Dear Premier Ford,
We share your concerns about the importance of vaccination for hospital workers and the impact that mandatory vaccination may have on the already critical staffing shortage in hospitals.
Ontario has had the fewest staff to hospital patients of any jurisdiction in the OECD for many years. Workloads that result from this chronic understaffing, together with over 10 years of real wage cuts, lack of full-time employment and unsafe conditions create a working environment where more and more hospital staff are simply walking away. These resignations and early retirements threaten the viability of our hospitals much more than the job losses reported resulting from vaccine mandates.
In recent polling done by CUPE, 87% of hospital Registered Practical Nurses (RPN) indicated they have considered leaving their nursing job after the pandemic because of the conditions cited above. Since COVID-19 began the number of vacancies for RPNs has increased 116%. Since 2015, RPN vacancies have increased sixfold and vacancies for RNs, aides, orderlies, patient service associates, and support workers have increased threefold over the same period.
When we look closely at the factors underlying this dynamic, the Ontario government and hospitals share responsibility for this critical and growing labour shortage:
- 10 years of wage suppression in the broader public sector, where government-imposed wage increases on hospital staff (who are predominantly female) were well below private sector and municipal settlements and the rate of inflation have cut real wages significantly. Bill 124 which limits hospital settlements to three percent below the current rate of inflation in 2021, just continues this trend. At the same time private agencies can and will pay 1.5 times the going salary rate for nurses to work in the very same hospitals where real wage cuts are happening.
- Government and the hospitals denied that COVID-19 was an airborne virus and worked to limit access to needed protections against airborne transmission by refusing access in many cases to N95 respirators. Our members who work in hospitals suffered the most workplace related COVID-19 illnesses and deaths, after long-term care. We continue to meet ongoing resistance to providing this equipment to staff even now, on hospital units with COVID-19 outbreaks. Yet, an N95 mask costs only $1.79, which leaves staff with a good sense of just how valued they really are.
- The overwhelmingly female hospital workforce faces a torrent of physical, sexual, and racially directed violence every single day. This creates a climate in which staff are vulnerable and unprotected and the working environment toxic. But the hospitals refuse to address this problem in a systematic way. And they are under no pressure from the Ontario government to address it either, despite widespread evidence of the scope of this problem and its devastating personal consequences.
- Full-time employment is the goal of most part-time hospital employees, but it is almost impossible to achieve, forcing people to work at multiple facilities to cobble together a living income, or to leave for better employment prospects offering stable working hours. Part-time employees have no benefits, including life insurance or sick leave, particularly problematic during a pandemic. 10% of CUPE front-line hospital members reported that they had been exposed to or contracted COVID-19 at work and 30% of those reported they had not been paid for their time off awaiting test results or off sick due to the virus.
- Hours of work are erratic. Overtime is rampant. Weekend work is frequent. Shift work is common. Vacations and days off are impossible to get approved. This dynamic for a female dominated workforce, many of whom have childcare responsibilities, is untenable in the long term.
These factors make hospitals unwelcome places to work and are the key factors driving the worsening staffing shortage in Ontario hospitals.
To address the questions which you asked us:
- How could making vaccinations mandatory benefit hospitals?
Vaccination clearly provides enhanced protection for patients, many of whom have compromised immune systems and might not survive COVID-19 if they were to contract it. It also clearly protects hospital staff, who are at higher risk of contracting the virus because of their risk of exposure and the fact that they are often inadequately protected.
- Should the government make COVID-19 vaccinations mandatory in hospitals or leave staffing decisions up to individual hospitals?
The Chief Medical Officer of Health ordered hospitals to develop vaccine mandates in mid-August. These mandates, and their consequences, are rolling out now. If the government had wanted to intervene, its opportunity was earlier in the process.
- Currently, there are two active outbreaks in hospitals. This low prevalence is due to strong IPAC measures and robust hospital safety policies. How would you assess the risk posed by potential future outbreaks compared to the risk of widespread HHR implications that may result from a vaccine mandate?
860 patients (according to the Star) have died in hospital Covid outbreaks. This is likely a low estimate. Vaccination of staff would certainly have reduced the numbers of those patient deaths, many of which were preventable.
- Do you believe mandatory vaccines would result in a diminishment of frontline staff in other parts of our health care system? If so, where?
Staff who resist vaccination will likely move to areas of the health care system where there are no vaccine mandates.
- Do you believe this policy could result in negative impacts in areas that face significant challenges recruiting and retaining health care workers, particularly in northern and remote parts of the province?
The problems of recruiting and retention in northern, remote and rural Ontario, as is the case throughout the hospital system, are much more serious than the losses experienced through vaccine mandates. We address these issues at length in this letter.
- Are there other parts of the system where unvaccinated workers can be reassigned, including administrative or other non-patient facing roles?
The opportunities for reassignment away from patient care may be limited in some locations.
- In your opinion, is there anything else the government can or should be doing to increase vaccination uptake among health care workers?
Every health care worker who is unsure about vaccination should have an opportunity to meet in person with a clinician to talk about her concerns and to have her questions answered.
Hospital staff who decline vaccination should not be treated in a way which permanently reduces the workforce, which would only worsen the staff shortage crisis going forward. Discipline is not appropriate in this circumstance. Testing and reassignment are viable options in some cases. However, when the individual right to decline vaccination conflicts with the right of patients to a safe environment for care and to her co-workers’ rights to a safe working environment, the collective rights must prevail.
We urge you to meet with us. There are many very helpful things that government can do:
- Increase staffing levels to reduce workloads and work to create a working environment where time off is possible and where work is safer.
- Allow wages to increase in real terms and strongly encourage the creation of full-time employment with benefits and pensions, as Quebec has done.
- Immediately and aggressively require the provision of proper protection against airborne transmission of COVID-19.
- Take decisive steps to reduce violence in the hospital sector by investing significantly in safety measures. Encourage amendments to the Canadian Criminal Code to enhance protections for health care workers. Encourage the prosecution of offenders.
- Stop hospitals from using private agencies, which actually compete with them for employees.
We look forward to the dialogue.
President, Ontario Council of Hospital Unions-CUPE