Health care provider experiences during the COVID-19 pandemic

In 2020–2021, health care workers’ overtime rates in hospitals were higher than in previous years. More than 18 million overtime hours were recorded in Canada’s hospitals in 2020–2021, up by 15% over the previous year. These overtime hours alone translate to over 9,000 full-time equivalents (FTEs). More than half of the hospital overtime hours in 2020–2021 were for nursing inpatient services, where nursing staff along with a host of other personnel performed 9,771,633 overtime hours (equivalent to 5,011 FTEs).

In response to COVID-19, many surge capacity initiatives were put in place to help control health workforce overtime requirements. In the early days of the pandemic, many non-urgent procedures and surgeries were postponed to accommodate COVID-19–related care in hospitals.Reference 2 Other surge capacity initiatives included calls for retired or non-practising health care workers to temporarily return to practice, reducing or removing isolation requirements for asymptomatic employees and redeploying health care workers to maintain staffing levels in hospitals.Reference 2 During this time, data suggests that hospitals relied more on agency staff to fill gaps than in years prior: in 2020–2021, these workers logged 3.7 million hours, a 5.5% increase from the previous year.

Share of overtime hours by hospital service area, provinces and territories with available data, 2020–2021

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Hospital service area	Share of overtime hours
Nursing inpatient services	53.8%
Ambulatory care services	16.2%
Administrative and support services	14.0%
Diagnostic and therapeutic services	11.8%
Community health services	3.4%
Research, education and other services	0.8%

Notes
Data is available for all provinces and territories except Quebec and Nunavut.
Data reflects hospital activity of medical and operational support staff (MOS) and unit-producing personnel (UPP) as reported to the Canadian MIS Database (CMDB) by ministries and departments of health. Excludes medical personnel.
Data for units within nursing inpatient services reflects activity by all MOS staff and UPP on those units, not just nurses.
Data for units within community health services expenses in this analysis represents only the amounts reported in hospital facilities and any allocation from shared and centralized services. Examples include case management, walk-in clinics, chronic disease screening and surveillance services, and community-based mental health clinics. Community health services are delivered and reported differently in each jurisdiction and may be reported in facilities other than hospitals.
Variables and concepts used to capture information on the CMDB are based on the Standards for Management Information Systems in Canadian Health Service Organizations (MIS Standards: 2019, 2016, 2013, 2011 and 2009; and MIS Guidelines: 2006 and 2004).
For more information about the CMDB and MIS Standards, including definitions, please refer to the CMDB user guide on CIHI’s website (cihi.ca).

Source
Canadian MIS Database, 2020–2021, Canadian Institute for Health Information.

Overtime hours among health care workers have been linked to decreases in physical and mental health and well-being, which can have long-term implications for the health of the health workforce and for health service delivery.Reference 3 A recent Statistics Canada survey on experiences of health care workers during the COVID-19 pandemicReference 4 showed that about 9 in 10 nurses (92.0%) reported feeling more stressed at work than before the pandemic. Increased stress was also reported by other health professionals including physicians (83.7%), personal support workers (PSWs) or health care aides (83.0%), and other health care workers (83.0%).

Among nurses not intending to retire, almost 1 in 4 (24.4%) intended to leave their job or change jobs in the next 3 years.Reference 4 Data on vacancy rates in Canada shows that in the fourth quarter of 2021 (October to December), job vacancies in the health care and social assistance sector reached an all-time high of 126,000, almost double the number of vacancies seen 2 years prior (64,000).Reference 5 Hospitals and nursing and residential care facilities had the largest increases in job vacancies during this period compared with other sub-sectors.

Calling nurses resilient is patching up the problem. If nurses are resilient, they can manage working short, they can return to work after a death in the waiting room, they can stay longer than 12 hours when there is no replacement coming. We don’t want to be resilient. We want safe staffing levels, safe patient care and safe work environments. The environment in the ER has taken away our ability to care for patients and families the way we want to, and the way they deserve to be cared for.— Claire Marshall-Catlin, Emergency department nurse, Vancouver

Personal support workers

PSWs, also referred to as health care aides or personal care providers, play a vital role in the long-term care (LTC) sector, providing support to residents in their daily activities and maintenance of their physical and mental health. PSWs were thus a key part of the COVID-19 response as LTC homes faced challenges in sustaining care for one of Canada’s most vulnerable populations during the early waves of the pandemic.

The recent survey on the experiences of health care workers during the COVID-19 pandemic Reference 6 found that about 2 out of 5 PSWs (41.5%) reported feeling more stressed than before the pandemic. 82.5% indicated that the pandemic caused them to experience difficulties in a range of interpersonal, health and financial areas including balancing caregiving responsibilities, meeting financial obligations and emotional distress. Among those intending to leave or change jobs in the next 3 years, 37.7% reported stress or burnout as the primary reason.

As Canada’s health care systems move toward system recovery over the coming months and years, health system planners are fortifying both recruitment and retention efforts to ensure a safe and healthy health workforce for the future.

• Health Workforce in Canada Quick Stats, 2021 (XLSX)
• Trends in Hospital Spending, 2005–2006 to 2020–2021