADUATE REASONS FOR NOT MATCHING THROUGH THE PORTAL

The three reasons most frequently cited by new graduates for not matching were that a

position had been secured outside the portal (34.2%), there was no response from employers

(20.1%) and available positions were not of interest or fell outside the geographic region of

choice (19.2%). These three reasons accounted for 73.5% of those given by new graduates

for not matching. Percentages for each reason given are listed in Table 13.

There is a substantial increase in the number of new graduates using the NGG.

58

Table 13. Reasons Given by Nursing Graduates for not Matching Into a Temporary Full-

Time Position Through the Portal

Reason

Percentage of Options Based on Frequency

2007 2008

Secured a position outside the portal 42.5 34.2

Posted positions are not of interest/Not in geographic regions of choice 18.1 19.2

Not seeking a nursing position at the present time 12.9 3.7

No response from employers/No positions available 11.3 20.1

Did not pass the nursing exam 2.2 3.2

Other 13.1 19.6

Total 100.0 100.0 Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2007, 2008-2009.

CREATING SUPERNUMERARY POSITIONS FOR NEW GRADUATES: BENEFITS OUTWEIGH THE CHALLENGES

Creating supernumerary positions required intensive planning and collaborative work by all

organizations. There was a need to balance resource issues with patient care needs and the

intent of the initiative throughout its various stages. Regardless of the nature and extent of the

challenges, employers, new graduates and all other stakeholders interviewed were supportive

and strongly positive about the benefits of supernumerary positions.

STAFF SHORTAGES AND RN GRADUATION

Hiring new graduates into temporary FT above complement positions presented varying

challenges across sectors and LHINs. It is common across all organizations to hire extra staff

during the summer months to cover vacations. With RN graduation occurring primarily in the

spring, the extended orientation offered through the NGG coincided with the summer staff

shortages. Fewer mentors were available because the hiring of new graduates into

supernumerary positions fell at the time when organizations needed to grant their FT staff

summer vacations. This issue of orientation coinciding with summer staff vacations was an

issue last year and continues to be a challenge for employers.

Launching the NGG orientation during the summer months continues to be a challenge for employers.

59

Some employers reported that they had to hire new graduates outside of the NGG in order to

have more immediate assistance available to relieve the summer workload. Other employers

mentioned that they would like more flexibility regarding the start time—if the new graduate

would like to start later, employers would like to have that flexibility. As explained by one

employer, "some new graduates would like to do something else immediately after

graduation, but we do not have the flexibility to accept them."

LICENSE AND EXAMS ISSUES: CHALLENGES AND STRATEGIES

Employers use a number of strategies to deal with setbacks and exam failure. One employer

reported that "the delay in license is one of our major headaches . . . new graduates may call

the day before orientation and say they are unable to come because they have not received

their temporary license.". With respect to failure on an exam, this year graduates were

allowed to return to their NGG position if they passed the second time they took the exam.

Compared to last year, this change in policy resulted in less confusion regarding failures.

Some graduates go on a leave of absence if they fail and then return after passing the exam.

In one case there were five failures after the second attempt at writing the exam, but the

organization kept the graduates on and placed them on a leave of absence. In other cases one

RN was moved to a non-direct nursing care role, some graduates were brought back as

interns and some were terminated.

ORIENTATION BENEFITS: MENTORING AND SUPPORT FOR NEW GRADUATES

Employers and new graduates were asked to rate the mentoring/supervision provided during

the temporary FT supernumerary position (see Table 14). Employer and new graduate ratings

were somewhat similar. Ninety-six percent (95.7%) of employers rated the provision of

mentoring as good or above; 82.8% of new graduates rated their experience as good or above.

The notable difference is that no employers rated the experience as poor. In contrast, 4.7% of

new graduates felt they had a poor experience and 12.5% rated their experience as only fair

during the supernumerary phase of the initiative. These two categories (17%) account for 109

new graduates in the NGG who viewed their experience as fair or poor. The number of new

Employers responded positively to the policy change with respect to failure on an exam.

A very small number of new graduates had a fair or poor experience with mentoring and orientation.

60

graduates who did not have a good experience during mentoring is an area that should be

monitored in the future.

Table 14. Employer and New Graduate Ratings of the Mentoring Process

Rating Employer: Provision of Mentoring Provided (%)

New Graduate: Experience With Mentoring (%)

Excellent 18.3 30.5

Very good 51.3 30.1

Good 26.1 22.2

Fair 4.3 12.5

Poor 0.0 4.7 Source: Employer Evaluation of Nursing Graduate Guarantee Survey, 2008-2009; New Graduate Evaluation of

Nursing Graduate Guarantee Survey, 2008-2009.

The opportunity to provide an extended orientation was viewed as a major benefit of this

initiative. One new graduate stated, "It was great for me because I didn’t feel I was ready to

start nursing. I wouldn’t have gone to a teaching acute care hospital to start working on my

own . . . I wouldn’t have had the confidence." Employers expressed similar sentiments about

the benefits of the mentoring program: "You do get very high calibre RPNs and RNS out of

this . . . once they have been mentored they have had a great benefit and are much stronger. I

think we need to recognize that."

Employers, new graduates and union representatives strongly believe in this opportunity.

Although organizations were resourceful in how they supported the new graduates, the

shortage of staff did have an impact on workload issues. In spite of the challenges, however,

most new graduates reported feeling very supported. The majority of comments about the

orientation and mentoring experiences are positive. Most graduates talked of the bridging as

an excellent learning experience that helped them ease into the workplace. However, there

were a few negative experiences. One RPN in acute care reported, "I haven’t had contact with

my mentor for a month . . . if they needed help she was yanked away . . . would go to a

different floor . . . I was on my own". An RPN in long-term care said, "[I am] not very happy

with the amount of overtime . . . [I'm] thinking if I don’t start saying no, I’m going to burn

out." An RN in an acute care setting reported she "kept getting transferred . . . had many

problems with management [and was] very dissatisfied." Another RN in acute care reported

Employer rating for the NGG is very high.

61

feeling "disposable and used by hospital." The negative comments made by new graduates

during the interviews came from both RNs and RPNs and were primarily from long-term care

and acute care.

MENTORING MODEL USED DURING BRIDGING

The type of mentoring model was generally a 1:1, in which one mentor is assigned to one

new graduate. It was common for graduates in this model to rotate out of the main unit to

other areas of choice, in which they were supervised by secondary mentors who reported

back to the primary mentor. When large numbers of graduates were placed in one area, it was

difficult to provide the required support and mentorship. Therefore, large urban centres

staggered their intake of new graduates. One large site reported that they had 5 intakes for

orientation during the summer. In the community and public health sectors, a 1:1 model was

viewed as limiting how many new graduates an organization could hire. One community

employer said, "Supernumerary works really, really well in the hospital sector . . . in [the]

community [sector] the mentor must be with the new graduate at all times."

In the hospital setting the mentor is on the unit but can be working at other tasks from a

distance, implying that the new graduate's transition to independence is gradual. However, in

the community sector, where home visits are made, the mentor is always overseeing the new

graduate. Supervision of the new graduate in this setting is time-consuming and can affect the

productivity of the mentor, a point that was mentioned last year. Even if the new graduate is

taking the lead during home visits, the mentor must still be present.

This year one community employer emphasized that "a mentor is not only a mentor but a

nurse . . . who needs to earn an income." If mentoring causes mentors to reduce their

caseload, there is a chance that their income is being reduced. One community employer

reported that they "would like to give a reduced client load for the first few weeks after

bridging into full-time but still pay a full-time salary." It was suggested that community

employers would like to use some of the surplus money to build in a transition program from

being supernumerary to working independently. The ease of mentoring on a 1:1 basis varies

across sectors and may require the development of individual strategies.

The shortage of staff impacts on workload issues related to orientation and mentoring.

Orientation and mentorship are different in the community sector compared to acute care.

62

CREATING AND SUSTAINING MENTORING RESOURCES: EDUCATIONAL AND ADMINISTRATIVE CHALLENGES

There continues to be some challenges regarding the resources for mentoring. The workload

of mentoring is viewed in various ways. Most employers and frontline staff nurses recognize

that mentoring a new graduate creates an additional workload for the mentor. Organizations

hold mentorship days or other forms of education to support mentors, and most of the

mentors have previously had experience as a preceptor. However, they still feel challenged in

supervising new graduates in the area of their objectives and learning plans. As reported by

one RN in an acute care hospital, "Doing a learning plan is a new skill; senior nurses have

worked for 30 years but have never done this . . . they struggle with that aspect."

Most employers reported having enough mentors. However, they felt they might have a

problem with the availability of qualified mentors because of the high turnover of senior staff

in the next few years. The simultaneous need for preceptors for students and mentors for new

graduates puts a strain on organizations. Although mentors volunteer to participate in the

NGG, some employers are beginning to feel that they "are wearing out their mentors." Most

new graduates were satisfied with the skill level and learning opportunity the mentors

provided for them. Similar to last year, there continues to be some variability in the practice

of paying $.60 per hour premium to mentors.

THE CHALLENGE OF INTEGRATING NEW GRADUATES: THE TENSION OF WORKLOAD AND LEARNING

Employers felt there was generally a positive response to having new graduates in the

organization in supernumerary positions. As was reported last year, new graduates were not

in the base staffing count in most instances, which was as intended (i.e., they were above

complement). However, the overriding issue of staffing shortages continually challenged

organizations to keep the new graduate in an above complement role. Problems arose when a

staff position could not be filled because of a sick call or other shortage. In was difficult in

these circumstances for the new graduate not to be given a heavier assignment and be put into

the position of having to work more independently.

While new graduates were not counted in basic staffing, stakeholders indicated that there

were days when graduates were not able to follow their educational plan because they worked

Mentoring new graduates is an additional workload for the mentor.

There are currently enough mentors and many volunteer to participate.

63

as base staff in an area where their mentor had a separate assignment. In most instances, new

graduates did not report this as a complaint and generally felt they could handle the

assignment. Compared to last year, nursing staff have become more understanding and

accepting of the new graduate supernumerary role. Many are strong advocates of the new

graduates and ensure they do not get put into a position of carrying a full patient load.

Nonetheless, there continues to be inconsistency in how some employers view the new

graduate role. One employer in long-term care suggested that it would be beneficial if the

new graduate could be "moved in and out of being supernumerary during peak staffing

seasons such as summertime." An acute care employer from a smaller hospital said they

outline their expectations in an interview and that there has been no confusion: "The new

graduate carries four patients without difficulty." A few employers felt that new graduates do

not fully understand the role and think "they will have no work assignment—they are above

complement . . . they think they will just shadow."

New graduates generally reported they had good learning experiences during the

supernumerary position. They felt they had enough supervision and that they took on some of

the mentor’s caseload and worked with the mentor. They were given one patient at first and

then the patient load was increased gradually. When the organization was short staffed, the

new graduate was sometimes asked to take on a full load. One graduate reported: "I just felt

they were taking advantage of the situation . . . [and] it wasn’t in the best interests of my

learning."

OFFERING PERMANENT FULL-TIME POSITIONS WITHIN THE REALITY OF THE WORKPLACE

REASONS WHY NEW GRADUATES WERE NOT OFFERED PERMANENT FULL-TIME POSITIONS

Employers surveyed gave various reasons for not bridging a nursing graduate into a

permanent FT position. Lack of available FT positions (38.5%), the nursing graduate’s failure

of her/his registration exam (18.6%) and the nursing graduate’s rejection of the FT position

(13.7%) were the top reasons for not offering permanent FT positions. Similar results were

found in 2007, when a lack of availability of FT positions (30.5%), the nursing graduate’s

There is some variation on how employers view the new graduate role.

The main reason for not bridging a new graduate is the lack of available full-time jobs.

Mentors are supportive of the new graduates in their supernumerary role.

64

rejection of a FT offer (22.8%) and the nursing graduate’s failure of his/her registration exam

(15.2%) were the top reasons given by employers for not bridging a graduate into a

permanent FT position. Table 15 provides a percentage breakdown of the reasons employers

gave for not offering a FT position across the two years of the portal evaluation.

Table 15. Reasons Given by Employers for not Bridging a New Graduate into a Permanent

Full-Time Position

Reason Percentage of Options Based on Frequency

2007 2008 Lack of availability of full-time positions 30.5 38.5 Nursing graduate rejection of the full-time offer 22.8 13.7 Failure of registration exam 15.2 18.6 Seniority/Union agreements 7.6 9.9 Inadequate performance 6.6 6.2 Lack of funding 6.6 9.3 Mismatch between offer and interest of nursing graduate 6.6 8.1

Other 8.6 16.1 Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009.

Note: Numbers do not add to 100% because employers were asked to check all that apply

Similar reasons for not offering FT employment were mentioned by employers in the focus

groups. Employers identified the lack of available FT positions, lack of funding, seniority and

union issues, graduates not being ready for a position because of their clinical level of

performance and graduates choosing to stay in a PT position in an area of preference rather

than accept a non-preferred FT position.

SECTOR VARIABLES: MAXIMIZING THE CREATION OF FULL-TIME POSITIONS

Sector variability occurred in the type of positions that could be offered. The public health

sector differs from other sectors in that current staff are primarily employed FT. The

interpretation of FT, however, is different in public health than in other sectors. Employers in

the public health focus group agreed that the usual way for employees to transition into

public health is by contract. They then have to wait until they get a permanent position, which

There may be full-time jobs available but no budget allocation.

65

may take two to three years. Employers in public health also mentioned that they have to

"gap positions" because of budget. In other cases they hire, even when there is no position,

because they have enough maternity leaves. One employer also mentioned that this is the first

year they had to move people within directorates to secure positions.

Long-term care employers report they do not have FT jobs to offer new graduates. They were

able to put a few RPNs into FT positions and reported having RN vacancies. As stated by one

of the long-term care employers: "There are a fair number of RN FT vacancies in the sector;

it comes down to vacancy, the timing, the seniority and the applicant . . . are we getting the

HFO applicant? We're not." In the community sector there is some variability in how

successful they have been able to offer FT positions. The employer at one site reported that

the position offered can be at any site within their organization (i.e., a position offered by

Saint Elizabeth can be in a different LHIN).

Some community health employers reported no difficulty in offering FT. However, they are

challenged by volumes which are driven by Community Care Access Centres. Thus, when

there is not enough volume for their existing FT employees, they may not be able to

transition their new graduates into FT positions. In other cases, even though new graduates

are offered positions, they leave the community because they can make more money in acute

care. This represents a great loss to the community sector because of the time spent orienting

and mentoring the graduates.

Small rural hospitals were limited in the number of FT positions they could offer because of

existing PT senior staff waiting for FT positions. Use of the float pool has made it possible

for rural hospitals to offer more FT positions, and some were able to offer FT positions to all

the new graduates in their organization.

Larger acute care sites were more likely to transition graduates into regular FT positions after

three months of bridging. These centres created resource pools and were generally more able

to offer FT positions. To make these positions more attractive, some sites developed float

pools that were based on a home unit requiring nurses to float to only two or three units,

which were created as pods of similar areas (e.g., cardiology, cardiac surgery and vascular

Small rural hospitals were limited in the number of full-time positions they could offer.

66

surgery). Employers also reported collapsing vacant PT positions to create FT lines or

developing FT positions across sites.

In the sectors where FT positions were not available, graduate nurses remained in the

bridging position for 7.5 months. In some instances this was reported to be too long a period

to remain in a supernumerary position. Mentors and graduate nurses both reported the new

graduate was ready to transition into a FT position, but the organization had to keep them in

the bridging role because there was no regular FT position. This was particularly true when

the new graduate had been on the same unit during a fourth-year student experience. In

general, new graduates felt ready to transition at the three-month mark, unless they were

rotating among sites during their bridging position or were placed in critical care or specialty

units.

NEW GRADUATE PREFERENCES: A VARIABLE IN TRANSITIONING TO REGULAR FULL-TIME POSITIONS

Once again employers reported the preferences of new graduates as a variable in how

successful they were in transitioning them into regular FT positions. Similar to last year, new

graduates who were mentored on a specialty unit did not want to bridge out to a different

unit. Employers reported that it was not uncommon for them to stay on that unit in a PT or

casual position rather than accept a FT position in a less preferred area. Another reason for

selecting PT is that some new graduates prefer to work in two different organizations. For

example, nurses in long-term care often wish to retain a position in an acute care hospital.

EMPLOYEE SENIORITY AND BARGAINING UNIT CONTRACTS

It is well understood by new graduates that organizations cannot offer them FT positions

when there are existing nurses who have been waiting for a FT position. As the availability of

positions decreases, there are increasing concerns that existing employees get their deserved

preference. As was stated by union leadership:

If there are reductions in positions, we will aggressively pursue the employer not to

continue the new graduates in their positions in the same organization. If someone’s

position is deleted, new graduates will need to be removed from their positions

immediately.

67

While this kind of extraordinary action has not been reported, employers did express concern

about budget cuts and future possibilities: "When we have to cut staffing to balance the

budgets, the first people to go will be the new graduates."

BARGAINING UNIT AND EMPLOYER COLLABORATION: WHERE ARE THE GAPS?

COMMUNICATION OF EMPLOYERS WITH THE BARGAINING UNIT

Union leaders strongly recommended collaboration and the inclusion of nursing leadership,

someone from human resources and the bargaining unit president or an appointed

representative. They feel that there is a better working relationship when the union is

involved from the beginning: "There is better buy-in and a better product." They also

recommended ongoing collaboration at various stages to ensure that the union is aware of

what is happening to the new graduates. Employers and union representatives agreed that

there is variability in how much employers are keeping the union informed.

When asked about communication prior to participation in the NGG, almost two-thirds

(63.7%) of union representatives indicated that employers communicated with the union,

one-third (36.3%) reported that employers did not (see Figure 11). It is interesting to note that

employers were less collaborative at the time of posting positions on the portal. Only 41.2%

said that employers consulted the union prior to posting, 58.8% said employers did not

consult unions prior to posting (see Figure 12).

Figure 11. Percentage of Union Representatives Consulted Prior to Employer Participation

in the Nursing Graduate Guarantee

63.7%

36.3%

Yes No

In order to smooth transitions, the union expressed interest in being involved from the beginning.

68

Figure 12. Percentage of Union Representatives Consulted Prior to Employer Posting on

Nursing Graduate Guarantee Portal

The employer focus groups support the survey findings that there is variability in

communication. Some employers reported that unions want to be informed, but they did not

view the union as part of decision making. Others indicated they have monthly meetings, and

some indicated a report goes to union every two weeks. Although union leadership interviews

identified improvements in employer-union relationships, communication continues to be one

of the biggest problems. One union leader stated: "Employers are not working with

bargaining units as is intended, both in the collective agreement and in the Ministry

guidelines."

NEW GRADUATES IN SPECIALTY POSITIONS: WHAT ARE THE ISSUES FOR THE BARGAINING UNIT

Similar to last year, some tensions arose because new graduates had the opportunity to gain

six-months of experience in some of the specialty areas. Consequently, when a position was

posted, the more senior nurses did not qualify because they had not had the opportunity to

obtain the necessary experience. Furthermore, the new graduate also accumulated seniority

during this period of orientation to the specialty. Union leaders expressed continued concern

about the potential disenfranchisement of union members who cannot gain the requisite

experience to compete for positions in specialty areas. However, while this remains an issue,

there were no grievances related to the NGG.

41.2%

58.8%

Yes No

New graduates never or almost never transitioned into a specialty position that an existing staff member would have wanted.

69

Union representatives (66.3%) indicated that new graduates never or almost never

transitioned into a specialty position that an existing staff member would have wanted but

could not qualify for (see Table 16). Nonetheless, union leaders strongly recommended that

new graduates be placed into medical-surgical positions during their supernumerary

experience. According to union leaders, new graduates should be placed into specialty areas

only with union approval. As reported by one union leader: "In some instances they have

gone to the union and asked to go to a specialty area, and the union has worked with the

employer to do that . . . if it does not disenfranchise a nurse waiting in the system." However,

union leaders reported that employers do not involve the union consistently.

Table 16. Percent Distribution of Union Representatives' Perceptions that New Graduates

Transitioned into a Specialty Area Position Ahead of Existing Staff

Rating Percent (%) of Union Representatives

Never 49.4%

Almost never 16.9%

Sometimes 23.6%

Almost Always 9.0%

Always 1.1%

REINVESTMENT OF FUNDS: WHO IS INVOLVED IN DECISIONS

The union leaders expressed concern that they are not being approached to discuss the use of

funds that are realized when a new graduate bridges out before the six-month timeline. They

further suggest that the involvement of the union is a way to obtain buy-in and it could easily

be put on the agenda of organizational meetings held by professional development

committees in hospitals and employer association committees in other sites.

Employers in focus groups did not identify this as an issue. One employer mentioned that

"the union wants to know where the money goes." To further understand the matter, union

representatives were asked whether the union is consulted about the reinvestment of funds.

As shown in Figure 13, only 20% said that the union is consulted, 80% said it is not. These

findings are consistent with the concerns expressed by the union leaders.

Union involvement from the beginning ensured union buy-in of the initiative.

Respondents indicated an interest in how unused funds were reinvested.

70

Figure 13. Percentage of Union Representatives Consulted Regarding the Reinvestment of

Nursing Graduate Guarantee Funds

DECISIONS ABOUT BRIDGING INTO FULL-TIME POSITION

There is inconsistency in union involvement at the time of transitioning new graduates from

the supernumerary position to FT. Some employers reported that a meeting was held between

nursing leadership, the new graduate and union representatives to determine the readiness of

the new graduate to transition into a regular FT position. New graduates were often ready to

transition out at three months, but they knew they could stay in the mentoring position

beyond the three months if they were not ready. This decision was often made with the

mentor and management. According to employers, tensions that developed were related to the

issue of getting a sign-off by the union before transitioning the graduate out of the bridging

position. This is consistent with the perception of union leadership that there are employers

who do not contact the union until they need the sign-off.

OVERALL IMPACT OF THE NURSING GRADUATE GUARANTEE

STAKEHOLDER RESPONSE

The overall response of all stakeholders to the NGG was very positive. As shown in Table 17,

the vast majority of employers rated the responsiveness of stakeholders in their organizations

to be receptive or very receptive for both clinical staff (97.7%) and administrators (96.6%).

Focus group and interview data supported these ratings. Receptiveness by both clinical and

administrative staff has increased since the 2007 evaluation.

19.8%

80.2%

Yes No

The overall response of all stakeholders to the NGG was very positive.

71

Table 17. Employer Rating of Clinical and Administrative Staff Responses to the Nursing

Graduate Guarantee Initiative

Rating Clinical Staff (%) Administrative Staff (%)

2007 2008 2007 2008

Receptive or very receptive 84.6 97.7 95.9 96.6

Neither receptive nor unreceptive 13.2 1.6 2.7 2.7

Unreceptive or very unreceptive 2.2 0.8 1.4 0.7 Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009.

WORKPLACE IMPROVEMENTS TO PROMOTE RECRUITMENT AND RETENTION

Stakeholders strongly supported the NGG initiative, indicating that the overall impact has

positive effects on the future employment of nurses. Employers in the focus groups thought

the 24/7 availability of the portal was valuable for recruitment activities. They like it because

"everything is there, the history is there, the résumés, the offer letter . . . it’s terrific." An

employer described as "one of the most important recruitment initiatives we take part in."

Employers stated that they get very high calibre RNs and RPNs through the NGG. The

extended orientation, supplementary FT positions and the reinvestment of additional funding

were viewed as definite benefits to the workplace and human resource planning.

Employers and new graduates saw the opportunity to offer extended orientation as a major

benefit to the ease of transition of new graduates into the workplace. One employer said:

I would hope that the NGG has an impact on recruitment into the nursing profession .

. . it builds their confidence, skills, working relationships, and understanding . . . so if

there was some sense of permanence to this initiative, I think that would send a great

message to people who might be considering nursing.

Employers reported that their regular orientations were improved because new graduates and

new nurses often oriented together. One employer noted that orientation has been totally

revamped.

Human resource planning is affected by the innovative strategies used to create FT positions.

Employers indicated that the initiative assists them in their workforce planning because they

know in advance that they can prepare for the employment of new graduates. They have

Employers believe this is an important recruitment initiative.

Employers reinforce that the NGG is a unique human resource strategy.

72

developed strategies to hire new graduates such as float pools and collapsing PT positions.

While new graduates reported that they sometimes prefer to stay in a PT position in an area

of choice, the NGG increased the option of FT positions. Employers reported that the

initiative forced them to build capacity by focusing on how to keep new graduates employed

in their organization, especially in the face of the high numbers of nurses approaching

retirements.

REINVESTMENT OF FUNDS: HOW ARE THEY USED AND WHO BENEFITS?

All sectors viewed the ability to reinvest the funds into educational initiatives as a major

benefit of the NGG. Variability existed across sectors and LHINs in the ability of the

organization to transition out the new graduates before the six-month orientation period

ended. The larger acute care centres realized the greatest benefits because they were able to

bridge the new graduates into FT positions after three to five months of orientation.

Employers reported that educational activities were enhanced province wide through various

ways.

On the survey, employers were asked about the reinvestment of remaining funds. Of those

who answered the question, 38.6% said they were able to use remaining funds for

reinvestment initiatives, 61.4% said they were not. As shown in Table 18, the majority of

employers allocated funds to backfill the 80/20 initiative (70.2%), support interprofessional

mentorship and preceptorship programs (59.6%) and internships for experienced nurses in

specialty areas (34.0%).

Table 18. Percent Distribution of Initiatives Employers Chose to Reinvest Funds

Initiatives Percentage of Employers

80/20 for staff nurses 70.2

Interprofessional mentorship and preceptorship programs 59.6

Internships for experienced nurses in specialty areas 34.0

Support internationally educated nurses and nurses re-entering the workforce 14.9

Other 12.8 Note: Numbers do not add to 100% because employers were asked to check all that apply Employers in the focus groups provided additional information and suggestions regarding the

reinvestment of extra funds. Employers in public health explained that they are usually

A variety of strategies were used for reinvesting the remaining funds.

73

unable to realize any extra funding because the FT positions offered in public health are in

the contract category. The larger acute care centres had the option to bridge new graduates

into large float pools as early as three months. Thus they were able to benefit by being able to

keep the extra funds.

Some employers also offered suggestions about the use of the funding. One employer thought

it would be helpful to use the bridging money to "carry" new graduates who fail the exam.

The nurses would be kept in a personal support worker role until they passed their exam.

Employers mentioned the short time line between when they know they will have the funding

to when it needs to be spent. One employer noted that this is particularly problematic when

someone is starting a position in June (or even later): "We may not realize until December

that we have extra funding but it needs to be spent by March 31 of the following year . . .

because it's a perpetual program and the funding isn’t perpetual. So they don’t match, they

don't align." Employers would like the money to be usable for a full year as opposed to the

current time limits.

ADMINISTRATIVE AND BUDGETARY ISSUES

EMPLOYER COMMUNICATION WITH THE MINISTRY OF HEALTH AND LONG-TERM CARE

The majority of employers were either neutral or satisfied with their experience accessing

funds through the NGG (75.4%) and using the MOHLTC service level agreement (77.6%).

However, compared to 2007, a greater percentage of employers rated accessing funds through

the NGG as difficult or very difficult (24.6% compared to 12.4%) and using the MOHLTC

services agreement as difficult or very difficult (22.5% compared to 4.7%). Table 19 provides

a breakdown of employer ratings of their experiences.

There continue to be issues with the online service agreements.

74

Table 19. Employer Rating of Their Experience Accessing Nursing Graduate Guarantee

Funds and Using the Ministry of Health and Long-Term Care Service Level Agreement

Rating

Accessing Funds Through the Nursing Graduate Guarantee

Initiative (%)

Using the Ministry of Health and Long-Term Care Services Level Agreement

(%)

2007 2008 2007 2008

Easy or very easy 36.1 28.3 43.0 31.2

Neither easy nor difficult 51.5 47.1 52.3 46.4

Difficult or very difficult 12.4 24.6 4.7 22.5

Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009.

Employer responses in the focus groups were varied and not sector specific. Some indicated

that they had no concerns and found it easier when the service agreement was done

electronically. The increased difficulties expressed by employers in the survey were also

reflected in the focus groups. Technical difficulties were a strong theme and were mentioned

across the sectors. The most frequently mentioned difficulty was the E-signature. As reported

by long-term care, "the biggest concern from all the homes was the signing of reports and

having the different log-on names."

Obtaining the sign-offs was a time-consuming process that involved multiple steps.

Furthermore, the timelines were very tight. One acute care employer suggested it would be

easier to enter monthly: "We have 200 graduates . . . it's a huge endeavour given the short

turnaround." The timeline was especially tight because of the deadline coinciding with

Christmas. Employers would like acknowledgement that the submission was received. One

employer stated, "No one got back to me . . . even the ones that were done and signed off in

December . . . we’re still waiting."

Employers also commented on their experience of trying to get help with electronic reporting.

Some employers found the help to be excellent and timely. However, an employer from long

term care said, "I actually put in for help and I never got any." An acute care employer

reported being able to get help earlier in the process, but when the deadline was approaching,

The help line was sometimes not accessible due to volume issues.

75

"it was anxiety-producing to not have someone on the other end when we called." An

employer from a rural area reported: "[It] was well over a week before we had a report back

from help desk . . . I guess they were inundated so much for the submission period." A

community employer said:

When doing the interim report and budget submission, [there is] only one person at

HFO and one at the Ministry to service all of us . . . they are on the phone constantly,

so it is hard to get through. Additional resources are needed at the time of the

deadlines.

The difficulties employers had were in relation to report submission, which they said was a

challenge even with support. Some felt the support they received was excellent: "Helpline for

funding submission was very helpful . . . received very good support." Others found that the

helpline was too busy during report and budget submission time and that "turnaround time for

help with reinvestment funds submission was days." Similar to last year, employers

mentioned that there was some confusion around HFO and the Nursing Secretariat with

respect to who was responding to which issues.

ORGANIZATIONAL BENEFITS AND FINANCIAL RESTRAINTS

Employers reported strong support for the initiative from a financial perspective. Although

some organizations benefited more than others, all sectors said they would participate again.

The larger acute care urban centres particularly benefited because they offered FT positions,

in many cases after three months. In the sectors where FT positions could not be readily

offered, organizations realized fewer benefits. For example, long-term care employers

reported that while they felt it was an excellent initiative, they do not have FT positions to

offer. Thus, in most cases, they paid the last six weeks of the orientation and then found that

nurses left for a FT position in another sector. The organization then felt it had committed a

lot of time, effort and money without the long-term benefits. The community sector has

similar problems offering FT positions and finds it difficult to compete with acute care.

Graduates leaving after the supernumerary position has ended is also a concern for acute care

centres. Organizational investment of time becomes problematic when new graduates do not

stay. One employer in the long-term care sector suggested that the issue of allowing for an

The long-term care and community sectors believed there was still an issue with new nurses being oriented and then leaving.

76

administrative cost should be revisited. The public health sector also indicated that because

their positions are contract, they generally do not realize any extra funding. The option to use

the remaining funds for educational programs was viewed as a major benefit by those who

can offer FT positions.

All stakeholders, employers, new graduates, mentors and union representatives strongly

believe that the orientation and mentoring is a major benefit to all concerned. Unfortunately,

there were some circumstances where new graduates felt used by the organization and

indicated they did not have a good mentoring experience. However, the overwhelming

response by new graduates was that the opportunity to integrate into the workplace gradually,

with the support of mentors and other staff members, was professionally beneficial.

Employers are unanimous in their recognition of the financial and workforce planning

benefits the initiative provides. They are able to factor in the new graduate recruits into their

workforce planning from year to year, knowing the initiative produces high quality

employees ready to take on FT employment.

WOULD THERE BE EMPLOYER SUPPORT FOR THE INITIATIVE AT LEVEL IV CLINICAL?

There were diverse responses to the question of whether there was any support for beginning

the initiative during the fourth-year clinical experience. The following issues were mentioned

by employers participating in the focus groups.

Preference for More Advanced Skills and Temporary License

A common concern was that fourth-year students would not work as well for the initiative as

new graduates because they would be more limited in what they would be able to do. Without

a temporary license, they would not be able to participate in the same capacity as a new

graduate. The issue of independent practice was raised by the public health sector, which

preferred to have new graduates with a "temporary license because then they can do pretty

well everything once they get oriented." Some employers in acute care had mixed feelings

and indicated they are not sure they would be in favour of having the initiative moved to

fourth-year clinical placement rather than upon graduation.

Financial and workforce planning benefits far outweigh any organizational issues.

77

University Semester is too Short

It was mentioned that for those who need only three months, the initiative might work during

fourth-year clinical. However, for those who need four to six months, the timing would

conflict with the student schedule for other courses and other clinical placements. The

varying lengths of time needed by the new graduates to transition into FT work can be

accommodated within the current arrangements. As noted by one employer: "It works well as

a new graduate initiative."

Impact of Variation in Clinical Placement Experiences

The larger acute care hospitals expressed concern that placing the initiative at fourth-year

clinical would limit the number of new graduates they could hire. One employer explained,

"It is very competitive to get a consolidation here, so we can’t bias our new graduate

positions to only those who are successful in getting a placement."

Employers in rural areas had different concerns. They said they may not be able to access the

dollars for such an initiative in fourth-year clinical because they do not have that many

consolidation students—maybe only a couple a year. They did say it might be possible if they

could work it out by having partnerships with universities. Another rural employer had a

different response and indicated that they have been trying to make connections with students

sooner: "We are way up north and they only stay a couple of years. It doesn’t matter whether

it is a student or new graduate; they only stay a few years."

Community employers said that it would be almost like an internship, which they felt can be

successful. They were concerned, however, that they would have some of the same

recruitment issues in fourth-year clinical as they do now because "the wage parity just isn’t

there." Long-term care saw it as a way of getting clinical placements for fourth year, which

they would support. They feel they need students at the third- and fourth-year levels. They

would like to have fourth-year students so that the students could learn more about

leadership. One long-term care employer said, "We have been trying to get a fourth-year

placement in long-term care for quite a while."

The long-term care sector was the only sector that was interested in the initiative being offered in fourth-year clinical placement.

78

Support Mixed With Ambivalence

Even those employers who could support the idea said they were ambivalent, particularly

because they did not want to give up the new graduate initiative. One employer from a

smaller acute care hospital expressed interest because currently "the students don’t get a lot

of placements in the hospital but lots . . . [in the] community." The overall concern is that

they like the NGG and hesitate to give that up for an initiative that has more unknowns for

them. Employers who had the least reservations were from the long-term care sector.

HOW CAN NURSES BE RECRUITED INTO LONG TERM CARE: EMPLOYER PERSPECTIVE FROM ALL SECTORS

Issue of Differences in Remuneration

One of the major concerns mentioned by employers in long-term care and other sectors was

salary differences with lower remuneration. One rural employer stated, "People are not going

to work in a long-term care facility where the wages are 30% less than it would be in a

hospital." Long-term care employers were in agreement about the issue of wage disparity and

felt something needs to be done to equalize both wages and pensions.

A Different Emphasis on Long-Term Care in School

Employers also mentioned that students are exposed to long-term care in their first and

second year and that this exposure is the personal support worker side of long-term care.

Long-term care employers said, "If we could get them exposed in the third and fourth year,

they would see the leadership component of the role of the RN and the community health

work that the RN does within a long-term care setting." Employers agreed that there needs to

be more emphasis on the complexity of the role: "[Students] come out of school thinking they

are going to be functioning with a very limited scope of practice in the long-term care sector."

One of the long-term care rural employers observed:

They can see many patients with a vast array of issues and that is one of the

challenges . . . there is a lot of talent involved . . . [there] has to be greater emphasis in

school on what long-term care offers.

A long-term care employer said: "What we have seen over the last few years with the RNs is

they just don’t know that long-term care is a career choice." Numerous employers also

Sector differences in remuneration continue to be a recruitment issue.

79

mentioned that the reason long-term care is not attractive to graduates is because of the paper

work involved.

CONCLUSION

Over the past 10 years, there has been a dramatic improvement in the employment status for

nurses in Ontario. In 1998, over 60% of nurses were PT or casual. Today, 64% of all nurses

and 76% of new graduates are employed FT.

EMPLOYMENT TRENDS: STATUS, LOCATION, SECTOR AND PREFERENCES

Since 2005, FT employment has increased 24% for new graduate RNs and 29% for new

graduate RPNs. The Toronto Central LHIN employs the largest percentage of new graduates,

and 75% of all new graduates are employed in the acute care sector. Overall, the community

and long-term care sectors hired fewer new graduates in 2008 compared to 2007. The

majority of RNs (88%) and RPNs (73%) surveyed indicated they were working in their

preferred area of clinical practice. The primary areas of practice for RNs were medicine,

surgery, emergency and maternal-newborn. The primary areas of practice for RPNs were

geriatrics, medicine and complex continuing care.

NGG EVALUATION: POSTING AND MATCHING ON THE HEALTHFORCEONTARIO PORTAL

Compared to last year, employers and new graduates found the portal easier to use; however,

employers reported that new graduates required assistance from them to apply on the portal.

The applicant pool was found to be smaller for certain sectors and locations (e.g., long-term

care and rural areas). Some new graduate portal registrants (34%) said they secured a position

outside the portal (compared to 43% last year). The portal was viewed positively in regard to

posting and matching, but employers expressed frustration with the online budget reporting

and found the E-signatures to be labour intensive.

NGG EVALUATION: ONLINE BUDGET REPORTING

Although not all employers had difficulty, a substantial number indicated the online budget

reporting method is an area that they would like to see improved. Obtaining E-signatures was

the most reported problem area. Those who had difficulty also indicated that the help line was

80

not sufficiently available during the week of the report deadline and felt it was likely due to

an overwhelming number of calls to the Ministry.

NGG EVALUATION: ORIENTATION/MENTORSHIP PHASE

Experienced nurses were supportive and willing to provide the mentorship needed for the

new graduates, although some employers expressed concern about mentor and preceptor

burnout. Some of the employers in public health and community reported that one-to-one

supervision can interfere with client load demands. The overall response to this phase of the

NGG was overwhelmingly positive. However, the experience was not positive for a small

percentage of the new graduates in acute care and long-term care.

NGG EVALUATION: OFFERING FULL-TIME PERMANENT POSITIONS

Some long-term care, community and rural organizations had difficulty offering FT positions.

Larger acute care centres could more readily access the additional funds made available when

the new graduate was transitioned into a FT position at three months. Barriers to offering FT

positions included lack of available FT jobs, nurse rejection of offer, failure of licensure

exam, seniority/union agreements and lack of funding. Rejection of FT offers by new

graduates occurred less often this year than last year.

BARGAINING UNITS AND EMPLOYER COLLABORATION

This year, in addition to interviews with two union leaders, a survey was sent to union

representatives. The union leaders recommended that collaboration between employers and

the union begin early and continue throughout the initiative. Communication did occur

between employers and the unions prior to NGG participation, but 80% of the union

representatives surveyed said there was no communication with them about reinvestment of

the extra funds. Union leaders were concerned that new graduates who were mentored in

specialty units could have a clinical advantage over existing staff when FT opportunities

arose. However, 66% of respondents in the union survey indicated that new graduates "never

or almost never" transitioned into specialty area positions ahead of existing staff.

Nonetheless, this continues to be an area that should be monitored in the future.

81

OVERALL IMPACT OF THE INITIATIVE

The overall response to the initiative was very positive. The NGG is viewed as a major

benefit for the recruitment and retention of nurses into the profession. All stakeholders

applauded the integration of new graduates into the workplace through extended orientation

and mentoring. The reinvestment of funds into other nursing priorities within organizations is

also a major benefit, although some sectors benefit more than others. During the current

unprecedented economic recession, the NGG afforded an opportunity for employment and

mentorship to new graduates, thus making it an attractive recruitment strategy in the 2008

hiring cycle. In conclusion, employers, new graduates, mentors and union representatives

provided valuable information about their perspectives on the NGG initiative. All groups are

in support of the NGG and provided excellent suggestions for future initiatives.

LIMITATIONS

Any evaluation of this type is done using a "point in time" approach. The data gathering

spans a six-month period and the numbers can vary depending on the time the data is

collected. For example, both the number of employed graduates and the number of available

positions changed as the months went on. What is important in evaluating the overall

initiative is the FT employment trend. This research demonstrates that the employment trend

is consistently upward, with a dramatic reduction of casual and PT employment categories.

The survey results are dependent on the willingness to participate. The response by

employers and new graduates to the interviews was very positive.

82

RECOMMENDATIONS

These targeted recommendations are intended to increase FT employment of newly graduated

nurses and facilitate their integration into the workforce. They are based on feedback from

the stakeholders and are categorized into four sections

Overall Employment Trends and Issues

• Retain an employment initiative for new graduates for 2010

• Focus on employment strategies for RPNs

• Conduct a needs-based analysis in the long-term care and community sectors to identify

barriers to offering FT employment to new graduates and retain mentored new graduates

• Focus on strategies to enhance FT employment in rural areas

Posting and Matching on the Portal

• Develop more educational strategies to ensure new graduates become self-sufficient on

the website, ensure there are clear instructions on all aspects of the application process

• More consistent advertising and promotion of the NGG in educational institutions

• Revisit job search page to enhance job search engine and posting to give more options

and flexibility, including save functions, posting medical-surgical separately and search

by clinical specialty

Orientation and Mentorship

• Retain an orientation and mentorship component of the NGG for all new graduates

• Enhance advertising and supportive materials to mentors to ensure their understanding of

the NGG guidelines and the intent of the supernumerary status

• Re-evaluate NGG guidelines to create mentoring models more suitable for the public

health and community sectors (adapt 1:1 models of supervision)

Administrative Issues

• Restudy the online budget and reporting process and make adjustments to increase

efficiency and availability of assistance to meet deadline (e-signatures particularly)

• Consider giving more flexibility to organizations in the March 31 deadline for use of

extra funding

• Enlarge evaluation parameters to include employer survey on real time job vacancies.

83

REFERENCES

Alameddine, M., Laporte, A., Baumann, A. O’Brien-Pallas, L., Croxford, R., Mildon, B.,

Wang, S., Milburn, B., & Deber, R. (2006a). Where are nurses working? Employment

patterns by sub-sector in Ontario, Canada. Journal of Healthcare Policy, 3(1), 56-77.

Alameddine, M., LaPorte, A., Baumann, A., O’Brien-Pallas, L., Mildon, B., & Deber, R.

(2006b). Stickiness and inflow as measures of the relative attractiveness of various

sub-sectors of employment. Social, Science and Medicine, (63)9, 2310-2319.

Allen, M., Ceolin, R., Ouellette, S., Plante, J., & Vaillancourt, C. (2006). Health human

resources and education: Outlining information needs. Ottawa, Ontario: Statistics

Canada: Culture, Tourism and Statistics Division.

Batch, M., Barnard, A., & Windsor, C. (2009). Who’s talking? Communication and the

casual/part-time nurse: A literature review. Contemporary Nurse, 33(1), 20-29.

Baumann, A., & Blythe, J. (2003). Restructuring, reconsidering, reconstructing: Implications

for health human resources. International Journal of Public Administration, 26(14),

1561-1579.

Baumann, Blythe, J., Cleverley, K., & Grinspun, G. (2006, May). Health Human Resource

Series Number 2. Employment of nursing graduates: Evaluation of a provincial policy

strategy. Hamilton, Ontario: Nursing Health Services Research Unit, McMaster

University.

Baumann, A., Fisher, A., Blythe, J., & Oreschina, E. (2003). Vacancy rate: A proxy for

staffing shortage. Hamilton, Ontario: Nursing Effectiveness, Utilization and

Outcomes Research Unit, McMaster University.

Baumann, A., Keatings, M., Holmes, G., Oreschina, E., & Fortier, V. (2006, October). Health

Human Resources Series 4. Better data, better decisions: A profile of the nursing

workforce at Hamilton Health Sciences Corporation 2002-2003. Hamilton, Ontario:

Nursing Health Services Research Unit, McMaster University.

Baumann, A., O’Brien-Pallas, L., Armstrong-Stassen, M., Blythe, J., Bourbonnais, R.,

Cameron, S., et al. (2001). Commitment and care: The benefits of a healthy workforce

for nurses, their patients and the system. Toronto, Ontario: The Change Foundation

and The Canadian Health Services Research Foundation.

84

Benach, J., & Muntaner, C. (2007). Precious employment and health: Developing a research

agenda. Journal of Epidemiology and Community Health, 61(4), 276-277.

Blythe, J., Baumann, A., Rheaume, A., & McIntosh, K. (2006, October). Health Human

Resource Series 3. Internationally educated nurses in Ontario: Maximizing the brain

gain. Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University.

Blythe, J., Baumann, A., Zeytinoglu, I., Denton, M., & Higgins, A. (2005). Full-time or part-

time work in nursing: Preferences, tradeoffs and choices. Healthcare Quarterly, 8(3),

69-77.

Blythe, J., Baumann, A., Zeytinoglu, I., Denton, M., Akhtar-Danesh, N., Davies, S., &

Kolotylo, C., (2008). Nursing generations in the contemporary workplace. Public

Personnel Management, 37(2), Summer 2008, 137-159.

Borbely, J. M. (2009). U.S. labor market in 2008: Economy in recession. Monthly Labor

Review, 3-19.

Buerhaus, P.I., Auerbach, D.I., & Staiger, D.O. (2009). The recent surge in nurse

employment: Causes and implications. Health Affairs, 28(4), 657-667.

Burke, R. J., & Cooper, C. L. (2006). Human resources revolution: Why putting people

first matters. Amsterdam, the Netherlands: Emerald Group Publishing Limited.

Canadian Institute for Health Information. (2007). Workforce trends of registered nurses in

Canada (2006). Ottawa, Ontario: Author.

Cherry, M. A. (2006). No longer just company men: The flexible workforce and employment

discrimination. Review essay on “From widgets to digits employment regulation for a

changing workplace” by Katherine V. W. Stone (2004). Berkeley Journal of

Employment & Labor Law, 27(1), 209.

College of Nurses of Ontario. (2007). Membership statistics report 2007. Toronto, Ontario:

Author.

College of Nurses of Ontario. (2008). Membership statistics report 2008. Toronto, Ontario:

Author

Cummings, K, J., & Kreiss, K. (2008). Contingent workers and contingent health: Risks of a

Modern economy. The Journal of the American Medical Association, 299(4), 448-

450.

85

Fisher, A., Baumann, A., & Blythe, J. (2007). The effects of organizational flexibility on

nurse utilization and vanacy statistics in Ontario hospitals. Nursing Leadership, 30 (4),

46-62.

Fraher, E., Carpenter, J., & Broome, S. (2009). Health care employment and the current

economic recession. North Carolina Medical Journal, 70(4), 331-336.

Grinspun, D. (2002). A flexible nursing workforce: Realities and fallouts. Hospital

Quarterly, 6(1), 79-84.

Grinspun, D. (2003). Part-time and casual nursing work: The perils of health-care

restructuring. International Journal of Sociology and Social Policy, 23(8/9), 54-70.

Hayes, L., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., Spence-

Laschinger, H., North, N., & Stone, P. (2006). Nurse turnover: A literature review.

International Journal of Nursing Studies, 43(206), 237-263.

Haygroup. (2001). Review and audit of the 1999/2000 Nursing Enhancement Fund: Final

report submitted to the Implementation Monitoring Sub-Committee of the Joint

Provincial Nursing Committee. Retrieved April 22, 2008 from

http://www.health.gov.on.ca/english/public/pub/ministry_reports/nursing_fund/nursing

_fund.pdf

HealthForceOntario. (2009). Nursing Graduate Guarantee overview: The Nursing Graduate

Portal. Retrieved November 9, 2009, from: http://www.healthforce

ontario.ca/Work/InsideOntario/OntarioNurses/NursingGradGuarantee/Overview.aspx

Heery, E., & Salmon, J. (2000). The insecure workforce. London: Routledge.

Ministry of Finance. (2008, March). 2008 Ontario Budget: Strengthening Ontario’s future by

investing in health care. Retrieved October 27, 2009, from www.fin.gov.on.ca

Ministry of Health and Long-Term Care. (1999, January). Good nursing, good health: An

investment for the 21st century. Retrieved November 9, 2006, from

http://www.health.gov.on.ca/english/public/pub/ministry_reports/nurserep99/nurse_re

p.html

Ministry of Health and Long-Term Care. (2004a). McGuinty government invests in nurses’

health and safety (2004, February 24, News Release). Retrieved April 22, 2008, from

http://ogov.newswire.ca/ontario/GPOE/2004/02/10/c8369.html?

lmatch=&lang=_e.html

86

Ministry of Health and Long-Term Care. (2004b). Hospital allocations announcement St.

Michael's Hospital (2004, July 26, News Media). Retrieved April 17, 2008 from:

http://www.health.gov.on.ca/english/media/speeches/archives/sp_04/sp_072604.html

Ministry of Health and Long-Term Care. (2004c). McGuinty government improving health

services by investing in better quality nursing care (2004, December 8, News

Release). Retrieved December 8, 2006, from http://ogov.newswire.ca/

ontario/GPOE/2004/12/08/c2943.html?lmatch=&lang=_e.html

Ministry of Health and Long-Term Care. (2005). 2005 Data quality report: The state of data

quality in Ontario. Retrieved May 14, 2008, from http://www.health.gov.

on.ca/transformation/providers/information/im_dataquality.html

Ministry of Health and Long-Term Care. (2006a). McGuinty government invests in nurses

(2006, January 26, News Release). Retrieved June 2, 2008, from

http://www.health.gov.on.ca/english/media/news_releases/archives/nr_06/jan/

bg_012606.pdf

Ministry of Health and Long-Term Care. (2006b). McGuinty government introducing

legislation to improve care in long-term care homes (2006, October 3, News

Release). Retrieved April 22, 2008, from http://www.health.gov.on.ca/english/

media/news_releases/archives/nr_06/oct/nr_100306.html

Ministry of Health and Long-Term Care. (2006c). McGuinty government improving health

services by investing in better quality nursing care (2006, December 8, News Release).

Retrieved June 2, 2008, from http://ogov.newswire.ca/ontario/

GPOE/2004/12/08/c2943.html?lmatch=& lang=_e.html

Ministry of Health and Long-Term Care. (2007, February). McGuinty Government Offers

Full-Time Job Opportunity for Every Ontario Nursing Graduate. Retrieved

September 12, 2008, from http://www.health.gov.on.ca/english/media/news_

releases/archives/nr_07/feb/nursing_graduate_nr_13_20070226.html.

Ministry of Health and Long-Term Care. (2008, June ). Guidelines for participation in the

nursing graduate guarantee. Retrieved March 18, 2009, from

http://www.healthforceontario.ca/upload/en/homepage/ngg%20posted%20revised%2

0guidelines%20-%20august%208.pdf

87

Ministry of Training, Colleges and Universities. (2005). Employment profile: A summary of

the employment experience of 2003-2004 college graduates six months after

graduation. Toronto, Ontario: Author.

O’Brien-Pallas, L., Duffield, C., & Alksnis, C. (2004). Who will be there to nurse? Journal of

Nursing Administration, 34(6), 298-302.

Ryten, E. (1997). A statistical picture of the past, present and future o registered nurses in

Canada. Ottawa, Ontario: Canadian Nurses Association.

Ryten, E. (2002). Planning for the future: Nursing human resource projections. a report to

the Canadian Nurses Association. Ottawa, Ontario: Canadian Nurses Association.

Salam, R. (2009). The death of macho. Foreign Policy. Retrieved October 19, 2009, from

http://www.foreignpolicy.com/articles/2009/06/18/the_death_of_macho

Simoens, S., Villeneuve, M., & Hurst, J. (2005). Tackling nurse shortages in OECD

countries (OECD Working Paper No. 19). Paris: Organisation for Economic Co-

operation and Development.

Standing, G. (2008). Economic insecurity and global casualisation: Threat or promise? Social

Indicators Research, 88(1).

Usalcas, J. (2008, March). Hours polarization revisited [Electronic version]. Perspectives on

Labour and Income, 9(3). Retrieved April 22, 2008, from

http://www.statcan.ca/english/freepub/75-001-XIE/75-001-XIE2008103.htm

Zeytinoglu, I. (Ed.). (1999). Changing work relationships in industrialized economies.

Amsterdam: John Benjamins Publishing Company.

88

APPENDIX A. NURSING GRADUATE GUARANTEE APPLICATION PROCESS

HealthForceOntario Nursing Graduate Guarantee Portal

New grad applies to Nursing Graduate Guarantee (NGG) positions of interest via the HealthForceOntario portal

Not invited for interview

Invited for interview with employer

No offer of employment

Offer of employment

Access HealthForceOntario supports (e.g., résumé writing, interview skills)

Seek employment outside of NGG

Graduate does not accept

Graduate accepts = MATCH *

*Ministry of Health and Long-Term Care provides funding for up to six months for each matched position

Bridge to FT Position

No reinvestment opportunity

Did not bridge to FT position

Employer must provide and fund an additional six weeks of FT supernumerary employment

Bridge to FT

Did not bridge. Employer obligation completed

Before six months

At six months

NEW GRADUATE REGISTRATION

EMPLOYER REGISTRATION

Employers may reinvest remaining funds in the following: - Interprofessional mentorship and preceptorship programs - 80/20 for staff nurses - Internships for experienced nurses in specialty areas - Support internationally educated nurses re-entering the workforce

89

APPENDIX B. NURSING GRADUATE GUARANTEE INITIATIVE

Orientation & Mentoring Programs

HealthForceOntario Nursing Graduate

Portal

NHSRU New Graduand 2007

Survey

Temporary Full-Time Positions

(Supernumerary)

Employer Demonstration

Projects

Ontario Nursing Employers

Ontario 2007 New Graduates

MOHLTC New Graduate

Guarantee

Impact and Process Evaluation (i) Surveys • New Graduate Evaluation of Nursing Graduate Portal 2008-2009 • Employer Evaluation of Employment Portal 2008-2009 • Evaluation of the Nursing Graduate Guarantee --Union Representative Survey

2008-2009 (ii) Stakeholder Analysis Focus Groups • 7 Employer Focus Groups with 54 participating employers from acute care (large,

medium, small, and rural), long-term care, public health and community) Interviews • New Graduates of 2008 Key Informant Interview Guide • Senior Nursing Staff Key Informant Interview Guide • Union Representative Key Informant Interview Guide

(iii) Document Analysis

Legend Green - Initiative Teal - Strategies/Projects Orange - Targets Purple - Methods

90

APPENDIX C. DATA COLLECTION AND REFINEMENT OF THE NURSING GRADUATE PORTAL EVALUATION SURVEY

Cleaning Stages Nursing Graduates Total Valid Responses Response Rate

Number of Responses Received

Number Providing

Consent to Participate

Number of Valid Entries

(Complete and Non Duplicate)

Registered Nurses


Total Responses/

Total Registered*

Total Valid/Total Registered*

1048 1035 998 715 283 29.5% 28.1% Note. Total number of Nursing Graduate Guarantee portal registrants was 3,550.


91

APPENDIX D. PERCENT DISTRIBUTION OF NURSING GRADUATES BY NURSE TYPE AND LOCAL HEALTH INTEGRATION NETWORK REGION

Number Local Health Integration Network Region

Registered Nurse

Registered Practical

Nurse

Total

1 Erie St. Clair 4.1% 7.1% 4.7% 2 South West 8.2% 8.4% 8.3% 3 Waterloo, Wellington 4.7% 5% 4.7% 4 Hamilton, Niagara, Haldimand,

Brant 8.8% 11.8% 9.5%

5 Central West 1.6% 2.5% 1.7% 6 Mississauga, Halton 6.5% 9.7% 7.2% 7 Toronto, Central 33.4% 12.6% 28.2% 8 Central 7.1% 7.6% 7.1% 9 Central East 5.2% 7.9% 5.8% 10 South East 0.01% 5.5% 2.1% 11 Champlain 11.1% 11.3% 11.1% 12 North Simcoe Muskoka 2.0% 3.8% 2.4% 13 North East 4.3% 5.5% 4.6% 14 North West 3.0% 1.3% 2.6% Total 100.0% 100.0% 100.0%

Note. The vast majority of graduate registered nurses (96%) and registered practical nurses (91%) indicated that

they were employed in their geographic region of choice.


92

APPENDIX E. DATA COLLECTION AND REFINEMENT OF THE EMPLOYER PORTAL EVALUATION SURVEY

Cleaning Stages Employers Valid Responses

Response Rate

Number of Responses Received

Number Providing

Consent to Participate

Number of Valid Entries (Complete &

Non Duplicate)

Posting Position on Portal

Valid Registered/

Total Registered

Valid Posting/Total

Posting

486 479 435 210 56.5%* 82.6%** Note. Response rate calculations will be based on the number of employers registered at the portal rather than

the ones who received the invitation.

*Valid registered (254)/total registered (449) = 56.5%

**Valid postings (210)/total number of registered employers (254) = 82.6%.


93

APPENDIX F. PERCENT DISTRIBUTION OF EMPLOYER SURVEY RESPONDENTS BY REGISTRATION STATUS AND LOCAL HEALTH INTEGRATION NETWORK

Number Local Health Integration Network Region

Portal Registered

Non-Registered

Total

1 Erie St. Clair 4.33 2.67 3.7% 2 South West 9.06 3.21 6.7% 3 Waterloo, Wellington 4.72 2.67 3.9% 4 Hamilton, Niagara, Haldimand,

Brant 11.42 13.90 12.6%

5 Central West 1.97 4.81 3.2% 6 Mississauga, Halton 3.54 6.42 4.8% 7 Toronto, Central 11.81 13.37 12.6% 8 Central 3.54 4.81 4.1% 9 Central East 8.27 3.74 6.4% 10 South East 2.36 5.35 3.7% 11 Champlain 11.02 8.56 10.1% 12 North Simcoe Muskoka 3.94 3.74 3.9% 13 North East 15.35 16.04 15.9% 14 North West 6.69 8.56 7.6% Other 1.97 2.14 2.1% Total 100.0% 100.0% 100.0%

94

APPENDIX G. PERCENT DISTRIBUTION OF NURSING GRADUATES BY PRIMARY AREA OF PRACTICE AND NURSE GROUP 2007 TO 2008

Primary Area of Practice 2007 2008

RN RPN Total (%) RN RPN Total (%)

Administration 0.0 0.2 0.1 0.2 0.0 0.2

Ambulatory/Outpatient 1.0 0.9 1.0 0.6 2.6 1.1

Case Management 0.4 0.2 0.3 0.5 0.4 0.4

Complex Continuing Care 1.2 12.7 5.5 0.8 11.1 3.4

Critical Care 6.4 0.2 4.1 8.5 0.4 6.4

Education 0.1 0.0 0.1 0.3 0.0 0.2

Emergency 11.1 1.1 7.4 11.1 0.9 8.4

Geriatrics 2.0 30.4 12.5 1.1 27.7 8.0

Maternal/Newborn 9.3 1.1 6.3 8.7 0.9 6.7

Medicine 17.7 11.2 15.3 18.5 18.6 18.6

Mental Health/Psychiatric/Addiction

4.0 7.6 5.3 5.3 3.4 4.9

Occupational Health 0.2 0.0 0.1 0.2 0.0 0.1

Palliative Care 0.8 1.7 1.1 0.5 2.1 0.9

Paediatrics 8.5 1.5 5.9 8.1 1.7 6.4

Perioperative Care 2.2 0.6 1.6 2.3 0.0 1.7

Primary Care 1.8 4.7 2.8 0.8 0.9 0.8

Public Health 3.4 0.6 2.4 3.3 0.0 2.4

Rehabilitation 1.4 5.0 2.8 1.2 5.5 2.3

Surgery 17.3 9.0 14.2 15.3 5.9 13.0

Visiting Nurse 1.9 5.8 3.3 1.4 8.5 3.2

Other 9.5 5.6 8.0 11.3 9.4 10.9

Total 100.0 100.0 100.0 100.0 100.0 100.0 Note. RN = registered nurse; RPN = registered practical nurse.


95

APPENDIX H. NUMBER AND PROPORTION OF NURSE GRADUATES BY NURSE GROUP, EMPLOYMENT STATUS AND SECTOR OF EMPLOYMENT 2007 AND 2008 Table 1. Data From 2008

Nurse Group

Sector of Employment/ Employment

Status

Permanent Full-Time

Temporary Full-Time

Permanent Part-Time

Casual Other Total

RN Hospital Sector 356 133 67 20 17 593 60.0% 22.4% 11.3% 3.4% 2.9% 100%

Community Sector

8 26 1 0 3 38 21.1% 68.4% 2.6% 0.0% 7.9% 100%

Long-Term Care Sector

1 0 1 2 2 6 16.7% 0.0% 16.7% 33.3% 33.3% 100%

"Other" Sector 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%

RPN Hospital Sector 20 52 25 18 19 134 14.9% 38.8% 18.7% 13.4% 14.2% 100%

Community Sector

7 3 3 0 0 13 53.8% 23.1% 23.1% 0.0% 0.0% 100%


10 24 20 4 7 65 15.4% 36.9% 30.8% 6.2% 10.8% 100.0%

"Other" Sector 2 1 4 1 2 10 20.0% 10.0% 40.0% 10.0% 20.0% 100%

Total 39 80 52 23 28 222 17.6% 36.0% 23.4% 10.4% 12.6% 100%


96

Table 2. Data From 2007

Nurse Group

Sector of Employment/ Employment

Status

Permanent Full-Time

Temporary Full-Time

Permanent Part-Time

Casual Other Total

RN Hospital Sector 531 143 90 22 9 795 66.8% 18.0% 11.3% 2.8% 1,1% 100%

Community Sector

32 27 3 6 1 69 46.4% 39.1% 4.3% 8.7% 1.4% 100%


6 1 2 1 1 11 54.5% 9.1% 18.2% 9.1% 9.1% 100%

"Other" Sector 17 10 1 3 1 32 53.1% 31.2% 3.1% 9.4% 3.1% 100%

Total 586 181 96 32 12 907 64.6% 20.0% 10.6% 3.5% 1.3% 100%

RPN Hospital Sector 52 115 47 37 20 271 19.2% 42.4% 17.3% 13.7% 7.4% 100.0%

Community Sector

23 13 12 10 5 63 36.5% 20.6% 19.0% 15.9% 7.9% 100.0%


35 69 36 24 12 176 19.9% 39.2% 20.5% 13.6% 6.8% 100.0%

"Other" Sector 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%


97

APPENDIX I. DISTRIBUTION OF NURSING GRADUATES BY EMPLOYMENT LOCATION AND NURSE GROUP

Employment Location Percentage Within Nurse Group Total Registered Nurse Registered Practical

Nurse Employed in Ontario 99.0 99.6 99.1 Employed in another Canadian province 1.0 0.4 0.9 Employed in the United States 0.0 0.0 0.0 Employed outside Canada 0.0 0.0 0.0 Total 100.0 100.0 100.0 Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009.

98

APPENDIX J. A COMPARISON OF EMPLOYMENT PREFERENCES OF NURSING GRADUATES BY NURSE GROUP 2007-2008

Nurse Group Employment Status is by Choice

Employment Status is not by Choice

2007 2008 Would Prefer Permanent Full-Time

Would Prefer Permanent Part-Time

2007 2008 2007 2008

Registered Nurses

76.5% 78.0% 85.5% 89.4% 10.0% 5.7%


51.9% 58.2% 88.5% 72.7% 10.3% 14.3%


99

APPENDIX K. EMPLOYMENT REGION PREFERENCE OF NURSING GRADUATES BY NURSE GROUP

Registered Nurse Registered Practical Nurse

Employment is in region of choice 96.4% 91.4%

If not, where would you like to work?

Local Health Integration Network Location Ranked By Preference

Weighted Value

Erie St. Clair 132 77 South West 73 56 Waterloo, Wellington 34 45 Hamilton, Niagara, Haldimand, Brant 31 26 Central West 36 22 Mississauga, Halton 70 53 Toronto, Central 73 98 Central 39 81 Central East 17 79 South East 11 19 Champlain 35 30 North Simcoe Muskoka 14 0 North East 22 15 North West 14 0 Source: New Graduate Evaluation of Nursing Graduate Portal Survey, 2008-2009.

100

APPENDIX L. LOCAL HEALTH INTEGRATION LOCATIONS WHERE NEW GRADUATES SEEK EMPLOYMENT BY NURSE GROUP

Registered Nurse Registered Practical Nurse

Percentage seeking employment 5% 14%

Local Health Integration Location Ranked by Preference

Weighted Value

Erie St. Clair 15 22

South West 43 24

Waterloo, Wellington 0 16

Hamilton, Niagara, Haldimand, Brant 15 30

Central West 32 47

Mississauga, Halton 72 87

Toronto, Central 192 126

Central 107 109

Central East 82 42

South East 0 7

Champlain 15 34

North Simcoe Muskoka 0 27

North East 13 18

North West 15 11

101

APPENDIX M. EMPLOYERS’ RATING OF THEIR SATISFACTION WITH THE EMPLOYMENT PORTAL Table 1. Employers’ Rating of Their Satisfaction With Employment Portal Instructions

Rating (%) Clarity of Registration Instructions

Clarity of Posting Instructions

Clarity of Matching Instructions

2007 2008 2007 2008 2007 2008

High or very high 69.1 73.2 63.2 75.2 66.7 70.5

Neutral 11.8 12.1 17.1 11.8 19.0 18.1

Low or very low 19.1 14.8 19.7 13.1 14.3 11.4 Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009. Table 2. Employers’ Rating of Their Satisfaction With Employment Portal Website

Rating (%) Design of Portal’s Website User-Friendliness of Website

2007 2008 2007 2008

High or very high 36.5 23.4 39.6 40.4

Neutral 30.2 39.0 37.7 35.5

Low or very low 33.3 37.6 22.7 24.1 Source: Employer Evaluation of Employment Portal Survey, 2007, 2008-2009.

102

APPENDIX N. NEW NURSING GRADUATE AND EMPLOYER RECOMMENDATIONS FOR THE IMPROVEMENT OF NURSING GRADUATE EMPLOYMENT PORTAL Introduction

The employment portal evaluation surveys were conducted from January 2009 to June 2009.

Both new nursing graduates and employers gave the portal high ratings.

This document is a subsection of the larger report on the evaluation of the Nursing Graduate

Guarantee. It is a summation of data that comes from open-ended survey questions: questions

#23/45 from the New Graduate Portal Evaluation Survey and questions #18, #26 and #41

from the Employer Portal Evaluation Survey.* These qualitative responses provided input on

how to improve the overall design, user-friendliness and utility of the employment portal. It is

recognized that improvements to the portal are ongoing and several of the recommendations

listed in this report may have already been addressed.

Table 1 presents the recommendations for improvement and is divided into three sections:

1. Similar recommendations reported by both new nursing graduates and employers

2. New nursing graduate specific recommendations

3. Employer specific recommendations

_________________________ *Question #23/45 in the New Graduate Portal Evaluation Survey: If you could change one thing in the Nursing

Graduate Portal, what would it be?

Question #18 from the Employer Portal Evaluation Survey: Do you have any suggestions to improve the process

for employer registration and posting of positions?

Question #26 from the Employer Portal Evaluation Survey: Do you have any suggestions to improve the

matching, confirmation and funding agreement process from and employer perspective?

Question #41 from the Employer Evaluation Survey: If you could change one aspect of the nursing graduate

portal, what would it be?

103

Additional support for the recommendations from employer focus groups and new nursing

graduate interview data is indicated by an asterisk (*).

Tables 2 and 3 are frequency counts of responses from question #24 from the New Graduate

Portal Evaluation Survey and questions #19, #25 and #31 from the Employer Portal

Evaluation Survey.

Table 1. New Nursing Graduate and Employer Recommendations for Nursing Graduate

Employment Portal

Similar Recommendations Reported by Both New Nursing Graduates and Employers

New Nursing Graduate Employer

1. Improve portal design (ease of use, layout and user-friendliness; include search boxes, navigation tools, quick links to important documents).

Improve portal design (ease of navigation, layout, set-up, time efficiency and user-friendliness, site is too buy and complicated).

2. Improve job search engine: allow the flexibility to search jobs by nurse group, date of posting, LHIN region, city, area of responsibility and unit; include save function for search strings).

Improve posting process (include unit description with posting number, allow search by ID, better flexibility in job categories, e.g., post medical and surgical vacancies separately; have separate section for small organizations).

3. Enhance the instructions section (how to register, post resume, apply for jobs, etc.).

Enhance the instruction section for employers (e.g., more distinction between NGG and general site for job postings).

4. Increase the number of training sessions to educational institutions and employers about the portal process (have someone visit schools for graduating class).

Increase the number of training sessions to employers and educational institutions about the portal process (e.g., create a module system or have webinars).

5. Regularly update site (especially job postings; create archive of old postings).

Regularly update site (remove new grad if accepted position elsewhere).

6. Allow direct communication between employer and new graduate (want better follow-up and call backs from employers).

Allow for direct communication between employer and new graduate.

104

Table 2: New Nursing Graduate Recommendations for Nursing Graduate Employment Portal

New Nursing Graduate Specific Recommendations

1. Increase number of posted jobs for registered practical nurse.

2. Increase number of posting across all employer types & geographic regions, especially under-serviced and rural areas.

3. Removal of postings by employers for all filled jobs from the portal database (no later than six months).

4. Evaluate the feedback mechanism (number of emails, windows and pop ups) (e.g., reminder emails not sent or sent repeatedly; too many emails/junk mail sent).

5. Refine the application of resume builder (make it easier to upload, don’t like resume wizard format, allow one to personalize; include tips on resume building).

6. Clearly outline new graduate rights and employer responsibilities when accepting a position (ensure new graduate not taken advantage of).

7. Don’t limit number of interviews (allow new graduate to interview with more than one employer or choose another employer if first choice does not work).

8. More clarity on dates on program needed (when to sign up, how long one is eligible to participate).

9. Job postings page needs to be better organized (e.g., create sub-folders for institutions and list positions for each).

10. Provide job security (post positions that will bridge to FT positions).

11. Enlarge evaluation parameters to include employer survey on real time job vacancies.

105

Table 3: Employer Recommendations for Nursing Graduate Employment Portal

Employer Specific Recommendations

1. Include save function for employers to decrease repetition of work (ability to save clinical information and hospital description).

2. Include one password for entire system.

3. Allow employer to search applicant pool.

4. Improve help desk (more timely responses).

5. Limit number of positions new grad can apply to (waiting for students to apply is time consuming if they have accepted job elsewhere).

6. Administrative issues (improve online reporting):

• too many layers to click through to manage budget; too cumbersome to complete reports

• provide better receipt of funds

• electronic signatures time consuming: written signatures preferred

• increase availability of reports (to update more frequently rather than at deadline)

• include letter of documentation outlining funding

• provide more notice for submission of final reports

Documents

Evaluation of a Provincial Policy Strategy Nursing ...fhs.mcmaster.ca/nhsru/documents/Series...2 Employment Integration of Nursing Graduates: Evaluation of a Provincial Strategy, November