The growing role of Practical Nurses

New Canadian Institute for Health Information (CIHI)  data  paints a picture of rapid change in nursing in Ontario, especially for Practical Nurses (called "RPNs" in Ontario and "LPNs" elsewhere).  Here is a summary of the most interesting data from those charts concerning Ontario.

  Note:

• The rapid increase in the Ontario RPN workforce (52.3% increase since 2005, and 5.6% in 2014)

• The rapidly increasing ratio of RPNs to RNs: Working RPNs are now at 38.1% of the number of working RNs in Ontario, up from only 27.3% only a decade ago
• While growth is much less marked, the RN workforce does continue to increase in Ontario – 9.2% since 2005 and 1.6% in 2014 alone
• The very rapid increase in RPNs who graduated from college within the last ten years
• The declining average age of RPNs and the increasing age of RNs
• The percentage of “full time” employment (as defined by the employer) increased for RNs but was fairly flat for RPNs over 2005-2014.  (That said, given the large increase in the number of working RPNs, the absolute number of full time RPNs increased significantly.)

Hospitals remain the largest employer of RPNs in Ontario, but only just, as LTC facilities now employ almost as many now.  If present trends continue, LTC will soon become the biggest employer of RPNs.  

Notably, across Canada, hospitals employ a bigger percentage of all practical nurses than hospitals in Ontario do,  with hospitals employing 48.9% of the total number of practical nurses across Canada versus just 40.9% of the total number of practical nurses in Ontario.  

This is a major change -- in 2005 Ontario hospitals employed 48.7% of the total number of Practical Nurses in the province, while across Canada, hospitals employed just 47.5%. 

Ontario hospitals now lag hospitals in other provinces in terms of Practical Nurse employment. 

Currently, Ontario has 1.11 practical nurses working in hospitals per 1000 population while Canada as a whole has 1.34 practical nurses. 

In other words, Canada as a whole now has about 21% more practical nurses working in hospitals per capita than Ontario does.  There is room for growth for Practical Nurses compared to the rest of Canada. 

While hospital RPN employment is shrinking rapidly as a percentage of total RPN employment in Ontario, the number of RPNs working in Ontario hospitals is still increasing significantly -- 36% since 2005 and 2.2% since 2013.

Indeed, the ratio of RPNs to RNs in Ontario hospitals has increased significantly over the last ten years -- increasing from 19.8% to 24.7%.

Nevertheless, this increase falls far behind the changes that have gone on in hospitals in Canada as a whole, where the ratio of Practical Nurses to RNs has increased from 19.2% to 27.4%. 

For Canada excluding Ontario, the Practical Nurse - RN ratio has increased from 18.8% to 29.0% over the same period - -increasing by more than half. Clearly, hospitals in the rest of Canada are increasing the use of Practical Nurses much more quickly than hospitals in Ontario.  

While Ontario hospital Practical Nurses are relatively sparse, the Ontario Practical Nurse workforce is only slightly below the country-wide average – 2.72 per 1000 population versus 2.76 Canada-wide.

Long-Term Care has seen more rapid growth in Ontario RPN employment -- 72% growth since 2005 and 6% since 2013.  

In terms of type of care provided, RPNs in Ontario continue to primarily provide LTC / geriatric care (42.3%), Medical/Surgical care (10.9%), psychiatric care (7.9%), and rehabilitation (4.6%). These four categories also account for the bulk of the Practical Nurse work across Canada.  There seems to be very little role for RPNs in Ontario in home care and public health. 

(A word of caution -- there was a very large increase in the catch-all category “other direct care” in 2014 and a sharp drop in “Community Health”.  So there may be some classification issues.)

For more CIHI nursing data charts click here.  


CIHI has also released a study  on nursing that has drawn some media comment.  Legitimate comment has been made on the fact that RN supply has decreased in the last year across Canada. 

Nevertheless, RN supply has also still seen 9.2% growth since 2005. (And, as noted above, the RN workforce continues to increase in Ontario.)  

Also notable is that part of the recent decline in RN supply Canada-wide  is connected with regulatory changes introduced in Ontario that resulted in 12,273 nurses leaving the profession: “In 2014, the College of Nurses of Ontario introduced the Declaration of Practice requirement whereby a member can renew only if she or he has practised nursing in Ontario within the past 3 years or has become registered or reinstated within the past 3 years. If these conditions are not met, the member has the option to move to the non-practising class, resign her or his membership or do nothing and have her or his membership revoked.”

The study also indicates the supply of Practical Nurses (LPNs, or, in Ontario, RPNs) continues to increase across Canada, albeit not quite as rapidly as over the last decade.  LPN supply is now 49% higher than in 2005.   (Note “RPN” for CIHI -- and in the graph above-- means Registered Psychiatric Nurse.)

Employed Nurses:  The CIHI study notes that from 2005 to 2014, the proportion of nurses “not employed” declined among RNs and Nurse Practitioners  from 5.2% to 2.2%.  This is perhaps not surprising given the recent decline in supply of RNs.  Despite the very rapid growth in LPN supply, LPNs “not employed” also declined (7.5% to 4.9%).

Rates of "full time employment" (as defined by the employer) for Practical Nurses lag RN and Nurse Pactitioner full time employment (48.5% for LPNs versus 58.5% for RNs / NPs).

Practical Nurses younger than 40 outnumbered those age 60 and older by more than 6 to 1. For RNs/NPs, the equivalent ratio was 3 to 1. This younger age profile for LPNs is not surprising given the rapid growth in LPN supply over the last decade.