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Peer Group Report Peer Group 4 | June 2017

Critical Care Workforce Profile — Peer Group 4 Report

2 Critical Care Services Ontario • June 2017

ACKNOWLEDGMENTSThe 2017 Critical Care Workforce Profile (CCWP) reflects data generated between April 1, 2015 to March 31, 2016. Critical Care Services Ontario would like to thank all Critical Care Stakeholders who have been instrumental in contributing data to complete the 2015/16 Critical Care Workforce Profile Survey. These contributions are vital to informing CCSO’s health human resource planning, efforts and work in identifying emerging challenges and considerations for the critical care workforce.


Critical Care Services Ontario • June 2017 3

TABLE OF CONTENTS

PEER GROUP REPORT OVERVIEW 4

PEER GROUP 4 HIGHLIGHTS 5

UNIT LEVEL RESULTS 7

Nurse Roles and Demographics 7Table 1: Length of Nurse Experience in the Critical Care Unit 7

Table 2: Age Group Distribution of Critical Care Nurse 8

Nurse Staffing Practices 9Table 3: Employment Status Distribution of Critical Care Nurses 9

Table 4: Employment Status Distribution of Critical Care Nurse Earned Hours 10

Table 5: Distribution of Critical Care Nurse Earned Hours by Type 11

Table 6: Overtime Hours as a Proportion of Productive Hours for Critical Care Nurses 12

Table 7: Sick Rate for Critical Care Nurses 13

Table 8: Education Hours as a Proportion of Total Earned Hours for Critical Care Nurses 13

Table 9: Approaches to Manage Short-Term Nursing Shortages 14

Table 10: Critical Care Nurse Worked Hours (including Overtime) per Patient Day 15

Nurse Training 16Table 11: Critical Care Training Attainment Distribution of Critical Care Nurses 16

Table 12: Advance Cardiac Life Support Training Attainment Distribution of CC Nurses 17

Table 13: Approaches to Professional Development Investment in Critical Care Units 18

Nurse Turnover 19Table 14: Critical Care Nurse Turnover, Overall 19

Table 15: Destination of Critical Care Nurses Leaving the Unit or Changing Employment Status 20

Nursing Recruitment 21Table 16: Vacancy Rate for Critical Care Units 21

Allied Health Professionals in Critical Care 22Table 17: Routine Use of Allied Health Professionals in Critical Care Units 22

Table 18: Pharmacist Support Hours per Day in Critical Care Units 23

Table 19: Pharmacist Provision of On-Call Support in Critical Care Units 23

Table 20: Physiotherapist Support Hours per Day in Critical Care Units 24

Table 21: Physiotherapist Provision of On-Call Support in Critical Care Units 24

Table 22: Respiratory Therapist Support Hours per Day in Critical Care Units 25

Table 23: Respiratory Therapist Provision of On-Call Support in Critical Care Units 25

PEER GROUP REPORT APPENDICES 26

Appendix A. Glossary of Terms 26

Appendix B. Calculations Table 27

Appendix C. Online Data Collection Tool 29



PEER GROUP REPORT OVERVIEWThe objective of this peer group report is to offer critical care units a perspective on their current nursing and allied health workforce in comparison with other ‘like’ units from their peer group. Peer level groupings were first launched by CCSO in July 2013 to facilitate comparison of a unit’s performance with ‘like’ units. Assignment to a specific Peer Group took into account factors such as unit designation (Level 2 or Level 3), academic affiliation, and severity of illness of patients managed in the units.

The peer group summary report provides two components of information specific to the peer group.

1. Peer Group Highlights: This section highlights findings that are unique to the peer group when comparing to the overall provincial results. This review considers the following elements of the main provincial report:

• Nurse Demographics covers experience in critical care, age and gender.

• Nurse Staffing Practices covers employment status, overtime, sick time and managing short term nursing shortages as well as nurse productivity.

• Nurse Training covers educational attainment, and specialized critical care training.

• Nurse Turnover covers nurse separations by age group and nurse employee turnover.

• Retention and Employee Engagement covers employee engagement, information on recruitment and recruitment strategies, new hires and vacancy rate.

• Allied Health Professionals in Critical Care covers allied health professionals and reports on the use of the different allied health professionals.

2. Unit Level Results: This section provides results for select measures across the individual critical care units within the peer group.

• Critical care nursing demographics, workforce utilization of both nursing staff and allied health professionals in critical care, and recruitment and retention indicators are reported.

• Data tables for 22 measures and results for all critical care units in the peer group that reported data are provided.



PEER GROUP 4 HIGHLIGHTSPeer Group 4 (Level 3 and Level 2 Cardiac/Cardiovascular Unit) is comprised of 11 Critical Care Units. The completeness of data reported for the units in this peer group varies across different dimensions of analysis, depending on the information that was provided through the data collection process.

The following are observations specific to Peer Group 4 (PG4), in relation to the overall provincial results from the Critical Care Workforce Profile:

NURSE ROLES AND DEMOGRAPHICS

• There are significantly less novice nurses with less than 3 years’ experience reported in Peer Group 4. The overall provincial average was 20.7% while Peer Group 4 reported the lowest proportion in this category with an average of 12%. Conversely, there were more nurses with 6 – 10 years experience were reported in Peer Group 4 than the overall provincial average with 22.9% vs. 28.6% (CCWP Provincial Report Figure 4).

• Peer Group 4 reported having 12% of nurses under 30 years of age, the lowest across all peer groups and lower than the provincial average of 19%. On the flip side of this, Peer Group 4 reports the highest percentage of nurses aged 40-49% at 31%, while the provincial average is 21%. (CCWP Provincial Report Figure 7)

NURSE STAFFING PRACTICES

• Peer Group 4 reported an average of 44% of “frequent” usage of “expanded assignments” to manage short-term nursing shortages. This is double the usage of the province at 22%. (CCWP Provincial Report Figure 26).

• Peer Group 4 reported the second highest hours per patient day among all Peer Groups at 22.7 hours (including overtime) which is higher than the provincial average of 17.1 hours. (CCWP Provincial Report Figure 29).

• Peer Group 4 has seen an increase of in the number of worked hours per patient days from 2013/14 to 2015/16 from 21.1 hours to 22.7 hours. (CCWP Provincial Report Figure 30).

NURSE TRAINING

• All Peer Groups in the province have nurses working in their critical are units who are internationally trained with a provincial average of 7.4%. Peer Group 4 is lower at 3.0%. (CCWP Provincial Report Figure 32).

• The frequency of ‘in-services’ among Peer Group 4 for professional development is 89%, this is significantly higher than the provincial average of 68%. (CCWP Provincial Report Figure 43).

• “Paid Courses and Certificates” is used frequently by 60% of all units provincially for professional development. It is frequently used by 67% of Peer Group 4 units. (CCWP Provincial Report Figure 44).



NURSE TURNOVER AND RECRUITMENT

• Peer Group 4 noted a larger proportion of nurses (67%) leaving their nursing positions to assume other ICU roles. This rate is higher than the provincial average of 43%. (CCWP Provincial Report Figure 50).

• Change in employment status from part-time to full-time occurs at an average of 35% for Peer Group 4. This average is lower than the provincial average of 58%. (CCWP Provincial Report Figure 53).

ALLIED HEALTH PROFESSIONALS IN CRITICAL CARE

• Across the province, critical care units reported an average of 1.6 hours per day of coverate during the weekend for physiotherapist support. Coverage during the weekends is higher for Peer Group 4 at 3.2 hours. (CCWP Provincial Report Figure 63).

• Across the province respiratory therapists are highly used in all Peer Groups on weekdays (16 hours), including in some Peer Groups on weekends (7.2 hours). Peer Group 4 had lower coverage of respiratory therapists on weekends at 3.2 hours per day. (CCWP Provincial Report Figure 65).

• Respiratory therapist FTE allocation varies considerably across Peer Groups. On average across the province, FTE allocation for respiratory therapist services in critical care units was 2.3. Peer Group 4 report the third highest number of respiratory therapist FTEs at 4.5 (CCWP Provincial Report Figure 67).

The intention of highlighting variation in practice allows peer groups and individual critical care units to understand where difference exists, and to address areas that may be of concern. Such efforts at the unit level will foster a more robust workforce and help ensure patients have access to timely and quality care. The following section provide unit level results for select measures from the 2015/16 results of the Critical Care Workforce Profile.



UNIT LEVEL RESULTSPeer Group data is shown at the provincial, peer group and unit level in table format in the sections that follow. In reviewing data, please note that “0”=true value and “-” =missing value. Reference to the related figures in the CCWP Provincial Report and data source have been noted before each table.

Nurse Roles and Demographics

Table 1: Length of Nurse Experience in the Critical Care UnitCCWP Provincial Report Figure 4: Length of Nurse Experience in the Critical Care Unit

Source: 2015/16 CCWP Online Data Collection Tool, Question 2A

Corporation Name Site Name CCIS Code

Years In Critical Care

< 3 3–5 6–10 11–20 > 20

Ontario 20.6% 17.5% 22.9% 23.6% 15.5%

PG4 12% 15.9% 28.6% 26.1% 17.4%

Southlake Regional Health Centre


004 29.1% 21.8% 20% 23.6% 5.5%

University of Ottawa Heart Institute


049 13% 16% 29% 25% 17%

Trillium Health Partners The Mississauga Hospital 093 3.2% 19.4% 32.3% 27.4% 17.7%

Health Sciences North Ramsey Lake Health Centre 103 9.1% 27.3% 28.8% 16.7% 18.2%

London Health Sciences Centre

University Campus 148 4.8% 13.6% 24% 26.4% 31.2%

St. Michael’s Hospital St. Michael’s Hospital 176 5.3% 1.8% 40.4% 42.1% 10.5%

University Health Network Toronto General Hospital 191 21.1% 13.8% 29.4% 24.8% 11%



Table 2: Age Group Distribution of Critical Care NurseCCWP Provincial Report Figure 7: Age Group Distribution of Critical Care Nurse

Source: 2015/16 Human Resources Data Collection Tool, Direct Care Nursing


Age Group

< 30 30-39 40-49 50-59 60-64 65+

Ontario 18.5% 28.0% 25.3% 21.8% 4.5% 1.8%

PG4 12.1% 28.8% 30.5% 22.9% 4.1% 1.6%



004 5.8% 53.8% 23.1% 17.3% - -



049 15.8% 36.8% 28.4% 15.8% 3.2% 0.0%

Hamilton Health Sciences

General Site 072 11.4% 17% 33% 34.1% 3.4% 1.1%

Trillium Health PartnersThe Mississauga Hospital

093 8.1% 27.4% 40.3% 21% 1.6% 1.6%

Health Sciences NorthRamsey Lake Health Centre

103 24.6% 21.5% 29.2% 20% 4.6% -

St. Michael’s Hospital St. Michael’s Hospital 176 1.8% 28.6% 32.1% 30.4% 5.4% 1.8%

Sunnybrook Health Sciences Centre

Bayview Campus 180 9.4% 25.9% 35.3% 22.4% 7.1% -

University Health Network

Toronto General Hospital

191 14.5% 31.6% 23.1% 21.4% 2.6% 6.8%

St. Mary’s General Hospital


214 11.9% 26.2% 23.8% 26.2% 11.9% 0.0%

Royal Victoria Hospital Barrie


231 12.5% - 62.5% 18.8% 6.3% -



Nurse Staffing Practices

Table 3: Employment Status Distribution of Critical Care NursesCCWP Provincial Report Figure 15: Employment Status Distribution of Critical Care Nurses

Source: 2015/16 CCWP OHRS UPP Data from Finance Department Submission


Total Head Count

Earned Hours Type

Casual Full-Time Part-Time

Ontario 8,435 891 5,560 1,984

PG4 785 81 551 152



004 56 8 45 3



049 96 1 86 9


General Site 072 86 5 57 24


093 62 13 39 10


103 49 1 30 18


University Campus 148 122 9 91 22

St. Michael’s Hospital St. Michael’s Hospital 176 63 8 38 17


Bayview Campus 180 83 13 48 22



191 108 15 86 7



214 41 5 23 13



231 19 3 9 7



Table 4: Employment Status Distribution of Critical Care Nurse Earned HoursCCWP Provincial Report Figure 17: Employment Status Distribution of Critical Care Nurse Earned Hours



Total Earned Hours

Earned Hours Type

Casual Full-Time Part-Time

Ontario 12,875,923 2.7% 79.9% 17.5%

PG4 1,248,920 2.5% 82.6% 14.9%



004 83,479 3.3% 91% 5.7%



049 168,240 0.3% 93.2% 6.5%


General Site 072 146,407 1% 81.4% 17.6%


093 91,778 5.9% 81.1% 13%


103 75,217 0.0% 70.2% 29.7%


University Campus 148 191,400 2.9% 85.1% 12%

St. Michael’s Hospital St. Michael’s Hospital 176 90,295 1.4% 76.5% 22.1%


Bayview Campus 180 128,704 5.5% 67.6% 26.9%



191 184,404 1.4% 93.5% 5.1%



214 59,970 3% 74.8% 22.2%



231 29,025 9.3% 57% 33.7%



Table 5: Distribution of Critical Care Nurse Earned Hours by TypeCCWP Provincial Report Figure 19: Distribution of Critical Care Nurse Earned Hours by Type

Source: 2015/16 CCWP OHRS Data from Finance Department Submission


Total Earned Hours

Earned Hours Type

Educ

atio

n

Orie

ntat

ion

Oth

er

Ove

r Tim

e

Regu

lar

Wor

ked

Sick

Vaca

tion

Ontario 12,853,341 0.8% 1.8% 4.4% 3.1% 78% 4.7% 7.1%

PG4 1,248,920 0.6% 1.6% 4.2% 3.3% 78% 4.9% 7.4%



004 83,479 2.7% 1.2% 4.5% 6.2% 74% 4.5% 6.8%



049 168,240 - 3.3% 3.8% 2.6% 75% 6.5% 8.8%


General Site 072 146,407 1% 3.3% 5.5% 2.8% 74% 6.3% 9.3%

Trillium Health Partners

The Mississauga Hospital

093 91,778 0.9% 1.5% 4.1% 4.2% 81% 3.4% 6.9%

Health Sciences North

Ramsey Lake Health Centre

103 75,217 - 0.1% 5.1% 3.2% 97% 5.1% 7.9%


University Campus 148 191,400 - - - 1.5% 78% - -

St. Michael’s Hospital St. Michael’s Hospital 176 90,295 0.9% 2% 4.1% 1.3% 80% 5.3% 8.4%


Bayview Campus 180 128,704 1.6% 0.6% 3.9% 5.8% 79% 3.6% 5.7%



191 184,404 0.2% 2.5% 4.5% 3.2% 76% 6% 8%



214 59,970 0.3% 3.2% 3.8% 5.5% 75% 5.5% 7.1%



231 29,025 0.7% 2.4% 3% 2.5% 80% 3.1% 8.2%



Table 6: Overtime Hours as a Proportion of Productive Hours for Critical Care NursesCCWP Provincial Report Figure 22: Overtime Hours as a Proportion of Productive Hours for Critical Care Nurse

Source: 2015/16 Data: CCWP OHRS UPP Data from Finance Department Submission


Total Earned Hours

Earned Hours Type

Over Time Regular

Ontario 10,329,701 3.9% 96.1%

PG4 1,015,217 4.1% 95.9%



004 66,973 7.7% 92.3%



049 130,775 3.3% 96.7%

Hamilton Health Sciences General Site 072 111,981 3.6% 96.4%

Trillium Health Partners The Mississauga Hospital 093 77,721 5% 95%

Health Sciences North Ramsey Lake Health Centre 103 75,217 3.2% 96.8%


University Campus 148 152,761 1.9% 98.1%

St. Michael’s Hospital St. Michael’s Hospital 176 73,476 1.6% 98.4%


Bayview Campus 180 108,928 6.8% 93.2%

University Health Network Toronto General Hospital 191 145,400 4.1% 95.9%

St. Mary’s General Hospital St. Mary’s General Hospital 214 48,035 6.9% 93.1%

Royal Victoria Hospital Barrie Royal Victoria Hospital Barrie 231 23,951 3.1% 96.9%



Table 7: Sick Rate for Critical Care NursesCCWP Provincial Report Figure 23: Sick Rate for Critical Care Nurses



Sick Hours

Total Earned Hours

Sick Rate

Ontario 606,527 12,692,456 4.8%

PG4 61,319 1,173,703 5.2%



004 3,786 83,479 4.5%



049 10,873 168,240 6.5%

Hamilton Health Sciences General Site 072 9,154 146,407 6.3%

Trillium Health Partners The Mississauga Hospital 093 3,098 91,778 3.4%

London Health Sciences Centre University Campus 148 9,811 191,400 5.1%

St. Michael’s Hospital St. Michael’s Hospital 176 4,770 90,295 5.3%


Bayview Campus 180 4,595 128,704 3.6%

University Health Network Toronto General Hospital 191 11,048 184,404 6%

St. Mary’s General Hospital St. Mary’s General Hospital 214 3,278 59,970 5.5%

Royal Victoria Hospital Barrie Royal Victoria Hospital Barrie 231 907 29,025 3.1%

Table 8: Education Hours as a Proportion of Total Earned Hours for Critical Care NursesFigure 24: Education Hours as a proportion of Total Earned Hours for Critical Care Nurses – CCWP Provincial Report



Education Hours

Total Earned Hours

Percent Education

Hours

Ontario 106,410 12,853,341 0.8%

PG4 8,085 1,248,920 0.6%



004 2,285 83,479 2.7%

Hamilton Health Sciences General Site 072 1,473 146,407 1%

Trillium Health Partners The Mississauga Hospital 093 809 91,778 0.9%

St. Michael’s Hospital St. Michael’s Hospital 176 777 90,295 0.9%


Bayview Campus 180 2,081 128,704 1.6%

University Health Network Toronto General Hospital 191 290 184,404 0.2%

St. Mary’s General Hospital St. Mary’s General Hospital 214 167 59,970 0.3%


St. Mary’s General Hospital St. Mary’s General Hospital 214 3,278 59,970 5.5%




Table 9: Approaches to Manage Short-Term Nursing ShortagesCCWP Provincial Report Figure 25: Approaches to Manage Short-Term Nursing Shortages

Source: 2015/16 CCWP Online Data Collection Tool, Question 15

1=Frequently Used, 2=Sometimes Used, 3=Rarely/Never Used


Nursing Shortage Coverage Approach

Staf

fing

Pool

Expa

nded

Sta

ff

Ass

ignm

ents

Sche

dule

d Ch

ange

s

Man

dato

ry

Ove

rtim

e

Bed

Clos

ures

Age

ncy

Staf

f



004 3 2 3 3 2 1



049 3 3 3 3 3 3

Trillium Health Partners The Mississauga Hospital 093 3 1 3 3 3 3

Health Sciences North Ramsey Lake Health Centre 103 3 1 3 3 3 3

London Health Sciences Centre University Campus 148 3 1 3 1 3 3

St. Michael’s Hospital St. Michael’s Hospital 176 - 1 3 3 3 2


Bayview Campus 180 2 3 3 3 3 2

University Health Network Toronto General Hospital 191 2 2 2 3 2 2

St. Mary’s General Hospital St. Mary’s General Hospital 214 3 2 3 3 3 3



Table 10: Critical Care Nurse Worked Hours (including Overtime) per Patient DayCCWP Provincial Report Figure 29: Critical Care Nurse Worked Hours (including Overtime) per Patient Day



Total Hours

(inc. OT)

Total Patient

Days

Hours / Patient

Day

Ontario 10,360,357 604,993 17.1

PG4 1,015,217 44,773 22.7



004 66,973 2,471 27.1



049 130,775 6,328 20.7

Hamilton Health Sciences General Site 072 111,981 5,041 22.2

Trillium Health Partners The Mississauga Hospital 093 77,721 3,172 24.5

Health Sciences North Ramsey Lake Health Centre 103 75,217 3,397 22.1


University Campus 148 152,761 6,911 22.1

St. Michael's Hospital St. Michael's Hospital 176 73,476 2,907 25.3


Bayview Campus 180 108,928 4,648 23.4

University Health Network Toronto General Hospital 191 145,400 6,097 23.8

St. Mary's General Hospital St. Mary's General Hospital 214 48,035 2,147 22.4

Royal Victoria Hospital Barrie Royal Victoria Hospital Barrie 231 23,951 1,654 14.5



Nurse Training

Table 11: Critical Care Training Attainment Distribution of Critical Care NursesCCWP Provincial Report Figure 38: Critical Care Training Attainment Distribution of Critical Care Nurses


Corporation Name Site Name CICS Code

Critical Care Training Type

> 300 Hrs. (Ontario CC

Nurse Training Standards)

> 300 Hrs. (CC

Diploma)

> 300 Hrs.

(Other)

< 300 hours

Not Completed / Unknown

Ontario 38.9% 17.3% 19.3% 11.2% 13.3%

PG4 60.1% 14.1% 11.7% 11.7% 2.4%



004 29.1% 56.4% 9.1% 0.0% 5.5%



049 68% 15% 15% 2% 0.0%

Trillium Health Partners

The Mississauga Hospital

093 0.0% 40.3% 32.3% 21% 6.5%

Health Sciences North

Ramsey Lake Health Centre

103 16.7% 9.1% 0.0% 74.2% 0.0%


University Campus 148 100% - - - -

St. Michael's Hospital St. Michael's Hospital 176 48.3% - 41.4% - 10.3%


Bayview Campus 180 100% - - - -



191 - - - - -



Table 12: Advance Cardiac Life Support Training Attainment Distribution of CC NursesCCWP Provincial Report Figure 40: Advance Cardiac Life Support Training Attainment Distribution of Critical Care Nurses


Corporation Name Site Name CICS Code

ACLS Training

≤ 2 yrs. Ago

> 2 yrs. Ago

Not Completed Unknown

Ontario 53.2% 16.3% 14.6% 15.8%

PG4 44.3% 25.5% 19.4% 10.9%



004 25.5% 56.4% 18.2% -



049 10% 36% 54% 0.0%

Trillium Health Partners The Mississauga Hospital 093 100% 0.0% 0.0% 0.0%


103 57.6% 28.8% 13.6% 0.0%

St. Michael's Hospital St. Michael's Hospital 176 10.5% 17.5% - 71.9%

University Health Network Toronto General Hospital 191 - - - -

St. Mary's General Hospital St. Mary's General Hospital 214 100% - - -



Table 13: Approaches to Professional Development Investment in Critical Care UnitsCCWP Provincial Report Figure 42: Approaches to Professional Development Investment in Critical Care Units


1=Frequently Used, 2=Sometimes Used, 3=Rarely/Never Used


PD Investment Approach

Paid

Con

fere

nce

Org

aniz

atio

nal

Mem

bers

hip

Fees

Paid

Cou

rses

/

Cert

ifica

tions

Burs

arie

s /

Scho

lars

hips

Com

mun

ity /

Fou

ndat

ion

Supp

ort

In-S

ervi

ce (W

ork

Hou

rs)

MO

HLT

C Su

ppor

t (N

TF)

Vend

or S

uppo

rt

Rese

arch

Gra

nts



004 2 3 1 2 3 1 2 2 3



049 1 3 1 1 3 1 1 2 3

Trillium Health Partners The Mississauga Hospital 093 1 3 1 2 2 1 3 3 3


103 2 3 1 3 2 1 1 2 3


University Campus 148 3 3 3 3 3 1 1 3 3

St. Michael's Hospital St. Michael's Hospital 176 2 3 3 3 3 1 2 3 3


Bayview Campus 180 3 3 3 3 3 3 3 3 3


Toronto General Hospital 191 1 3 1 3 2 1 3 1 3

St. Mary's General Hospital

St. Mary's General Hospital

214 2 3 1 3 3 1 2 2 3



Nurse Turnover

Table 14: Critical Care Nurse Turnover, OverallCCWP Provincial Report – Nursing Turnover Section

Source: 2015/16 CCWP Human Resources Data Collection Tool, Direct Care Nurses


Total Exits Headcount

Total Workforce Headcount

Turnover Rate

Ontario 690 7,936 8.7%

PG4 32 678 4.7%



004 2 52 3.8%



049 5 95 5.3%

Hamilton Health Sciences General Site 072 5 88 5.7%

Trillium Health Partners The Mississauga Hospital 093 1 62 1.6%

Health Sciences North Ramsey Lake Health Centre 103 2 65 3.1%

St. Michael's Hospital St. Michael's Hospital 176 2 56 3.6%


Bayview Campus 180 1 85 1.2%

University Health Network Toronto General Hospital 191 9 117 7.7%

St. Mary's General Hospital St. Mary's General Hospital 214 2 42 4.8%

Royal Victoria Hospital Barrie Royal Victoria Hospital Barrie 231 3 16 18.8%



Table 15: Destination of Critical Care Nurses Leaving the Unit or Changing Employment StatusCCWP Provincial Report Figure 50: Destination of Critical Care Nurses Leaving the Unit or Changing Employment Status



Destination of Critical Care Nurses Leaving the Unit or Changing

Employment Status

Remain in ICU

Outside of ICU

Unkown/Other

Ontario 42.6% 21.2% 36.2%

PG4 66.7% 16.7% 16.7%



004 100% 0.0% 0.0%



049 14.3% 57.1% 28.6%

Trillium Health Partners The Mississauga Hospital 093 40% 20% 40%

Health Sciences North Ramsey Lake Health Centre 103 77.8% 11.1% 11.1%


University Campus 148 80% - 20%


Bayview Campus 180 100% - -

University Health Network Toronto General Hospital 191 100% 0.0% 0.0%



Nursing Recruitment

Table 16: Vacancy Rate for Critical Care UnitsCCWP Provincial Report Figure 55: Vacancy Rate for Critical Care Units



Vacant Positions

Total Budgeted Positions

Vacancy Rate

Ontario 473 9536 5.0%

PG4 30 728 4.1%



004 1 56 1.8%



049 4 104 3.8%

Trillium Health Partners The Mississauga Hospital 093 2 64 3.1%

Health Sciences North Ramsey Lake Health Centre 103 0 66 0.0%


University Campus 148 10 135 7.4%

St. Michael's Hospital St. Michael's Hospital 176 2 59 3.4%


Bayview Campus 180 2 87 2.3%

University Health Network Toronto General Hospital 191 6 116 5.2%

St. Mary's General Hospital St. Mary's General Hospital 214 3 41 7.3%



Allied Health Professionals in Critical Care

Table 17: Routine Use of Allied Health Professionals in Critical Care UnitsCCWP Provincial Report Figure 60: Routine Use of Allied Health Professional in Critical Care Units

Source: 2015/16 CCWP Online Data Collection Tool, Question 22A

1=Yes


Allied Health Professionals Routinely Used in Critical Care Units

Chap

lain

/

Spiri

tual

Car

e

Die

titia

n/Cl

inic

al

Nut

ritio

nist

Occ

upat

iona

l Th

erap

ist

Phar

mac

ist

Phys

ioth

erap

ist

Resp

irato

ry

Ther

apis

t

Soci

al W

orke

r



004 1 1 1 1 1 1 1



049 - 1 1 1 1 1 1

Trillium Health Partners The Mississauga Hospital 093 - 1 1 1 1 1 1

Health Sciences North Ramsey Lake Health Centre 103 1 1 1 1 1 1 1


University Campus 148 1 1 - 1 1 1 1

St. Michael's Hospital St. Michael's Hospital 176 1 1 1 1 1 1 -


Bayview Campus 180 1 1 - 1 1 1 1

University Health Network Toronto General Hospital 191 1 1 1 1 1 1 1

St. Mary's General Hospital St. Mary's General Hospital 214 1 1 - 1 1 1 -



Table 18: Pharmacist Support Hours per Day in Critical Care UnitsCCWP Provincial Report Figure 61: Pharmacist Support Hours per Day in Critical Care Units

Source: 2015/16 CCWP Data Collection Tool, Question 23


Pharmacy Support

Weekdays Weekends

Days/Week

Hrs/Day

Days/Week

Hrs/Day

Ontario 4.7 7.7 0.9 5.4

PG4 5 7 0.8 4.2



004 5 7 0 0



049 5 8 0 0

Trillium Health Partners The Mississauga Hospital 093 5 2 2 1

Health Sciences North Ramsey Lake Health Centre 103 5 8 0 0


University Campus 148 5 7 - -

St. Michael's Hospital St. Michael's Hospital 176 5 8 2 24


Bayview Campus 180 - 8 - 0

St. Mary's General Hospital St. Mary's General Hospital 214 5 8 - -

Table 19: Pharmacist Provision of On-Call Support in Critical Care UnitsCCWP Provincial Report Figure 62: Pharmacist Provision of On-Call Support in Critical Care Units


0= No On-Call Support, 1=On-Call Support Available


Pharmacy Support

Weekday On-Call

Weekend On-Call

Southlake Regional Health Centre Southlake Regional Health Centre 004 0 0



049 0 0

Trillium Health Partners The Mississauga Hospital 093 1 1

Health Sciences North Ramsey Lake Health Centre 103 1 1

London Health Sciences Centre University Campus 148 - 1

St. Michael's Hospital St. Michael's Hospital 176 1 1

St. Mary's General Hospital St. Mary's General Hospital 214 1 1



Table 20: Physiotherapist Support Hours per Day in Critical Care UnitsCCWP Provincial Report Figure 63: Physiotherapist Support Hours per Day in Critical Care Units



Physiotherapist Support

Weekdays Weekends

Days/Week

Hrs/Day

Days/Week

Hrs/Day

Ontario 4.7 5.7 1 3.2

PG4 4.7 6.7 1.7 3.9



004 5 7 2 4



049 3 8 2 8



London Health Sciences Centre University Campus 148 5 7 - -

St. Michael's Hospital St. Michael's Hospital 176 5 4 2 1


Bayview Campus 180 - - - 4

St. Mary's General Hospital St. Mary's General Hospital 214 5 8 2 8

Table 21: Physiotherapist Provision of On-Call Support in Critical Care UnitsCCWP Provincial Report Figure 64: Physiotherapist Provision of On-Call Support in Critical Care Units




Physiotherapist Support

Weekday On-Call

Weekend On-Call




049 0 0



London Health Sciences Centre University Campus 148 - 1

St. Michael's Hospital St. Michael's Hospital 176 0 0




Table 22: Respiratory Therapist Support Hours per Day in Critical Care UnitsCCWP Provincial Report Figure 65: Respiratory Therapist Support Hours per Day in Critical Care Units



Respiratory Therapist Support

Weekdays Weekends

Days/Week

Hrs/Day

Days/Week

Hrs/Day

Ontario 4.7 17.2 1.7 17.5

PG4 5 18.8 2 18.9



004 5 10 2 4



049 5 24 2 24



London Health Sciences Centre University Campus 148 5 24 2 24

St. Michael's Hospital St. Michael's Hospital 176 - 12 - -


Bayview Campus 180 - 8 - 8

St. Mary's General Hospital St. Mary's General Hospital 214 5 24 2 24

Table 23: Respiratory Therapist Provision of On-Call Support in Critical Care UnitsCCWP Provincial Report Figure 66: Respiratory Therapist Provision of On-Call Support in Critical Care Units




Respiratory Therapist Support

Weekday On-Call

Weekend On-Call




049 0 0






PEER GROUP REPORT APPENDICES

Appendix A. Glossary of Terms

Direct Care Nurses Intended to capture nursing roles providing direct bedside care to patients. Includes roles such as Registered Nurses or Registered Practical Nurse.

Full-Time Equivalent (FTE) Hours paid to one employee working on a full-time basis. Includes both worked and benefit hours. Does not include overtime hours. In most organizations, 1 FTE = 1,950 hours annually.

Functional Center A department or unit within a hospital to which costs and activity are tracked.

Headcount Count of individuals employed, regardless of FTE allocation. Intended to capture the number of staff, across each nursing and allied health role, associated with the unit/functional centre that support critical care activities.

Management and Operational Support (MOS)

Terms from the Ontario Healthcare Reporting Standards. Staff that are indirectly supporting the core functions of a unit. In the case of critical care units, these staff would include clerical roles, management roles, and indirect care nurses.

Ontario Healthcare Reporting System (OHRS)

OHRS provides the framework for the accounting and reporting of financial and activity data across healthcare organizations in a consistent and standardized way.

Support Nurses Intended to capture roles not directly providing bedside care. Includes roles such as Clinical Nurse Specialist, Nurse Educator, Nurse Manager, Nurse Practitioner.

Unit Producing Personnel (UPP)

Term from the Ontario Healthcare Reporting Standards. Staff that are directly contributing to the core function of a unit. In the case of critical care units, these staff would include staff delivering direct bedside care.



Appendix B. Calculations Table

CALCULATIONS USED IN DATA COLLECTION FOR WORKFORCE PROFILE

Measure

Related Figures from Provincial Report

Definitions Calculation

Response Rate

Figure 1

Table 3

Table 16

A unit was included in the overall response rate if any usable data was provided for the data collection tool.

= [Num. of units Responded] / [Total Number of Units in Group]

UPP Nursing Earned Hours by Type

Figure 19

• UPP regular worked hours (OHRS account 635***2)

• UPP overtime hours (OHRS account 635***1)

• UPP sick hours (OHRS account 635***3)

• UPP vacation hours (OHRS account 635***4)

• UPP education hours (OHRS account 635***5)

• UPP orientation hours (OHRS account 635***6)

• UPP other hours (OHRS account 635***7 and 635***8)

• UPP earned hours (OHRS account 635****)

• Nursing (occupational classes 11-18)

• Includes all employment status groups (e.g. 1-6)

= [UPP nursing hrs. type] / [UPP nursing earned hrs.]

UPP Nursing Overtime Hours as a Proportion of Productive Hours

Figure 20

Figure 21





• Units included in the numerator match units included in the denominator

= [UPP nursing overtime hrs.] / [(UPP nursing regular worked hrs.) + (UPP nursing overtime hrs.)]

UPP Nursing Sick Rate

Figure 22

Figure 23

• UPP sick hours (OHRS account 635***3)





= [UPP nursing sick hrs.] / [UPP nursing earned hrs.]



Measure

Related Figures from Provincial Report

Definitions Calculation

UPP Nursing Education Time

Figure 24

• UPP education hours (OHRS account 635***5)




• Units included in the numerator do not match units included in the denominator. All units reporting earned hours are included in denominator.

= [UPP nursing education hrs.] / [UPP nursing earned hrs.]

UPP Nursing Worked Hours per Patient Day

Figure 29

Figure 30





• Patient days (OHRS account 403****)


= [(UPP nursing regular worked hrs.) + (UPP nursing overtime hrs.)] / [Patient days]

Direct Care Nurse Turnover

Figure 47

Figure 48

• Number of direct care nursing exits (including retirements) as identified in Human Resources data submission for the fiscal year (e.g. April 1 to March 31)

• Number of direct care nurses as identified by Human Resources data submission as of March 31


= [Num. of direct care nursing exits] / [Num. of direct care nurses]

Vacancy Rate

Figure 54

Figure 55

Figure 56

• Number of reported vacant nursing positions as of March 31, 2016 as identified in the online data submission

• Number of nursing staff as identified in question 1 B of the online data submission

• Includes all nursing staff for full-time, part-time and casual positions

= [Num. of vacant nursing positions] / [(Num. of nursing staff) + (Num. of vacant nursing positions)]



Appendix C. Online Data Collection Tool

QUESTIONS RELATED TO THE NURSING WORKFORCE AND TRAINING:

Please answer the questions 1 to 9 relating to the nursing staff employed in your Critical Care unit on March 31, 2016:

1. A. What is the total number of nurses ( i.e.. individuals, not FTEs) on your Critical Care unit in each of the following groupings:

a. Clinical Nurse Specialist (CNS)

b. Nurse Educator

c. Nurse Manager

d. Nurse Practitioner (NP)

e. Permanent charge nurse without a patient assignment

f. Registered Nurse (RN), not included in other groupings listed

g. Registered Practical Nurse (RPN)

h. Other (please specify)______________

1. B. What is the total number of nurses in your Critical Care unit from Question 1A: ____ (Free numeric text)

2. A. Of the X number of nurses on your Critical Care unit, please identify your understanding of how many have been working in THIS particular unit for the following periods of time:

a. Less than 3 years

b. 3 - 5 years

c. 6 - 10 years

d. 11 - 20 years

e. More than 20 years

2. B. Of the X number of nurses on your Critical Care unit, please identify your understanding of how many have been working in Critical Care for the following periods of time:


b. 3 - 5 years

c. 6 - 10 years

d. 11 - 20 years




2. C. Of the X number of nurses on your Critical Care unit, please identify your understanding of how many have been working as a registered nurse for the following periods of time:


b. 3 - 5 years

c. 6 - 10 years

d. 11 - 20 years


3. Of the X number of nurses on your Critical Care unit, please indicate your understanding of the number of nurses whose highest level of education falls into the following categories:

a. Nursing diploma

b. Non-nursing undergraduate degree

c. Nursing undergraduate degree

d. Nursing master’s degree

e. Non-nursing master’s degree

f. Nursing doctorate

g. Non-nursing doctorate

4. Of the X number of nurses on your Critical Care unit, please identify your understanding of the number of nurses who attained their basic nursing training outside of Canada (If there are none please indicate 0):_____ (free numeric text)

5. Of the X number of nurses on your Critical Care unit, please identify your understanding of the number of nurses who have completed a Critical Care Course, according to the following categories:

a. 300+ hours of didactic and clinical training (Ontario Critical Care Nurse Training Standards)

b. 300+ hours of didactic and clinical training (Critical Care Diploma)

c. 300+ hours of didactic and clinical training (Other)

d. < 300 hours of didactic and clinical training

e. Not completed a critical care course

6. Of the X number of nurses on your Critical Care unit, please identify your understanding of the number who have completed Advanced Cardiac Life Support (ACLS) Training, according to the following categories:

a. Have completed ACLS training within the last two (2) years

b. Have completed ACLS training more than two (2) years ago

c. Have not completed ACLS Training

d. Don’t know if ACLS Training has been completed



7. Of the X number of nurses on your Critical Care unit, please identify your understanding of the number who have completed Pediatric Advanced Life Support (PALS) Training, according to the following categories:

a. Have completed PALS training within the last two (2) years

b. Have completed PALS training more than two (2) years ago

c. Have not completed PALS Training

d. Don’t know if PALS Training has been completed

8. Of the X number of nurses on your Critical Care unit, please identify your understanding of the number who have completed Trauma Nursing Core Course (TNCC) Training, according to the following categories:

a. Have completed TNCC training within the last year

b. Have completed TNCC training more than a year ago

c. Have not completed TNCC Training

d. Don’t know if TNCC Training has been completed

9. Of the X number of nurses on your Critical Care unit, please identify your understanding of the number who have completed Critical Care Response Team (CCRT) Training, according to the following categories:

a. Have completed CCRT training within the last year

b. Have completed CCRT training more than a year ago

c. Have not completed CCRT Training

d. Don’t know if CCRT Training has been completed

QUESTIONS RELATED TO NURSING TURNOVER:

Please answer questions 10 to 13 based on staff who left your unit or changed employment status (e.g. went from full-time to casual, etc.) in your Critical Care unit between April 1, 2015 and March 31, 2016.

10. Please identify the total number of nurses who have left or changed employment status (e.g. went from full-time to casual, etc.) in your Critical Care unit between April 1, 2015 and March 31, 2016. Please include nurses in the following categories: Clinical Nurse Specialist (CNS); Nurse Educator; Nurse Manager; Nurse Practitioner (NP); Registered Nurse (RN); Registered Practical Nurse (RPN). ________ (free numeric text)



11. Of the X number of nurses that left or changed employment status (e.g. went from full-time to casual, etc.) in your Critical Care unit between April 1, 2015 and March 31, 2016, please identify your understanding of how many exited their roles for the following reasons:

a. Move to a new nursing role or position

b. Retirement

c. Illness or disability

d. Left to pursue non-nursing education

e. Exit from nursing profession

f. Promotion to another role

g. Personal relocation

h. Not Applicable / Unknown

i. Other

12. Of the X number of nurses that left or changed employment status (e.g. went from full-time to casual, etc.) in your Critical Care unit between April 1, 2015 and March 31, 2016, please identify your understanding of how many moved to the following destinations:

a. Remains in ICU – same unit

b. Remains in ICU - different unit within same hospital

c. Remains in ICU - different hospital

d. Remains in nursing outside of ICU - within same hospital

e. Remains in nursing outside of ICU - different hospital

f. Remain in nursing - outside of hospital setting

g. Promotion to another role

h. Not Applicable / Unknown

i. Other

13. Of the X number of nurses that left or changed employment status (e.g. went from full-time to casual, etc.) in your Critical Care unit between April 1, 2015 and March 31, 2016, please identify your understanding of how many changed their employment status in the following categories:

a. Move from full time to part time

b. Move from full time to casual

c. Move from part time to full time

d. Move from part time to casual

e. Move from casual to a permanent or temporary position

f. End of a temporary assignment

g. Not Applicable / Unknown

h. Other



QUESTIONS RELATED TO RECRUITMENT AND RETENTION

Please answer questions 14 to 18 based on your experience with recruitment and retention in your Critical Care unit between April 1, 2015 and March 31, 2016.

14. On March 31, 2016 please indicate the total number of vacant budgeted RN positions (according to your hospital’s position management system) for your Critical Care unit in the following categories:

a. Full-time

b. Part-time

c. Casual

15. How does your Critical Care unit deal with short-term (shift-to-shift) RN shortages?

Please identify how often each approach is used, according to the scale provided.

Frequently used ( i.e.. >50% of the time)

Sometimes used (i.e.10-50% of the time)

Rarely / never used ( i.e.. <10% of the time)

a. Hospital-wide critical care RN staffing pool

b. Expanded staff assignments

c. Scheduled changes (e.g. cancelling ORs)

d. Mandatory overtime (including weekend staffing)

e. Bed closures

f. Agency staff

g. Other (please specify)____________

16. Please indicate how your Critical Care unit RNs receive support for professional development.





a. Paid conference registration (full or partial)

b. Payment of professional organization membership fees (full or partial)

c. Paid courses and certifications e.g. ACLS (full or partial)

d. Bursaries/scholarships

e. Community/foundation support

f. In-services during work hours

g. MOHLTC support (e.g. Nurse Training Fund)

h. Vendor support (e.g. pharmaceutical, supplies, equipment) support

i. Research grants

j. Other (please specify____________



17 A. What recruitment strategies do you use for nurses within your Critical Care unit?





a. Attending job fairs (either the hospital, or the unit)

b. Internship programs

c. Scholarship programs

d. Employee referral programs

e. Financial incentives

f. Mentorship programs

g. Flexible scheduling opportunities

h. Other (please specify)_____________

17. B. What has proven to be the most effective recruitment strategies you use to hire nurses within your Critical Care unit?

Please identify how effective each strategy is, according to the scale provided.

Completely effective (i.e. identifies hires each time)

Very effective (i.e. identifies hires >50% of the time)

Somewhat effective (i.e. identifies hires 10%-

50% of the time)

Not effective (i.e. identifies hires <10% of the time)

a. Attending job fairs (either the hospital, or the unit)

b. Internship programs

c. Scholarship programs

d. Employee referral programs

e. Financial incentives

f. Mentorship programs

g. Flexible scheduling opportunities

h. Other (please specify)________________



18 A. What retention strategies do you use to keep nursing staff engaged within your Critical Care unit?

Please identify how often each strategy is used, according to the scale provided.

Frequently used ( i.e.10+ times per year)

Periodically used (i.e.3-9 times per year)

Infrequently used (i.e. 1-2 times per year)

Never used

a. Employee recognition events - unit level

b. Long service recognition - unit level

c. Team building events e.g. pot lucks, seasonal events – unit level

d. Staff appreciation events – unit or hospital led

e. Flexible staff scheduling

f. Regular staff meetings with staff leadership

g. Unit council

h. Education/training events for staff

i. Scholarship programs

j. Preceptor program (≤3 months)

k. Preceptor program (> 3 months)

l. Mentorship program

m. Employee wellness initiatives – hospital level

n. Employee wellness initiatives – critical care specific

o. Exit interviews that are acted upon

p. Other (please specify)______________



18. B. What strategies do you believe are most effective for staff retention on your Critical Care unit?

Please identify how effective each strategy is, according to the scale provided.

Very effective (i.e. perceive is valued by >75% of staff)

Somewhat effective (i.e. perceive is valued

by 25% to 75% of staff)

Limited effect (i.e. perceive is valued

by <25% of staff)

Not applicable as this strategy is not

used

a. Employee recognition events (unit level)

b. Long service recognition (unit level)

c. Staff appreciation events

d. Team building events (e.g. pot lucks, seasonal events)

e. Flexible staff scheduling

f. Regular staff meetings with staff leadership

g. Unit council

h. Education/training events for staff

i. Scholarship programs

j. Preceptor program (≤3 months)

k. Preceptor program (> 3 months)

l. Mentorship program

m. Employee wellness initiatives – hospital level

n. Employee wellness initiatives – critical care specific

o. Exit interviews that are acted upon

p. Other (please specify)_____________



QUESTIONS RELATED TO EMPLOYEE ENGAGEMENT

Please answer questions 19 to 21 relating to employee engagement for all staff in your Critical Care unit.

19. A. Does your unit participate in hospital-led employee engagement surveys?

a. Yes – critical care beds represent 50% or more of my unit

b. Yes – critical care beds represent less than 50% of my unit

c. No (please proceed to Q. 22)

d. Other (please specify)

19. B. In which fiscal year was the last staff engagement survey conducted?

a. 2015/16

b. 2014/15

c. Other (please specify)

20. For the last survey conducted, what was the response rate for your unit? ( i.e. what percentage of staff in your unit responded to the employee engagement survey?)

a. Please specify a percent here _________

b. If don’t know, enter zero here_________

21. Please identify the top two (2) improvement opportunities identified for employee engagement within your unit that was outlined in this survey.

a. Job characteristics (e.g. Flexibility in schedule/work hours; Balance of family/personal life with work; Have adequate resources/equipment to do work; Have time to carry out all your work; Get recognition for good work)

b. Training and development (e.g. Opportunity to make improvements in how your work is done; Opportunity to receive education/training; Opportunity to advance in career)

c. Work team (e.g. We have enough staff to handle workload; We work in crisis mode)

d. Senior management (e.g. Senior management acts on staff feedback)

e. Organization (e.g. I feel that I can trust this organization)

f. Other (please specify)

g. Improvement opportunities were not identified per unit



QUESTIONS RELATED TO ALLIED HEALTH PROFESSIONALS

Please answer questions 22 and 23 relating to Allied Health support on your Critical Care unit, referring to the period between April 1, 2015 and March 31, 2016

22 A. Recognizing the many team members that support critical care patients, please identify which allied health team members are routinely (e.g. daily or weekly) involved in care within your Critical Care unit. Please check all that apply. Please do not include assistants or technicians.

a. Chaplain/Spiritual Care/Pastoral Care

b. Dietitian/Clinical Nutritionist

c. Occupational Therapist

d. Pharmacist

e. Physiotherapist

f. Respiratory Therapist

g. Social Worker

h. Other (please specify)

22 B. For the identified disciplines in Q 22A, please identify which are included within your Critical Care unit budget vs. which are allocated from an allied health department budget.

a. Included in nursing unit budget

b. Allocated from allied health department budget

c. Not present in my unit

22 C. For the identified disciplines, please provide your Critical Care unit’s approximate FTE allocation for each. (Between 0.2 FTE to 1+ FTEs or casual as needed). _____(Free numeric text)

23 A. For the identified disciplines, please identify the weekday hours of coverage.

a. Average days per week (Between 0 to 5)

b. Average hours per day on the days with coverage above (Between 0 to 24)

c. Provision of “on-call” (No or Yes)

23 B. For the identified disciplines, please identify the weekend hours of coverage.

a. Average days per week (Between 0 to 2)

b. Average hours per day on the days with coverage above (Between 0 to 24)

c. Provision of “on-call” (No or Yes)

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