Trends and indicators of nursing workforce shortages in Canada: a retrospective ecological study, 2015-2022

To examine longitudinal trends and identify key indicators of nursing workforce shortages across Canadian provinces and territories using publicly available data.

Retrospective ecological study.

Primary and secondary care in Canada. National data were extracted from Statistics Canada and the Canadian Institute for Health Information (CIHI) between 2015 and 2022 at the provincial and territorial levels.

The study included registered nurses and registered psychiatric nurses employed in the Canadian healthcare system. Licensed practical nurses and nurse practitioners were excluded. Territories with missing data were excluded from the analysis.

The primary outcome was nursing workforce shortage, assessed in relation to potential indicators, including the nurse-to-population ratio, job vacancy rate and annual costs of overtime work, using structural equation modelling (SEM).

The Canadian nursing workforce grew by 8.0%, with the nurse-to-population ratio increasing from 11.08 to 12.13 per 1000 population. Job vacancies rose by 6.4% (95% CI: 6.29 to 6.51%), overtime hours increased by 13.09 million (95% CI: 10.28 to 15.87) and yearly overtime costs rose by 0.78 billion CAD (95% CI: 0.64 to 0.92). SEM revealed significant associations between workforce shortage and the nurse-to-population ratio (standardised β=0.863, 95% CI: 0.942 to 0.975), job vacancy rate (β=0.958, 95% CI: 0.927 to 0.990) and yearly overtime costs (β=0.983, 95% CI: 0.967 to 0.999). Predicted shortage scores were lower before 2020 but increased significantly after 2020, potentially reflecting the impact of COVID-19 pandemic.

Despite growth in the nursing workforce, increasing job vacancies, overtime hours and costs highlight persistent shortages. Monitoring these indicators is essential for effective workforce planning and sustainable healthcare delivery.