Tracking workplace measures

Having a clear picture of the number of vacant positions in health care can be used to track labour market demand and point to gaps in health workforce capacity. This information is a critical measure to support informed workforce planning. CIHI collaborated with Statistics Canada to develop a set of pan-Canadian health care job vacancy metrics for different health professionals.Reference1

In 2022–2023, there were an average of 120,140 health care job vacanciesFootnotei across the 4 quarters of the fiscal year. This reflects a doubling of vacancies from 2019–2020 (prior to the onset of the COVID-19 pandemic) and a quadrupling since 2015–2016. Job vacancies were highest for personal support workersFootnoteii (30,800 vacant positions; 25.7% of all health care vacancies), followed by registered nurses and registered psychiatric nurses (28,000; 23.3%) and selected mental health workersFootnoteiii (21,360; 17.8%). Collectively, these professionals accounted for two-thirds of all health care job vacancies in 2022–2023. 

All provinces experienced growth in health workforce–related job vacancies in 2022–2023 compared with the previous year, but there was variation in the size of that growth.

Monitoring vacancy metrics can further our understanding of the dynamics around supply of and demand for health professionals. These measures can inform initiatives to improve education and training programs, as well as recruitment and retention strategies. To explore vacancy metrics for different health professionals in more detail, explore the Health Workforce Quick Stats (see Related resources below).

Overtime metrics can give a sense of staff workload. These trends indicate that Canada’s health systems are over capacity trying to address population health needs, which can result in a cycle of burnout and increased stress for health care workers. 

Health spending records show that, overall, hospital staff (excluding physicians) performed more than 26 million hours of overtime in 2021–2022.Reference2 The number of overtime hours worked by nurses and other hospital health workers (excluding physicians and management staff) on inpatient units reached 14.2 million, as highlighted in Hospital staffing and hospital harm trends throughout the pandemic. This represents a 53% increase from the previous year and is equivalent to over 7,000 full-time positions. 

Overtime was most prevalent on mental health and substance use units — out of a total 23.2 million hours worked on those units in 2021–2022, there were 1.9 million overtime hours (8%). The pandemic led to worsened mental health and psychological distress for many Canadians,Reference3 which may have been a contributing factor to pressures felt in these units. 

Intensive care units (ICUs) ranked second in terms of overtime rate — out of a total 30.7 million hours, there were 2.2 million overtime hours (7.3%) worked in 2021–2022. The increased need for overtime on ICUs was likely driven by the COVID-19 pandemic. Patients admitted to ICUs require specialized care that can be more resource-intensive in terms of the need for highly trained providers, the use of specialized technology and continuous close monitoring of patients.Reference4 This type of care can be more difficult to backfill (either internally through upskilling or through use of private agency staff), which can place higher demands on existing staff.Reference4

Health care worker sick time and the number of workplace mental health and violence reportsReference5 are also on the rise. In the first year of the pandemic, lost-time claims (including claims due to illness, injury and workplace violence) submitted to insurance for those working in the health care and social assistance sector increased by almost 25,000 (a 50% increase compared with 2019).Reference5 For professional occupations in nursing, lost-time claims nearly doubled from 2019 to 2020, reaching over 11,000.Reference5

In hospitals, 2021–2022 saw an uptick in rates of sick leave taken by staff (excluding physicians) following a 5-year period of stability. More than 14 million sick time hours were logged on nursing inpatient units in 2021–2022, a 17% increase over the previous year. This is a substantial change compared with the annual average growth of about 3% between 2017–2018 and 2020–2021.Reference6 Sick leave hours reported on ICUs and obstetric units made up a larger percentage of total worked hoursFootnoteiv compared with those reported on other inpatient units in 2021–2022 (6.5% for both, compared with an average of 6% across other inpatient units).Reference2

To fill the resulting staffing gaps during the pandemic, hospitals increasingly relied on the use of agency health workers. Before the pandemic (between 2017–2018 and 2019–2020), the annual average growth of agency staff hours worked in hospitals was about 8%; this increased to 32% between 2020–2021 and 2021–2022, reaching a total of 4.8 million hours.

Staffing challenges combined with the negative mental health impacts on staff stemming from increased amounts of overtime can lead to a cycle of burnout and understaffing. These issues can have a domino effect on patient care, including creating the potential for unintended harm to occur. Across Canada, the rate of hospital harm increased to 5.9% in 2020–2021 and 6% in 2021–2022 and 2022–2023 after remaining stable between 5.3% and 5.4% since 2014.Reference7

These trends warrant careful monitoring as the demands on the health workforce grow. More detailed data on provider experiences, including by profession and area of practice, is needed to support the development of targeted retention strategiesReference8 to address specific areas of strain across the system, promote overall wellness of the health workforce and improve quality of care. 
 

• Health Workforce in Canada, 2022 — Quick Stats
• Hospital staffing and hospital harm trends throughout the pandemic
• Nursing retention toolkit: Improving the working lives of nurses in Canada