WINDSOR STAR COLUMN: There are options to convince more nurses to stay in Windsor

As Ontario and the rest of the country struggle to keep hospitals staffed, you might wonder where we might be able to find more health care workers.

New research by SecondStreet.org shows part of the answer might be right under our noses.

It should come as no surprise to hear how thousands of Ontario nurses commute from Windsor to Detroit for work — the Motor City is right next door and workers will try to get a job where they feel it makes the most sense.

But the number of nurses getting up every day and crossing the border might be higher than you expected.

SecondStreet.org was able to send a survey to just over 3,000 Ontario nurses who currently have nursing licences in Michigan. This research project found approximately 1,887 of those nurses commute regularly to Michigan for work.

Further, another 248 Ontario nurses hope to work in Michigan in the future.

For context, Windsor Regional Hospital currently employs 1,862 nurses. That means enough nurses to fill an entire extra hospital work in Michigan instead of here in Canada.

While Windsor Regional Hospital appears to have made some strides recently in attracting nurses through its new $25,000 signing bonus, our report shows the problems run deeper than just money.

When asked what the most significant reason was that led them to work in the U.S., most nurses responded that availability of work (30 per cent) was the most common reason. Many indicated they wanted full-time, stable hours, but such work was unavailable in Canada.

Many nurses said it was a struggle to find full-time positions in Ontario, while it was much easier to do so in Detroit. To quote one survey respondent: “Give nurses full-time contracts!”

Compensation was the second most common response (25 per cent), followed by working conditions (23 per cent).

One nurse told SecondStreet.org: “Union at health care facility (is) protecting bad employees, it (becomes) hard for management to take (disciplinary) actions against bad employees due to union.”

Similarly, another nurse noted: “Stop the absurd amount of waste. There is no need for most of the administrators in health care.”

Some raised concerns about the level of technology in Canada.

One nurse wrote: “Get current with the technology and upgrade the hospitals in the community.”

In fact, when SecondStreet.org spoke with Liz McDowell, a nurse from Windsor with 50 years of experience (about 15 in Canada and 35 in the U.S.), she told us nurses in Canada have to work with “outdated and minimal equipment.”

It’s a problem she largely attributes to politics — areas that tend not to vote for the party in government “aren’t prioritized.”

Moving forward, if government-run hospitals addressed some of the concerns raised in the survey, they could potentially convince hundreds of nurses to work locally instead of crossing the border. If they don’t, don’t be surprised to see more nurses continuing to cross the border in the future.

Also, going forward it is no longer just government-run hospitals that could potentially convince some of these nurses to work in Canada.

Remember, Premier Doug Ford announced in January how the Ontario government would be ramping up partnerships with private clinics to help reduce the surgical backlog.

Private clinics in Ontario could also soon give these nurses more choices in terms of where to work — perhaps offering nurses the types of work arrangement they told us they can’t find in government-run facilities — full-time work, steady hours, better pay, etc.

When many Windsor-based nurses originally decided to work in Detroit, there wasn’t much choice — work for the government or somewhere else.

Soon, they will continue to have more options. We believe that’s good for workers and patients.

Dom Lucyk is communications director for SecondStreet.org, a national watchdog group.

This column was originally published in The Windsor Star on April 22, 2023.

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.