The demand for healthcare professionals reached record levels during the COVID-19 pandemic. In the first quarter of 2023, the number of job vacancies in health occupations was 95,200, more than double the first quarter of 2020 (43,000) at the onset of the COVID-19 pandemic.
With demand exceeding supply, the challenges posed by staff shortages have invariably affected the workload and working conditions of healthcare workers.
A new study released today, “Quality of employment and labour market dynamics of healthcare workers during the COVID-19 pandemic,” reports on the employment experiences of healthcare workers during the pandemic. It focuses on workers in three broad occupational groups: nurses, personal support workers and care aides, and other health care workers (excluding physicians).
The study shows that compared with the pre-pandemic period, healthcare workers missed more workdays due to illness or disability, worked more overtime than ever before, and reported feeling more stressed at work. In addition, some expressed their intention to leave their job because of the heavy workload.
Work absences because of illness or disability increased among healthcare workers during the pandemic
Missing work due to personal illness or disability became more common during the pandemic, especially for healthcare workers who were required to treat patients with possible or known cases of COVID-19.
In 2020, work absences among healthcare employees reached their highest annual level since the late 1990s, with full-time healthcare employees missing an average of 17.6 days of work due to illness or disability. This is an increase of 3.4 days compared with 2019. The increase in absences was led by nurses, who missed an average of 19.5 days of work in 2020 (+4.9 days compared with 2019).
This was followed by a return to a pre-pandemic level of absences in 2021, only to rebound to an even higher number of absences in 2022. A peak of 18.0 absences per year among healthcare employees coincided with the emergence of the Omicron variant in 2022, which dwarfed all previous waves of COVID-19 in terms of the number of infections.
More healthcare employees are working long hours
The pandemic exacerbated existing difficulties in maintaining a sufficient workforce in the healthcare sector. Mitigating strategies included, among other things, temporarily reducing the number of services available, introducing alternative or complementary modes of service delivery, such as virtual health care services, and requiring staff to work additional hours.
Since 2019, the proportion of healthcare workers who reported working overtime increased each year. By 2022, 31.7% of full-time nurses and 18.2% of personal support workers and care aides put in additional hours over and above their scheduled paid hours. This includes both paid and unpaid overtime.
Moreover, among healthcare workers who reported working overtime, the number of hours worked increased. In 2022, nurses who reported working overtime worked on average an extra 8.6 hours per week above their normal schedule (+1.9 hours compared with 2019).
Working long hours—defined as working 49 hours per week or more—also increased significantly during the pandemic. In 2022, 7.9% of full-time healthcare employees reported working long hours, well above the proportion in 2019 (5.9%).
Nurses (9.5%) were the most likely to report working long hours in 2022, followed by personal support workers and care aides (7.5%), and other healthcare workers (6.9%).
The proportion of healthcare workers reporting long hours also varied according to their characteristics. For example, among healthcare workers, men (12.9%) were almost twice as likely as their female counterparts (6.6%) to work long hours, while workers in the public sector (9.2%) were significantly more likely to report working long hours than those in the private sector (6.1%).
High workload: A reason given by healthcare workers wanting to leave their jobs
The changes in employment quality among healthcare workers during the COVID-19 pandemic coincided with increased levels of stress and worsening mental health among these workers.
From September to November 2021, the majority (87%) of healthcare workers reported feeling more stressed at work compared with the pre-pandemic period. At 92%, nurses were most likely to feel more stressed at work, compared with personal support workers and care aides (83%) and other health care workers (83%).
Similarly, during the same period, 45% of healthcare workers reported poorer mental health compared with the pre-pandemic period, with nurses (52%) being more likely than other healthcare workers (44%) and personal support workers and care aides (34%) to report worsening mental health.
Meanwhile, some healthcare workers also expressed a desire to leave their current job. In August 2022, 11.2% of permanent healthcare workers reported that they intended to leave their positions within the next year, with little difference between occupational groups. Although this proportion was similar to that observed among permanent workers in non-health occupations (12.0%), the reasons for wanting to leave varied between healthcare workers and workers in non-health occupations.
Retirement (24.6%) and having too large a workload (20.7%) were the most common reasons reported by healthcare workers for intending to leave. Meanwhile, changing careers (26.2%), going back to school (17.5%) and low pay (15.7%) were the most common reasons cited by permanent workers in non-health occupations.
Among healthcare workers not intending to retire over the course of the following year, nurses were considerably more likely to cite being overworked as the main reason for intending to leave (41.6%) than personal support workers (23.5%), other healthcare workers (17.7%) and workers in non-health occupations (9.7%).
Little change in the proportion of healthcare workers who voluntarily left their job during the pandemic
Although many healthcare workers indicated their intention to leave their current position during the pandemic, the ability to make this change depends on a variety of personal factors, occupational considerations (e.g., tenure, pension) and local labour market conditions.
Indeed, the proportion of healthcare workers who voluntarily left their current jobs remained unchanged from its pre-pandemic rate.
Specifically, in 2020, the proportion of healthcare workers who left their job in a given month averaged 1.4%, unchanged from one year earlier. This rate was similar in 2021 (1.5%) and 2022 (1.4%) and remained close to historical levels for each of the healthcare occupational groups.
Note to readers
Data from the Labour Force Survey (LFS) and the Survey of Health Care Workers’ Experiences during the Pandemic were used in this study, with supporting information from the Survey of Employment, Payrolls and Hours and the Job Vacancy and Wage Survey.
In this study, healthcare professionals were split into three separate groups: 1-nurses, 2-personal support workers or care aides and 3-other healthcare workers.
Although physicians play an integral role in Canadian healthcare systems, they have been excluded from this study as they are more likely to be self-employed than other healthcare workers. As such, their job characteristics, such as compensation amount and structure, can be much different than those of other healthcare workers.
Days lost due to illness or disability are calculated by computing hours lost during the LFS reference week as a proportion of usual weekly hours for full-time paid workers, then multiplying by the estimated number of working days in a year (250).