More Practising Nurses in Manitoba Active Practicing Nurses,

Manitoba Nursing Labour Market Supply - 2014 The Manitoba Nursing Strategy announced March 1, 2000, includes five targeted goals: increase the supply of nurses improve access to staff development improve use of nurses improve working conditions increase opportunities for nurses input into decision-making To monitor the effectiveness of various initiatives implemented since 2000 and to ensure the adequate supply of nurses, Manitoba Health, Healthy Living and Seniors (MHHLS) continues to collect and monitor information from several areas, including the registration data of the three nursing colleges, nursing education and training, and provincially-funded nursing positions. This report is intended to build on the nursing supply information provided as of December 2013, and describe the current regulated nursing workforce in Manitoba. Continued Growth in Active Practicing Nurses Across Manitoba There were 17,806 active practicing nurses in Manitoba in 2014, according to registration data received from the College of Registered Nurses of Manitoba (CRNM), the College of Registered Psychiatric Nurses of Manitoba (CRPNM) and the College of Licensed Practical Nurses of Manitoba (CLPNM). 18,000 17,500 17,000 More Practising Nurses in Manitoba Active Practicing Nurses, 1992 2014 16,624 17,118 17,265 17,652 17,795 17,806 16,500 16,000 15,500 15,000 14,500 15,665 15,386 15,039 14,966 14,645 14,501 14,187 14,092 14,173 14,250 14,554 14,971 15,296 15,545 15,681 15,881 16,126 14,000 13,500 Source: Annual Reports of the College of Registered Nurses of Manitoba, College of Registered Psychiatric Nurses of Manitoba and the College of Licensed Practical Nurses of Manitoba. 1

From 1992 through to 1999, Manitoba experienced a net loss of 1,573 nurses. Between 1999 and 2014, Manitoba has seen a net gain of 3,714 nurses. Manitoba has far exceeded the target of 700 more nurses between 2007 and 2011. In that period, 1,437 nurses were added to the registries. Total Active Practicing Nurses by Type, 1999-2014 Year RNs RN(EP)s LPNs RPNs All Nurses Net Gain/Loss 1992 11,206 3,269 1,190 15,665 1993 11,125 3,086 1,175 15,386-279 1994 11,026 2,864 1,149 15,039-347 1995 11,096 2,737 1,133 14,966-73 1996 10,963 2,580 1,102 14,645-321 1997 10,936 2,488 1,077 14,501-144 1998 10,813 2,320 1,054 14,187-314 1999 10,792 2,263 1,037 14,092-95 2000 10,820 2,327 1,026 14,173 81 2001 10,827 2,410 1,013 14,250 77 2002 11,072 2,486 996 14,554 304 2003 11,353 2,626 992 14,971 417 2004 11,624 2,688 984 15,296 325 2005 11,800 4 2,765 976 15,545 249 2006 11,811 32 2,860 978 15,681 136 2007 11,980 49 2,889 963 15,881 200 2008 12,160 65 2,930 971 16,126 245 2009 12,627 81 2,953 963 16,624 498 2010 12,996 101 3,041 980 17,118 494 2011 13,205 110 2,967 983 17,265 147 2012 13,297 118 3,261 976 17,652 387 2013 13,488 131 3,209 967 17,795 143 2014 13,510 149 3,164 983 17,806 11 Source: Annual Reports from the College of Registered Nurses of Manitoba, College of Registered Psychiatric Nurses of Manitoba and the College of Licensed Practical Nurses of Manitoba. Overall, Manitoba continues to see a stable supply of nurses choosing to practice in the province. The number of active practicing nurses in the LPN category has varied throughout the 1999-2014 reporting period. As reported by the CLPNM, the 2014 LPN number, which is lower than the previous year, still exceeds the total in all but the last two reporting periods. The 2014 level is accounted for by several influencing factors. The CLPNM reports that the relatively new National Nursing Assessment Service (NNAS), established in August 2014, has not resulted in the number of applications for registration from internationally educated nurses (IENs) that would typically be seen at this point in time previous years. Further, the decline in registration numbers may be compounded in part by the number of IENs accessing Bridging Program seats in Manitoba that year. The CLPNM is also monitoring notable shifts in the age of the registrants, as well as reasons for deregistering, but only if this information is voluntarily shared with the College. In 2014, the College data identified 73% of new registrants were 35 years of age or younger, whereas approximately 30% of de- 2

registrants were 60 years of age or older, illustrating ongoing renewal of the workforce. There continues to be a steady growth in the registered nurse (RN) and nurse practitioner (NP) category. In terms of age breakdown of members, over half of the RNs registered in 2014 were 36-59 years of age, and a relatively small percent (14%) were over 60 years of age (44% of de-registrants were over 60 years of age). The CRNM does not collect information regarding reasons for de-registration. The RPN registry remains the most dynamic with respect to nurses leaving and then returning to active practice. The number of members in the 46-50 age cohort remains stable. While there has been a year-toyear increase in the number of RPNs aged 55+, this is generally being offset by the number of RPNs in the 25 years of age and younger, and 26-35 age cohorts. Although numbers of active practicing RPNs has risen over the past two years, continued targeted efforts are required in order to ensure that these nurses are provided opportunities to practice in sites that optimize their education and training. Often, and to the benefit of those who receive care, RPNs are working as part of intra-professional teams with other regulated nurses. It should be noted that currently, and most notably outside of major centers, RPNs may be hired into positions in which RNs may also be employed in order to enhance health service delivery by addressing vacancies. Nonetheless, to ensure that care is provided by the right provider in the right place, including new, interprofessional team-based care settings outside of typical community, acute and long-term care sites, deliberate and collaborative efforts will be undertaken to ensure that our nursing workforce supply remains sufficient. These efforts will be complemented by continued targeted efforts towards planning for the replacement of those nurses reaching retirement status, and optimizing the utilization of the nursing workforce through effective scheduling and distribution of work hours. Report on 2011 Nursing Workforce Commitment Recognizing both the potential retirement bubble as well as the continued need to expand the nursing workforce to meet patient care needs, the Manitoba government made a commitment in 2011 to hire 2,000 nurses, which would replace the 1,000 expected retirements and add 1,000 more practicing nurses to the province. The Canadian Institute for Health Information (CIHI) data for the report: Regulated Nurses, 2013 shows that nurses aged 60 years or older were 13.9% of the total nursing workforce in Manitoba. This is higher than the 12% reported by CIHI, in its Registered Nurses: Canadian Trends, 2007-2011. De-registrations reported from the nursing colleges for those aged 55 or over are used as a proxy for retirement estimation in Manitoba. Utilizing data provided by the nursing colleges from years 2011 to 2014, 1,731 retiring nurses have been replaced. In addition, 688 net new nurses have been added to the active practice registries for a total of 2,419 nurses added to the practice registry. As a consequence, provided the overall count of nurses continues to grow, retirees are considered replaced by new nurses working in Manitoba. Recruiting and Retaining More Nurses In 1999, the Nurses Recruitment and Retention Fund (NRRF) was established to assist with the recruitment and retention of RNs, RPNs and LPNs in Manitoba, and later nurse practitioners. The grants have helped nurses offset the cost of relocating to work in Manitoba, as well as offering funding to encourage nurses to work in rural and northern regions and other areas of need to enhance the delivery of health care across the province. The Reimbursement for Relocation Costs Grant introduced by Manitoba in 1999 continues to attract many nurses to either return to, or move to Manitoba to practice. Eligible nurses are entitled to up to $8,000 to help offset costs associated with relocating to Manitoba. Since 1999, the NRRF has provided 3

relocation cost assistance to almost 2,000 nurses who have moved to Manitoba from out of province. This includes close to 800 nurses who have relocated to rural and northern Manitoba. Approximately 60% of the nurses have relocated from across Canada, with the remaining nurses relocating from the United States, and beyond. The number of new nurses choosing to embark on their career in a rural location remains steady. The NRRF Conditional Grant Program encourages eligible new nursing graduates to consider their first employment opportunities in a rural or northern location, in exchange for return of service for the $4,000 grant. Experiences in rural and northern Manitoba offer unique and broad learning opportunities, allowing nurses to consolidate knowledge and skills gained from their recent nursing education program. Over 1,000 new nursing graduates have received the Conditional Grant since the grant was established in 2004. The Nurse Practitioner Education Grant established in 2013 covers tuition costs for nurse practitioner (NP) students or recent graduates who, as a condition of receiving a $10,000 grant, agree to fulfill a oneyear return-of-service agreement at no less than 0.6 equivalent full-time (EFT) in a rural community in Manitoba upon graduation. At the close of the December 2014 competition, there were 38 grants disbursed. NPs continue to fill positions in community, acute, and long term care settings across the province, and are an important provider in emerging inter-professional and team-based primary care settings, as established through the Family Doctor for All Initiative. The Nurses Recruitment and Retention Fund (NRRF) will continue to be an important resource in order to assist with the recruitment and retention of all categories of nurses in Manitoba. This fund has and will continue to provide incentives for nurses to work in those areas of greatest health system priority. Work is underway to review the current uptake of all NRRF Grants in order to ensure fair and equitable access, as well as a more targeted approach to meeting health system priorities in terms of geographic population health and vacancy rates. Nursing Optimization Maximizing the use of our professional nursing resources is a key component in promoting and maintaining efficiency and effectiveness of our health services provincially. In order to establish a process for health system improvements, employers and MHHLS are working collaboratively with the Manitoba Nurses Union (MNU) and its members as part of the settlement ratified on April 30, 2014, through a new Memorandum of Understanding (MOU) agreed to, entitled Collaborative Discussions to Optimize Patient Care. Over the term of the current collective agreements, this Committee is to focus efforts towards working collaboratively with the health system in order to achieve the following: Improved scheduling practices to reduce the use of overtime and agency nurses; Creation of a balance of full-time and part-time positions; Improved quality of work-life balance through the implementation of the group self-scheduling guidelines, and improved use of weekend staffing resources through broader implementation of the weekend worker. In order to achieve these and other system efficiencies and measurements of success, data must be reported and analyzed. Raw EFT data exists in the HR scheduling and payroll software residing with each of the RHAs. RHA amalgamation transition continues to be dynamic in terms of data consistency challenges. Work is needed to make the reporting definitions of full time and part time consistent amongst reporting regions. MHHLS will work with RHAs to adjust their full/part time definitions. Provincial baseline measurement metrics will be finalized utilizing December 2014 data received from all of the regions. Once the baseline measurement metrics are established, the impact of shifting nursing EFTs toward a more optimal level will be assessed, concurrent with ongoing implementation of higher EFT positions. 4

Manitoba will continue to build its nursing workforce. MHHLS s commitment is to ensure nurses are available to bring safe and high quality care to citizens of Manitoba. These efforts will not decrease the number of nurses employed or available EFT nursing positions. Rather, the creation of a plan will enable us to maximize the use of nursing resources in the future, identify challenges and barriers that employers are facing in relation to the effective use of their nursing resources, and innovate staffing and scheduling to better meet the needs within the health care system. Educating Nurses in Manitoba Total funded seats in nursing education programs have almost doubled since 1999 due to seat expansions at the University of Manitoba (U of M), Brandon University (BU), Red River College (RRC), Assiniboine Community College (ACC), Universitaire de Saint-Boniface (USB), and University College of the North (UCN). These increases in nursing education seats are reflected across all three nursing professions. The most recent additions occurring in 2012, when BU began offering the only Post-Graduate (Masters) Psychiatric Nursing Education Program in Canada; and in 2013, the establishment of a new Francophone Practical Nursing Program at USB. As health system priorities evolve, opportunity will also be sought to ensure that all nursing professions will have a level of inter-professional, team-based education and training to meet the increasing complexity and challenges facing our health care system. 1400 1200 1000 800 600 400 200 626 709 Nurse Training Seats in Manitoba (1998/99 2014/15) 907 932 932 1,002 1,074 1,081 1,088 1,074 1,114 1,146 1,133 1,143 1,174 1,203 1,233 0 Source: 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 Education and Advanced Learning. More Filled Positions in Manitoba Nursing Workforce The following graph illustrates the number of provincially-funded permanent and term nurse positions filled in Manitoba s health care system. All positions, including full-time and part-time, are reflected in the data. It includes position data submitted by the regional health authorities (RHAs), Selkirk Mental Health Centre (SMHC) and the Manitoba Developmental Centre (MDC), but does not include casual positions in the health system, federally-funded positions (i.e. federal hospital or nursing station ), or the private sector. Work is underway to better identify and report the numbers and location of nurses working outside of traditional positions within RHAs. High level data regarding nurses hired by the Government of Manitoba, and working in such locations as correctional facilities, provincial nursing stations, and family services outside of the MDC, shows that in addition to the total counts presented in this report, there are 358 nurses working in these environments. Efforts to further incorporate the data on the nurses working in these locations, including further details on nursing classifications and EFTs will be undertaken for future reports. Since 2000, a total of 3,229 nurse positions (RNs, RPNs, LPNs and nurse practitioners) have been created across the province. The number of filled nurse positions has increased by 2,432 over the same 5

period, an increase of 27%. Total Filled Nursing Positions (2000-2014) 12,000 11,500 11,000 10,500 10,344 10,741 10,790 10,851 10,903 11,338 11,406 11,270 11,363 11,540 11,564 10,000 9,500 9,132 9,635 9,511 9,904 9,000 8,500 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Source: Notes: Data submitted from regional health authorities, Selkirk Mental Health Centre and Manitoba Developmental Centre. All nursing positions, including full-time and part-time positions, are incorporated. Data submitted by RHAs, Selkirk Mental Health Centre and Manitoba Developmental Health Centre. See notes beneath following table for further data explanation. 6

Manitoba Nursing Workforce: Filled and Vacant Positions, 2000-2014 TOTAL FILLED NURSE POSITIONS (PERMANENT AND TERM) Nursing Positions 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012* 2013* 2014* RN Positions Filled 7,023 7,414 7,366 7,568 7,876 8,187 8,277 8,306 8,398 8,747 8,833 8,733 8,848 8,877 8,815 RN (EP) Positions Filled n/a n/a n/a n/a n/a n/a 32 39 56 57 65 73 82 88 97 RPN Positions Filled 569 589 518 540 587 641 570 519 475 440 371 387 395 392 513 LPN Positions Filled 1,540 1,632 1,627 1,796 1,881 1,913 1,911 1,987 1,974 2,094 2,137 2,077 2,039 2,183 2,139 Total Positions Filled 9,132 9,635 9,511 9,904 10,344 10,741 10,790 10,851 10,903 11,338 11,406 11,270 11,363 11,540 11,564 TOTAL VACANT NURSE POSITIONS (PERMANENT AND TERM) Nursing Positions 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 RN Positions Vacant 853 1,213 1,284 891 639 661 835 995 948 1,073 987 1,005 1,040 1,253 1,327 RN (EP) Positions Vacant n/a n/a n/a n/a n/a n/a 10 7 20 19 15 24 25 25 32 RPN Positions Vacant 44 69 106 91 64 48 70 86 89 86 52 88 54 71 120 LPN Positions Vacant 145 136 197 139 99 105 117 190 215 295 276 343 376 428 360 Total Positions Vacant 1,042 1,418 1,587 1,121 802 814 1,032 1,278 1,272 1,473 1,330 1,460 1,494 1,777 1,839 TOTAL NURSE POSITIONS (PERMANENT AND TERM) Nursing Positions 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012* 2013* 2014* RN Positions Total 7,876 8,627 8,650 8,459 8,515 8,848 9,112 9,301 9,346 9,820 9,820 9,738 9,888 10,130 10,142 RN (EP) Positions Total n/a n/a n/a n/a n/a n/a 42 46 76 76 80 97 106 113 129 RPN Positions Total 613 658 624 631 651 689 640 605 564 526 423 475 449 463 633 LPN Positions Total 1,685 1,768 1,824 1,935 1,980 2,018 2,028 2,177 2,189 2,389 2,413 2,420 2,415 2,611 2,499 Positions Total 10,174 11,053 11,098 11,025 11,146 11,555 11,822 12,129 12,175 12,811 12,736 12,730 12,857 13,317 13,403 Source: Data submitted by regional health authorities, Selkirk Mental Health Centre and Manitoba Developmental Centre. Notes: Provincial total includes all RHAs, Selkirk Mental Health Centre and the Manitoba Developmental Centre. The RN, LPN, RPN and RN (EP) positions in Winnipeg have been adjusted to include the large relief pool of permanent nurses the region maintains to routinely fill vacancies across the system. *The reporting of nursing positions across the province remains a dynamic process which continues to be influenced by the following: Regional amalgamation which reduced the number of regions from eleven to five HR/Payroll systems which are yet to be fully integrated across sites in the regions The development and use of standard definitions for positions Relief/Float pools which are maintained by some regions to routinely fill positions *Certain of the prior year s figures have been reclassified to conform to the current year s presentation Definitions: RN Registered Nurse; RN (EP) Registered Nurse (Extended Practice), also known as nurse practitioners (NP); RPN Registered Psychiatric Nurse; LPN Licensed Practical Nurse

Geographic Distribution of Permanent and Term Nursing Workforce Positions and Vacancies, 2014* Permanent and Term Nursing Positions Permanent and Term Nursing EFTs Winnipeg RN RN(EP)* RPN* LPN* TOTAL RN RN(EP) RPN LPN TOTAL Total Positions 7,357 75 196 1,093 8,721 5,654.7 57.8 147.2 789.6 6,649.3 Total Positions Filled 6,568 57 173 981 7,779 5,109.6 46.0 131.1 722.0 6,008.7 Total Positions Vacant 789 18 23 112 942 545.1 11.8 16.1 67.6 640.6 South RN RN(EP) RPN LPN TOTAL RN RN(EP) RPN LPN TOTAL Total Positions 2,390 44 437 1,280 4,151 1,737.0 39.3 407.9 885.04 3,069.27 Total Positions Filled 1,940 35 340 1,061 3,376 1,432.0 33.6 353.4 755.46 2,574.36 Total Positions Vacant 450 9 97 219 775 305.1 5.8 54.5 129.58 494.91 North RN RN(EP) RPN LPN TOTAL RN RN(EP) RPN LPN TOTAL Total Positions 395 10 0 126 531 359.47 9.0 0.0 105.5 473.97 Total Positions Filled 307 5 0 97 409 279.37 4.5 0.0 82.4 366.27 Total Positions Vacant 88 5 0 29 122 80.1 4.5 0.0 23.1 107.7 Provincial Total RN RN(EP) RPN LPN TOTAL RN RN(EP) RPN LPN TOTAL Total Positions 10,142 129 633 2,499 13,403 7,751.2 106.1 555.1 1,780.1 10,192.5 Total Positions Filled 8,815 97 513 2,139 11,564 6,820.9 84.1 484.5 1,559.9 8,949.3 Total Positions Vacant 1,327 32 120 360 1,839 930.3 22.1 70.6 220.3 1,243.2 Source: Data submitted by RHAs and Selkirk Mental Health Centre effective December 2014. 2013 values employed for Manitoba Developmental Centre. *The reporting of nursing positions across the province remains a dynamic process which continues to be influenced by the following: Regional amalgamation which reduced the number of regions from eleven to five HR/Payroll systems which are yet to be fully integrated across sites in the regions The development and use of standard definitions for positions Relief/Float pools which are maintained by some regions to routinely fill positions **Certain of the prior year s figures have been reclassified to conform to the current year s presentation The 2013 total position counts for RN(EP)s, RPNs, and LPNs in Winnipeg have been adjusted as follows for consistency with the current reporting methodology: RN (EP) 76; RPN 205 and LPN - 1158 Definitions: South includes Prairie Mountain Health, Southern Health-Santé Sud, Interlake-Eastern Regional Health Authority, SMHC and MDC. North includes Northern Health and former Churchill region. Provincial total includes all RHAs, Selkirk Mental Health Centre and the Manitoba Developmental Centre. RN Registered Nurse; RN (EP) Registered Nurse (Extended Practice), also known as nurse practitioners (NP); RPN Registered Psychiatric Nurse; LPN Licensed Practical Nurse; EFT Equivalent Full-time positions