Nursing Career Pathways

Nursing

Career

Pathways

Opportunities and Barriers

2023

Table of

contents

Introduction

Building nursing career pathways in Ontario

Ontario’s nursing workforce

Opportunities, barriers and recommendations

Nursing proles

Conclusion

Reference list

Appendix A: Ontario government supports for

nursing retention and recruitment

Appendix B: Nursing Career Pathways – RNAO consultations

Appendix C: Nursing Career Pathways explanatory notes

Appendix D: Canadian Nurses Association specialty chart

Nursing Career Pathways | 2023 3

Introduction

Nursing is a profession that has the power to inspire, attract and fulll people who

choose to care for the wellbeing of others with knowledge and compassion. Nurses

– the backbone of our health system – form the largest body of registered health

professionals in Ontario and Canada. They work across the health system in various

roles which together contribute to its effective functioning and the health of the

public.

A mature and sophisticated profession, nursing presents a world of opportunities for

new entrants. Countless educational and career pathways can be explored en route

to a wide range of nursing roles, specialties, areas of practice and health settings. This

report illustrates pathways to nursing and proles nurses working across the health

system. This report also provides context and data in support of recommendations to

widen and strengthen the pathways to nursing careers in Ontario.

The central role of nurses demands that governments and employers show – in

words and in deeds – robust and steady respect towards the nursing profession. Yet,

this has by and large not happened in a meaningful way for almost three decades

now.

The COVID-19 pandemic tipped our already-understaffed nursing workforce into a

deep crisis. Over the past three years, nurses across Ontario have selessly cared for

the people of Ontario while risking their own health and safety and that of their loved

ones. It has come at a cost. According to RNAO’s 2022 Nursing Through Crisis report,

Ontario’s nurses are experiencing depression, anxiety and stress as never before.

Seventy-ve per cent of nurses are burnt out. Sixty-nine per cent of the more than

5,000 nurses surveyed reported their intention to leave their nursing position within

ve years.

The nursing crisis has meant that the health system has fallen into distress both in

Ontario and across Canada. Emergency rooms and intensive care units have been

forced to close due to nursing shortages. Surgeries, procedures and treatments have

been cancelled and patient safety is put at risk. The crisis highlights the centrality of

nursing, the vital roles that nurses play across the system, and the need to care for

the people and the profession that cares for us.

The way to resolve this crisis is by making nursing an even more desirable profession

in Ontario, building the incentives to attract new nurses and retain existing nurses,

and enhance the pathways for nurses to expand their education, skills and roles.

Nursing Career Pathways | 2023 4

Building nursing career

pathways in Ontario

Ontario’s nursing workforce,

supported by an elaborate

education and licensing system,

is highly educated. The three

classications of nurses are rooted

in their level of foundational formal

education and entry-to-practice

licensing requirements.

The scope of practice of a nurse

expands with higher levels of

education, as does the ability

to care for unstable, complex

patients/clients. Registered

practical nurses (RPN) in Ontario

must earn a two-year diploma

in practical nursing. Registered

nurses (RN) must earn a bachelor

of science in nursing degree

(BScN) or bachelor of nursing

degree (BN). Nurse practitioners

(NP), also known as “RNs, extended

class,” must earn a master’s

degree and NP certicate.

In addition to earning academic

credentials, those who wish

to practise nursing in Ontario

must rst pass a licensing exam

and register with the province’s

regulatory body for nurses – the

College of Nurses of Ontario. Many

nurses return to the education

system during their careers to

attain higher levels of education

and pursue new roles in different

domains of practice.

Educational Pathways

After attaining a high school diploma,

prospective students can pursue any of the

following:

• A college-level personal support

worker (PSW) certicate would be the

educational pathway to become a PSW.

• Completion of a college-level practical

nursing diploma and RPN licensing

exam would be the pathway necessary

to become an RPN in Ontario.

• To become an RN in Ontario, the

educational pathway includes

attaining a bachelor’s degree in nursing

(for example: Standard, Generic,

Collaborative, Accelerated, Fast Track,

Advanced, Second-degree Entry,

Compressed, LPN to RN and RPN to RN,

Post-RN bachelor’s) and passing the

NCLEX examination.

After this step, RNs can choose to partake in

the following educational pathways.

• To become a master’s prepared RN

(including APNs and CNSs), a master’s

degree in nursing or applicable subject

is necessary.

• To become an NP, the educational

pathway would include a master’s

degree in nursing and an NP certicate,

as well as completion of an NP licensing

examination.

• Master’s prepared nurses can also

attain a doctoral degree (PhD, DN, DNP)

in nursing or another applicable subject.

Nursing career pathways: domains

High school/College

PSW

RPN RN (incl. 4,352 NPs)

Diploma

Certificate

Nursing

Other Other Other Other Other

Nursing Nursing/ Advanced

practice nursing

Research/

Policy

Clinical

administration

Clinical

administration

Senior clinical

administration

Senior clinical

administration

Executive

administration

Research/

Policy

Research/

Policy

Research/

Policy

Advanced

research/Policy

Nursing/clinical

education

Nursing/clinical

education

Nursing/clinical

education

Nursing/clinical

education

Nursing/clinical

education

Advanced practice

nursing

Advanced practice

nursing

RPN Exam RN NCLEX Master’s Degree NP Exam Doctorate

Diploma as PN BScN/BSN

5,180 (+851)

(6,104)(6,636)

61,482 (+1,984)

RPNs: 51,414

44,527 (86%)

503 (1%)

119 (1%)

1,164 (2%)

5,101 (10%)

77,515 (86%)

1,765 (2%)

429 (1%)

3,759 (4%)

6,480 (7%)

4,674 (49%)

1,387 (15%)

194 (2%)

1,817 (19%)

1,412 (15%)

3,650 (95%)

83 (2%)

3 (0.07%)

44 (1%)

59 (2%)

373 (41%)

351 (38%)

37 (4%)

64 (7%)

94 (10%)

RNs: 89,948 Master’s Prepared

RNs: 9,484

Nurse Practitioners:

3,839

Doctorate prepared RNs

(incl. 121 NPs): 919

127,110 (+2,174 RNs, +317 NPs)

(+551) (386) (+18)

300 (+109) 289 (+79) 20 (-8)

MScN/MN MN NP Doctorate (Nursing)

College-UniversityCollege University University University

Acronyms:

Exams for RPNs in Ontario:

Regulatory Exam – Practical Nurse (REx-PN)

Education

Number of nurses registered

with the CNO in 2022

Number of CNO applicants

who passed the licensing exam

(in the latest reported year)

Change in graduate-prepared

RNs (incl. NPs) working in Ontario

(over previous reported year)

Number of graduates with nursing degrees in the latest

reported year (and change over previous reported year)

Number of nurses

employed in Ontario

Functional specialities

Represented in blue: 155,604

Represented in brown: +569Represented in teal: 13,126

Represented in pink: 5,789 (+1031)

Represented in orange: 188,592

National Council Licensure Examination –

Registered Nurses (NCLEX-RN)

Adult-Gerontology Primary Care Nurse Practitioner Exam

Pediatric Primary Care Nurse Practitioner Exam

Canadian Nurse Practitioner Examination: Family/All Ages (CNPE:F/AA)

Exams for RNs in Ontario:

Exams for NPs. The NP candidate writes one of the following:

LEGEND

Graphic 1

Nursing Career Pathways | 2023 6

Nurses are most often associated with clinical roles. Clinical nursing roles are

characterized by the provision of nursing or advanced practice nursing care to

patients, clients and/or residents in a health-care setting or within the public health

sphere, including clinics, shelters, correctional facilities and more. Attaining a nursing

specialty certication is a preferred way for nurses practicing in the clinical domain

to engage in continuing education and professional development. The Canadian

Nurses Association (CNA) Certication program currently consists of 22 nursing

practice specialties, with 19 exams offered (Appendix D). Nurses in Ontario may also

choose to engage in further education to attain a specialty certicate in a specic

practice area. For example, some colleges and universities in Ontario offer continuing

professional development certicates for nurses to help them build their knowledge

and skills in areas such as critical care, surgeries and surgical care, obstetrics,

leadership and education.

Nurses can also advance their education to pursue different nursing designations.

RPNs often “bridge” to RN roles to expand their scope of clinical practice. Personal

support workers (PSW) may choose to bridge to nursing roles through continuing

education and licensing. While most nurses work as staff nurses, some choose to

attain a master’s degree in nursing and serve in advanced practice nursing and

clinical nurse specialist roles. These “master’s prepared” nurses contribute to the

health system in a variety of clinical roles:

• Clinical nurse specialists (CNS) hold a master’s degree or doctorate from a

nursing program and develop expertise in a clinical nursing specialty, providing

specialized care for clients with highly complex needs.

• NPs hold at minimum a master’s degree in nursing and an NP certicate, and

are authorized to diagnose, order and interpret diagnostic tests, and prescribe

medications and other treatments.

The expertise of nurses in all clinical roles advances quality health outcomes for

Ontarians and for our health system.

Nurses may decide to attain master’s degrees or doctorate-level degrees – whether

a PhD or doctorate of nursing (DN), a doctorate of nursing practice (DNP) in nursing,

or a graduate degree in a related discipline:

• PhD studies help nurses develop high-level leadership, analytical and research

skills needed to address complex clinical, theoretical, and health-system issues,

as well as advance the boundaries of nursing knowledge.

• DN/DNP studies are focused on applying research knowledge to positively

impact nursing practice, clinical innovations, care delivery, nursing education

and the health-care system.

Nursing career pathways: sectors

High school/College College-UniversityCollege University University University

PSW

RPN

RN (incl. 4,352 NPs)

61,482 (+1,984)

127,110 (+2,174 RNs, +317 NPs)

RPNs: 51,414

21,933 (42.7%)

3,101 (6%)

846 (1.6%)

4,473 (8.7%)

3,674 (7.1%)

12,553 (24.4%)

3,329 (6.5%)

318 (0.6%)

107 (0.2%)

1,080 (2.1%)

59,416 (66%)

3,483 (3.9%)

4,574 (5.1%)

7,673 (8.5%)

5,015 (5.6%)

6,305 (7%)

294 (0.3%)

847 (0.9%)

1,066 (1.2%)

1,275 (1.4%)

4,911 (52%)

301 (3%)

898 (10%)

693 (7%)

659 (7%)

454 (5%)

26 (0.3%)

960 (10%)

397 (4%)

185 (2%)

1,418 (37%)

1,484 (39%)

49 (1%)

224 (6%)

322 (8%)

126 (3%)

11 (0.3%)

85 (2%)

24 (0.6%)

96 (3%)

268 (29.2%)

42 (4.6%)

20 (2.2%)

45 (4.9%)

78 (8.5%)

43 (4.7%)

3 (0.3%)

371 (40.3%)

22 (2.4%)

27 (2.9%)

RNs: 89,948 Master’s Prepared

RNs: 9,484

Nurse Practitioners:

3,839

Doctorate prepared RNs

(incl. 121 NPs): 919

Diploma

Certificate RPN Exam RN NCLEX Master’s Degree NP Exam Doctorate

Diploma as PN BScN/BSN MScN/MN MN NP Doctorate (Nursing)

5,180 (+851)

(6,104)(6,636) (+551) (386) (+18)

300 (+109) 289 (+79) 20 (-8)

Other

Hospital

Primary Care Primary Care Primary Care Primary Care Primary Care

Public Health Public Health Public Health Public Health Public Health

Hospital Hospital Hospital Hospital

Government/

Professional

Organization

Home and

Community Care

Other

community

Other

commuanity

Other

community

Other

community

Other

community

Long-Term

Care Facility

Long-Term

Care Facility

Long-Term

Care Facility

Long-Term

Care Facility

Long-Term

Care Facility

Retirement

Home

Retirement

Home

Retirement

Home

Retirement

Home

Retirement

Home

College/

University

College/

University

College/

University

College/

University

College/

University

Home and

Community Care

Home and

Community Care

Home and

Community Care

Home and

Community Care

Government/

Professional

Organization

Government/

Professional

Organization

Government/

Professional

Organization

Government/

Professional

Organization

Other Other Other Other

Graphic 2

Nursing Career Pathways | 2023 8

While most nurses prepared at the master’s and doctorate levels remain in clinical

nursing roles, a growing proportion work within the education, research, policy

and administrative domains. Nursing administrative positions span from middle

management roles to executive positions – they include manager, director, chief

nursing executive, chief nurse ofcer and more.

Nursing expertise in leadership roles is paramount in all domains of practice. Nurse

leaders serve as a voice for nursing within health-care settings, providing a health-

focused perspective. They direct attention to social and environmental determinants

of health, inspiring evidence-based practice and improving health outcomes,

shaping healthy work environments, transforming health policies, and advancing

health systems.

Nurses also contribute to bettering the health system and nursing profession

through research and policy roles. The expert research and analytical skills of nurse

researchers and policy analysts help advance nursing science, nursing education,

health policy and health outcomes – through robust evidence, innovative programs

and policy work.

Education is a crucial domain of nursing practice. The next generation of nurses

depends on an adequate supply of high-quality nurse educators to provide nursing

education in clinical and academic settings.

Nurses working in all domains and roles can be found across multiple settings in

the health system. These include public health, primary care, hospitals, home and

community care, long-term care, retirement homes, colleges and universities,

government and professional associations and many other settings. Regardless

of setting and role, nurses draw on their nursing knowledge, skills, and judgment to

provide expert care and services to persons, communities and the health system.

Effective functioning of a health system that provides access to all in Ontario requires

nurses be engaged vibrantly across all health sectors and systems of care.

Nursing Career Pathways | 2023 9

Ontario’s nursing workforce

The College of Nurses of Ontario (CNO) is the regulatory body for nurses in Ontario.

Nurses must be registered and in good standing with the CNO to practise nursing

in Ontario. Data from the CNO provides insight regarding the nursing workforce in

Ontario, allowing workforce trends to be monitored. Such monitoring is crucial in the

context of the Ontario nursing crisis.

Not all CNO registrants, however, are currently participating in Ontario’s nursing

workforce. At present, this group, encompassing nearly 18 per cent of CNO

registrants, includes:

• nurses in the “non-practising class”

• nurses working outside of Ontario

• nurses who are seeking employment in nursing

• nurses who are not seeking employment in nursing

• nurses who are on leave

Source: CNO (2022b).

CNO

registrants

RPN

Grand total

16.4%

18.4%

17.5%

51,414

100,230 RNs (including

9,484 Master’s prepared

and 798 PhD prepared)

3,960 NPs (including

121 PhD prepared)

155,604

61,482

122,758

4,352

188,592

+1,984

+2,174

+317

+4,475

Total registrants

(including registrants

in the non-practising

class, as of 2022)

Number of registrants

who are employed in

nursing in Ontario (2022)

Proportion of

registrants who are

not practising nursing

in Ontario (2022)

Change

from 2021

Nurses registered to practise in Ontario

Nursing Career Pathways | 2023 10

The percentage of CNO registrants not engaged in Ontario’s nursing workforce has

consistently risen over the years, showing that an increasing proportion of nurses

registered in Ontario are choosing not to practise nursing in Ontario.

This is contributing to Ontario’s present nursing crisis where we nd ourselves with

a growing number of nursing vacancies. In fact, according to Statistics Canada,

RN and RPN vacancies – and the number of Ontario nursing vacancies that have

remained unlled for 90 days or more – have more than doubled since the start of

the pandemic.

Indeed, Ontario entered the COVID-19 pandemic nearly 22,000 RNs short of the rest of

Canada on a per-capita basis. Over the course of the pandemic, this gap has grown

to 24,000 RNs. This means Ontario would need 24,000 more RNs to bring the province

to the same RN-per-population ratio as the rest of Canada.

Source: Statistics Canada (2022a).

Job vacancies

2000

4000

6000

8000

10000

Q2 2021

Q1 2021

Q4 2021

Q1 2022

Q2 2022

Q3 2022

Q3 2021

Q4 2020

Q3 2020

Q2 2020

Q1 2020

Q4 2019

Q3 2019

Q2 2019

Q1 2019

Q4 2018

Q3 2018

Q2 2018

Q1 2018

Q4 2017

Q3 2017

Q2 2017

Q1 2017

Q4 2016

Q3 2016

Q2 2016

Q1 2016

Q4 2015

Q3 2015

Q2 2015

RN 90+ day vacancy growth

RN vacancy numbers over time

RPN 90+ day vacancy growth

RPN vacancy numbers over time

Ontario RN and RPN vacancies

Nursing Career Pathways | 2023 11

Moreover, when comparing sector-specic RN-per-population ratios with the rest

of Canada, Ontario’s ratio of RNs is lower than the rest of Canada for every sector.

Overall, the Ontario RN-per-population ratio in 2020 was 80.6 per cent of the average

for the rest of Canada, but it varied by sector. The ratio was slightly higher in the

hospital sector and the community sector, while the gap is very large in the LTC/

retirement home sector and other sectors.

Source: Calculation by RNAO. RN statistics from Canadian Institute for Health

Information (2022). Population statistics from Statistics Canada (2022b).

Ontario leads or deficits for RNs, NPs and RPNs

2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

RNs NPs RPNs

-25,000

-20,000

-15,000

-10,000

-5,000

5000

10,000

Nursing Career Pathways | 2023 12

If we want to address the nursing crisis in Ontario, the rst task is to tackle the barriers

standing in the way of retaining and recruiting nurses and advancing their career

pathways. Policymakers should start by addressing the barriers to retention, including

compensation and workloads. They must also leverage opportunities to pave the way

for a brighter future for nursing in Ontario. This is the only way to emerge from this

crisis with a stronger nursing profession and health system.

The recommendations that follow will bring about transformational change to

Ontario’s nursing profession and health system, if implemented.

Source: Calculation by RNAO. RN statistics from Canadian Institute for Health

Information (2022). Population statistics from Statistics Canada (2022b).

RN crisis in Ontario: sector-specific data

Hospital Community Health Nursing Homes/

Retirement Homes

Other

50%

100%

150%

The rest of Canada’s

RN-per-population ratio

Ontario’s percentage

of Canada’s average

83.6% 85.1% 69.9% 73.5%

Nursing Career Pathways | 2023 13

BARRIER B1: Compensation

• The income of nurses, in real terms, has been in decline since 2010 and dropped

precipitously due to government wage restraint legislation and historically high

ination.

• There are signicant wage disparities within and between nursing classications,

and across different sectors.

• Wage compression within the profession discourages nurses from assuming

the responsibilities and accountabilities associated with higher nursing

classications.

Sources: Ontario Nurses’ Association (2021), page 89, Article 19; Statistics Canada (2023), Table

18-10-0005-01; Bank of Canada (2023), page 9, Table 1.

Opportunities, barriers

and recommendations

See graphic 3 on page 14

First year staff nurse real hourly wages in 2022 dollars

April 1 201

April 1 2011

April 1 2012

April 1 2013

April 1 2014

April 1 2015

April 1 2016

April 1 2017

April 1 2018

April 1 2019

April 1 202

April 1 2021

March 3 202

(forecasted)

$32

$33

$34

$35

$36

$37

$38

$39

$40

Real (2022$)

Nursing career pathways:

opportunities and barriers

Entry pool: General Population | Internationally Educated Nurses | Pre-Qualified Candidates

Re-entry pool: Non-Registered Nurses (Retired | Resigned | Not Renewed)

O6 O6 O6 O6 O6 O6O8 O8 O8 O8 O8 O8

O1 O1

B1 B2 O2 O3 O8

O7 O7

O8O8 O8

O5 O8

High school/

College

College-

University

College University University University

Diploma Diploma as PN BScN/BSN MScN/MN MN NP

Doctorate

(Nursing)

PSW

Retention Recruitment

O3: Increase career

development opportunities

O6: Expand nursing

education pathways

B1: Compensation B2: Workloads

O1: Provide mentorship

supports

O2: Provide leadership

training

O5: Increase nursing education

seats and funding

O4: Register internationally

educated nurses

O8: Eliminate racism and

discrimination

O7: Return nurses to

the workforce

O=Opportunity B=Barrier

RPN registrants RN and NP registrants

NURSING WORKFORCE

LEGEND

Graphic 3

Nursing Career Pathways | 2023 15

Inadequate compensation has been identied as a signicant barrier to nurse

retention in several recent large-scale reports (Ben Ahmed and Bourgeault, 2022;

RNAO, 2022; Tomblin Murphy et al., 2022). The enormous stress of the COVID-19

pandemic, combined with the disdain of the Ontario government embodied in Bill 124,

has caused a serious nursing retention issue in Ontario. That issue has been further

compounded by the government’s appeal of the Superior Court decision declaring

Bill 124 to be “void and of no effect.”

Low salaries offered to NPs, in addition to the drastic shortage of RN support, has

made it difcult to attract NPs into sectors and roles where they are needed such

as long-term care and corrections. And government increases to PSW wages, while

fully warranted, have narrowed the gap between PSW and RPN salaries, creating a

disincentive for RPNs to continue assuming the professional liabilities associated with

nursing.

We note that these long-standing compensation issues affect not only individual

nurses, but entire sectors of their practice. For example, organizations representing

the Ontario home care and long-term care sectors have called for wage parity

as a key recruitment and retention factor for nurses in these sectors (Home Care

Ontario 2022; Ontario Community Support Association, 2022; AdvantAge Ontario,

2023). This issue predates the current century, as evidenced by the landmark report,

Good Nursing, Good Health: An Investment for the 21st Century: “Salary differentials

compared with other sectors, mainly reported in home care sector and also in LTC, is

a signicant retention and recruitment impediment” (Strelioff et al., 1999).

• Increase compensation for Ontario nurses in all roles, domains and

sectors so it is competitive with compensation in other jurisdictions,

including the U.S.

• Address pay disparities among nurses working in different sectors,

including home care and long-term care, by harmonizing their

compensation upwards.

RECOMMENDATIONS:

Nursing Career Pathways | 2023 16

BARRIER B2: Workloads

The long-standing and detrimental impact of RN understafng on patient care and

nurse wellness is well-documented in several national surveys. As far back as 2005,

data from Statistics Canada showed that a high percentage of nurses experienced

work overload, preventing them from providing high-quality care (Statistics Canada,

2005). Results from comprehensive surveys reported in Nursing Through Crisis (RNAO,

2022) demonstrate that nurses are being confronted with heavier workloads than

ever before, which is contributing to increasing burnout, stress, depression, anxiety,

and turnover. When Canadian nurses were asked about work-related concerns

resulting from the pandemic, their most frequently identied concerns were stafng

levels, skills mix and managing workload.

Personal concerns: Per cent “moderately or extremely concerned”

60.3%

68.3%

53.8% 53.3%

expressed concerns about

stafng levels (number of

staff/ratios of staff to

patients/clients)

The top retention factor was

better workplace supports

expressed concerns about

skills mix (number/ratios

of the right kinds of staff)

expressed concern about

managing workload

Nurses who were moderately or extremely concerned about stafng levels, skills

mix and workload had signicantly higher scores for depression, anxiety, stress,

disengagement and exhaustion, compared with those who were not at all, slightly or

somewhat concerned across the three work factors. Further, the top retention factors

for nurses planning to leave the profession were better workplace supports (68.3 per

cent) and reduced workloads (63.3 per cent).

Other retention factors:

63.3%

58.3% 55.4% 43.4%

Reduced workload

Ability to adjust

work schedules

Improved benets Better career

development opportunities

See graphic 3 on page 14

Nursing Career Pathways | 2023 17

RECOMMENDATIONS:

• Ensure safe and healthy workloads for nurses by increasing nurse stafng

and supports across all sectors.

• Implement evidence-based recommendations to retain and recruit

nurses by providing full-time employment, mentorship and professional

development, occupational health and safety measures and

enforcement, as well as safe workloads.

OPPORTUNITY O1: Provide mentorship supports

According to Nursing Through Crisis (RNAO, 2022):

• 21.5 per cent of potential nurse retirees indicated that more mentoring

opportunities and spending less time in direct care might persuade them to stay

in the profession.

• 24.5 per cent of nurses reported that better access to mentoring might keep

them from leaving the profession.

Report ndings also highlighted that early-career nurses are particularly vulnerable

to turnover. However, the risk of turnover can be mitigated through effective transition

supports such as mentorship. The following recommendation from the 1999 report

Good Nursing, Good Health, reinforces the need for improved transition supports for

new nurses: “Provide sufcient nancial resources to employers to provide time and

opportunities for experienced nurses to teach new nurses” (Strelioff et al. 1999).

See graphic 3 on page 14

Nursing Career Pathways | 2023 18

RECOMMENDATIONS:

• Expand the Nursing Graduate Guarantee (NGG) to include all new nursing

registrants in Ontario and internationally educated nurses (IEN).

• Reinstate the Late Career Nurse Initiative (LCNI), and encourage recently

retired nurses to return as mentors for new graduates.

Upon the inception of the NGG program in 2007, the Ontario government invested $89

million to benet up to 4,000 new nursing graduates in Ontario. Funding allocations

for this program have dropped signicantly, with only 1,019 new nurses benetting

from the NGG program in 2021-2022.

The ministry of health has indicated that the LCNI is no longer being offered at this

time, despite public commitments from the current government to reinstate this

initiative.

In addition to the above policy priorities, RNAO has created programming to make

mentorship opportunities available to all nurses as they progress through their

careers to ensure supportive experiences. RNAO has also created a “health and

wellbeing” stream of its Advanced Clinical Practice Fellowship (ACPF), through which

RN or NP participants can focus on promoting wellbeing and creating a healthy work

environment, improving retention or recruitment of nurses, or providing mentorship or

support for new staff.

OPPORTUNITY O2: Provide leadership training

Nurses who are in current or prospective leadership roles must have access to

training, to ensure that they are able to effectively lead their teams (Ben Ahmed

and Bourgeault, 2022; RNAO, 2022). According to Nursing Through Crisis, different

perceptions between front-line nurses and their management counterparts

regarding workplace control and support reinforce the need for leadership programs.

Such programs must enable management to better understand the needs of front-

line nurses, leading to greater retention (RNAO, 2022).

See graphic 3 on page 14

Nursing Career Pathways | 2023 19

RECOMMENDATION:

• Provide nurse leaders with leadership training and supports.

In 2022, RNAO launched a series of nursing leadership programs intended to provide

the skills needed to lead in the context of nursing human resource constraints.

The rst virtual Leadership and Management for Nurses Program was made open

to RNs, NPs and RPNs in managerial roles in Ontario hospital or long-term care

settings. The program serves to enhance key knowledge and skills to achieve goals,

support shared decision-making and create healthy work environments and team

functioning.

OPPORTUNITY O3: Increase career development opportunities

There is considerable evidence linking continuing education and professional

development opportunities to improved nurse retention. According to Nursing

Through Crisis, 43.4 per cent of nurse participants who indicated that they were

planning to leave the profession cited “better career development opportunities” as

a key retention factor (RNAO, 2022). Moreover, expanding scope of practice for RNs

and NPs and scaling out innovative models of care would provide meaningful career

development opportunities for nurses. Unfortunately, RNs and NPs face legislative and

regulatory barriers that prevent them from functioning to their full scope (RNAO, 2019;

RNAO, 2021).

Nurses also often face challenges when attempting to further their education,

including tuition and other education-related costs, work and family obligations, time

commitments and lack of funding resources. This can be evidenced by the fact that

there were 6,587 Ontario nurses with a CNA specialty certication in 2021 (Appendix

D), representing only four per cent of Ontario’s workforce. Nurses have expressed that

access to accessible and funded continuing education opportunities would inuence

their decision to migrate to another province (Lalonde et al., 2013). In the context of

heavy workloads, increasing patient acuity, long hours and overtime, nurses feel

they need to be compensated for the time and expenses associated with continuing

education activities (Lalonde et al., 2013).

See graphic 3 on page 14

Nursing Career Pathways | 2023 20

RECOMMENDATIONS:

RECOMMENDATION:

• Expand RN scope of practice to include RN prescribing.

• Expand NP scope of practice and innovative models of care, including

more NP-led clinics.

• Increase funding and resources for nurses to pursue continuing education,

professional development and nursing specialty certications.

• Provide nurses with time off, exible work scheduling and compensation

when pursuing continuing education.

• Continue to implement policies and programs to ensure IENs who reside in

Canada and want to practise in Ontario are registered with the CNO in a

timely manner.

OPPORTUNITY O4: Register internationally educated nurses

RNAO’s analysis of the Fairness Commissioner’s Fair Registration Practices Report

2020 showed a backlog of up to 26,000 IEN applications with the CNO in 2020. RNAO

has long urged the CNO to adopt a more streamlined approach to process IEN

applications of nurses who are already in Canada – one that avoids the international

recruitment or “poaching” of nurses that has caused much harm in disadvantaged

regions of the world (World Health Organization, 2020). RNAO’s advocacy, especially

over the past couple of years, has been instrumental in inuencing the government

and the CNO to make signicant efforts to improve registration processes for IENs in

2022. According to CNO data, 4,942 new IEN registrants have been registered with the

CNO over the past 12 months (as of Feb. 1, 2023) while 5,965 IENs are still in the CNO

applicant queue (CNO, 2023a; CNO, 2023b).

See graphic 3 on page 14

Nursing Career Pathways | 2023 21

OPPORTUNITY O5: Increase nursing education seats and funding

Multiple nursing schools in Ontario have cited an increase in applications, indicating

that there is a large potential pool of future nurses that could be recruited into

the profession. Recruitment of new nurses must be of great priority in Ontario, to

address the ongoing nursing human resources crisis in the province. To leverage the

increased interest in nursing education in Ontario, we must make concerted efforts to

further expand the enrolment capacity of domestic nursing schools.

RECOMMENDATIONS:

• Increase the supply of RNs by further increasing enrolments and funding

for four-year baccalaureate nursing programs, second entry/compressed

programs and RPN-to-RN bridging programs by 10 per cent per year for

ve years.

• Compress the RPN-to-BScN bridging programs to two years.

• Support faculty retention and recruitment in both college and university

programs as a critical strategy to increase the RN supply in Ontario.

• Increase the supply of masters and PhD/DNP/DN-prepared RNs by

increasing enrolments and funding for these nursing programs.

• Increase the supply of NPs by increasing the funding and capacity for

student-NP seats and associated program costs. This should include

enabling more NPs to be prepared at the PhD/DNP/DN levels for faculty

support.

• Support a 50 per cent increase in the number of NPs by 2030 as set out in

RNAO’s 2021 NP Task Force report, Vision for Tomorrow.

See graphic 3 on page 14

Nursing Career Pathways | 2023 22

Due to the nancial and personal costs associated with pursuing advanced

education, and the need for more graduate-prepared nurses, we urge the

government to provide fully-funded tuition packages for all types of nursing

programs, with special priority for MN-NP, MN/MScN and doctoral nursing programs.

These funding packages should include full tuition and an annual stipend or salary

for the duration of the studies (Johnson, 2021). See appendix A on page 35 for existing

government pledges and commitments for nursing education.

OPPORTUNITY O6: Expand nursing education pathways

We have the opportunity in Ontario to capitalize on the eagerness of many nurses,

throughout their careers, to return to the education system in pursuit of deeper

knowledge, additional skills and more advanced roles in the health system. Some

international jurisdictions offer a wider variety of compressed and accelerated

education pathways than Ontario, allowing nurses to bridge between nursing

classications and/or advance their education, skills and training. Ontario could be

at risk of losing nurses due to the greater accessibility of education pathways in other

countries. Ontario has the capacity to offer these opportunities in the province.

RECOMMENDATION:

• Develop expanded and optimized nursing education pathways similar to

the U.S. and other countries to encourage nurses to advance their nursing

education and careers in Ontario.

See graphic 3 on page 14

Nursing Career Pathways | 2023 23

14,900 3,618 5,596

3,005 5,869

“non-practising

class”

working outside

of Ontario

seeking nursing

employment

not seeking nursing

employment

on leave

RECOMMENDATION:

• Establish a “Return to Nursing Now” program to attract CNO registrants

back into Ontario’s nursing workforce.

OPPORTUNITY O7: Return nurses to the workforce

As of 2021/2022, there were 10,068 RPNs, 22,528 RNs, and 392 NPs registered with CNO

as “non-practising” or otherwise not employed in nursing in Ontario (CNO, 2022b).

These people – 32,988 in total – represent a pool of nurses who could potentially be

brought back into the nursing workforce by putting into place effective retention and

recruitment policies and programs:

See graphic 3 on page 14

Nursing Career Pathways | 2023 24

OPPORTUNITY O8: Eliminate racism and discrimination

Racism and discrimination form a public health crisis that contributes to health

and socio-economic disparities across Ontario. Systemic racism and all forms of

discrimination exist, too, within the nursing profession. RNAO’s Black Nurses Task Force

report addressed in detail the microaggressions and discrimination experienced by

Black nurses from colleagues, patients, families and superiors – in both workplace

and academic settings – and the profound impact it has on their lives and careers.

Black nurses are not alone in confronting systemic racism and discrimination in

the profession. Other racialized nurses, Indigenous nurses and 2SLGBTQI+ people

have also historically experienced, and continue to experience, discrimination and

prejudice in the nursing profession and the health system.

For all nurses in these groups, racism and discrimination exist as foundational barriers

to educational and career pathways to other roles and sectors and to educational

attainment, professional development and career advancement. They also exist

as barriers to health in the workplace. We know from our evidence-based guideline

development work that, just as safe and inclusive environments are needed to enable

nurses to optimize health outcomes for those receiving care, so are safe and inclusive

environments essential to the health, wellbeing and dignity of those providing that

care.

The current nursing and health system crisis presents an opportunity to build nursing

careers in Ontario. That opportunity, properly and fully realized, means ridding

the nursing profession – its organizations, regulatory bodies, associations and the

broader health system – of systemic racism and discrimination in all its forms.

The barriers identied in this report – compensation and workload – may also

disproportionately affect those impacted by systemic racism and discrimination

in Ontario. These barriers will only be fully dismantled when compensation and

workloads are equitably distributed within the profession. Similarly, all pathways

through the education system and into and out of sectors and roles must be open to

all nurses and ensure diversity, equity and inclusion (DEI) in the nursing profession.

See graphic 3 on page 14

Nursing Career Pathways | 2023 25

RECOMMENDATIONS:

• Mandate the collection of race-based data by the CNO.

• Provide cultural safety education and awareness building at individual,

organizational and policy levels.

• Incorporate DEI principles in all health human resources policies to ensure

fair and equitable access to educational opportunities, professional

development and career advancement potential.

• Ensure programs that support DEI, such as mentorship, are available in all

workplaces.

Nursing Career Pathways | 2023 26

Nursing proles

The public most often associates nurses with clinical roles and bedside care. Yet,

nursing is a mature, diverse and sophisticated profession with countless educational

and career pathways to explore. With such a variety of career routes and roles, nurses

form the backbone of our health system. These proled health-care workers are just a

few of the unheralded tens-of-thousands who ensure that Ontarians receive the care

they need:

BScN student

George Brown and Toronto Metropolitan University

Diana

Mugambi

I am a second-year BScN student in the collaborative program at George

Brown and Toronto Metropolitan University. I initially started working as a

personal support worker to earn an income to support myself as a 21-year-

old who had just immigrated to Canada. I am grateful for the eight years

of experience I had while working as a PSW because they stirred within me

a passion to further my career in nursing. I discovered my desire to bring

tangible change in human lives. People often ask what’s like transitioning

from a PSW to a baccalaureate program and my simplest answer is that

passion breaks all barriers.

RPN

Clinical Lead for Pain and Palliative Care

Fairview Lodge, Whitby

Jennifer Ferris

When given the clinical lead position for pain and palliative care at Fairview

Lodge, I thought the universe was aligning for me. After losing close family

members, I made a personal commitment to ensure my residents receive

the best possible care and that their families feel supported. As a nurse,

palliative care became a passion for me. There is joy in knowing I have done

everything possible to manage pain and to provide honourable, dignied

and respectful care. Our role as nurses is to learn, improve, listen, and

always be open to feedback from our interprofessional colleagues.

Nursing Career Pathways | 2023 27

RN, BScN, CCU course

Critical Care Unit nurse

Michael Garron Hospital, Toronto

Marilou Ahmad

“I want to be a nurse someday,” I wished as a girl, inspired by nurses in

their white uniform and nursing cap. My dream came true when my father

enrolled me in nursing school in the Philippines. Interacting with people

physically, emotionally and psychologically is exciting, scary and frustrating

at times – but I found my true potential and strength in serving others.

As a bedside nurse for 35 years – 20 in Ontario – the greatest reward has

been making a difference in people’s lives. Later in my career I took on the

challenging role of critical care RN. The responsibility of caring for acute

cardiac patients and others with life-threatening conditions is enormously

rewarding and inspiring. This is my dream fullled – I will always be proud to

be a nurse!

RN, MN, PNC(C)

Yonge Street Mission, Toronto

Clinical Nurse Specialist

Women’s and Infants’ Health Program at Mount Sinai Hospital

Marisa

Bannavong

Emily Fung

I was initially inspired to pursue a career in nursing during a co-op

placement. After becoming an RN, I discovered my love for community care

through a volunteer role at a non-prot organization. I now work there as a

primary care RN providing direct quality care to street-involved, homeless

youth and their families. Being able to offer access to free health services

helps reduce some of the cost to our health-care system. Each day, my

patients inspire, teach and motivate me with their courage and resilience. I

wish to see the nursing profession as a whole continue to grow in size, unity

and impact.

My consolidation placement changed my idea of a nursing career and I

was passionately enthralled in the perinatal eld. Working in an acute-care

academic hospital allowed me to explore opportunities that bridge the

gap between evidence-based best practices and patient care. Therefore, I

pursued my MN to be a change agent in the health system as an advanced

practice nurse. My interests in advancing the quality and safety of care for

patients and families, and in empowering staff to provide this holistic care,

led me to my current role. I hope that nurses continue to strive for excellence

in health care.

Nursing Career Pathways | 2023 28

Safer Opioid Supply Clinical Lead

Parkdale Queen West Community Health Centre, Toronto

Marysia (Mish)

Waraksa

I’m an NP providing primary care and harm reduction services to people

who use drugs and are at high risk for opioid overdose. I prescribe

medications to help people reduce their use of street opioids and use

drugs more safely. What I love most about my job: being able to connect

people who face immense barriers and stigma to care that feels welcoming

and safe. I believe NPs provide high quality care, bringing their unique

skills, perspectives and front-line nursing experience to primary care. We

excel at helping patients navigate health system challenges and building

interprofessional bridges in care. My wish for our profession: to expand

the use of nurses and NPs to improve access to primary care across the

province.

RN, BScN, MN

Nursing Policy Analyst

Registered Nurses’ Association of Ontario

Christina

Pullano

RNAO’s Mind the Safety Gap report inspired my love for health policy and

opened my eyes to the many public policy issues impacting our profession

and health system. Every day I put my master’s of nursing, informed by

experience at the bedside as an RN, to work to determine how to improve

the system for those who use it and those who work in it. I’m a data fanatic

and love the pursuit of evidence to support change in care delivery. I want

to see more nurses in our system so that the job becomes safer for patients

and healthier for nurses.

NP-PHC, MN

Nurse Practitioner

Palliative Care Consult Team, Sarnia-Lambton County

Gabrielle Heil

I am an Indigenous woman and a member of Oneida Nation of the Thames.

I am grateful to have the opportunity to connect with patients to help

them live as well as possible, for as long as possible. When faced with

terminal and/or progressive diagnoses, people often search for spiritual

connection. Being an Indigenous woman, I know how important spirituality

is to one’s wholistic health, and I love being able to explore spirituality with

my patients. I am privileged to be teaching an Indigenous health course

at Western University, where I educate future RNs to provide culturally-safe

care and encourage them to advocate for anti-racist structures, policies

and legislation. It is such an honour to be able to incorporate both these

passions in my work as an NP.

Nursing Career Pathways | 2023 29

RN, PhD, FCAN

Associate Professor and Director

Arthur Labatt Family School of Nursing, Western University, London

Victoria Smye

I have been an academic since 2001 when I left the clinical practice domain

to join the faculty at the University of Victoria’s School of Nursing. It is my

view that health equity is nursing’s social mandate for the 21st century. My

current role as an academic and director of a school of nursing provides me

with a unique opportunity to help achieve this mandate. It is a challenging

but incredibly exciting time for nursing. Research, expanding nursing

education and working collaboratively for transformative change in the

nursing education, practice and policy domains energize me AND it is a

great privilege to do this work alongside so many wonderful people.

RN, MSc., MBA

President and CEO

Northumberland Hills Hospital

Susan Walsh

I became a nurse out of love for human sciences and a deep desire to have

a purpose-driven life. Today, as a RN, a hospital president and CEO, my focus

remains the same – driven by purpose, with an eye on ensuring systemic

impact. I know that by creating the right inputs and providing a healthy

work environment, we directly and indirectly impact the lives of many. As a

hospital CEO, I never forget the privilege that comes with being an RN and

our duty to provide high-quality trusted care with knowledge, empathy and

dignity for all.

RN, BScN, MN

Manager of Professional Practice & IPAC Lead

VHA Home HealthCare

Matt Wong

I didn’t always know that I wanted to be a nurse. Part of me felt destined for

a high-paced business environment where strategic decisions translate

to operational success. My BScN studies challenged my preconceived

notions of the nursing profession, fuelling my passion. As a novice nurse, an

inquisitive nature for how/why nursing practice decisions were made led me

to complete my MN. As an advance practice nurse, I support patient safety

through education, policies, procedures and models of care that maximize

nurses working to full scope. I love being able to impact practice and create

environments where nurses’ desire to provide optimal patient care can

thrive. My wish for nursing is to continued advocacy for a seat at every

decision-making table – the nursing perspective is essential to health-care

transformation.

Nursing Career Pathways | 2023 30

Conclusion

Nurses hold the key to addressing our current health-care crisis – but only if our crisis

in nursing is rst resolved. Because nursing is a caring profession, we sometimes

forget that nurses, too, need nurturing. They need access to education, healthy work

environments and workplace supports to continue fullling their vital roles.

We’ve outlined important opportunities to begin rebuilding careers in nursing in

Ontario and enhancing the pathways to the diverse roles that nurses fulll in our

health system. We must take proactive steps and allocate the funds needed to clear

away the barriers to entering and staying in nursing.

We have provided a snapshot of nursing career pathways and the current state of

nursing in Ontario. RNAO’s purpose is to inspire those who want to join the profession

and those who are immersed in it day-to-day to continue and advance in their

career journey. RNAO also expects to motivate those in a position of inuence to effect

change and address the nursing crisis. Systemic change is required – to open nursing

seats, doors and other opportunities, as well as provide supports and funding to those

who want to become a nurse or who are nurses already. The goal of nurses is to keep

Ontarians healthy. Your goal – policymakers – is to provide nurses with the resources

and tools they require to fulll and thrive in their jobs. Nurses – and Ontarians’ health

– deserve nothing less.

Nursing Career Pathways | 2023 31

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Nursing Career Pathways | 2023 34

Current Ontario government programs available in nursing:

• Community Commitment Program for Nurses (CCPN)

This program provides $25,000 in grant funding to eligible RNs, RPNs and NPs,

in exchange for a two-year commitment from them to work for an eligible

employer in the hospital, long-term care, home and community care, primary

care, or mental health and addiction setting in an area of need within Ontario.

• Advanced Clinical Practice Fellowships

This program provides opportunities for registered nurses (RN) and nurse

practitioners (NP) to advance projects that will meet a need or gap in service

within their organizations. The standard nancial contribution for each fellowship

is $20,000 –$15,000 provided by RNAO through funding from the government of

Ontario and a minimum of $5,000 in funding from the organization sponsoring

the fellow.

• Learn and Stay program for tuition funding

This grant program provides funding (free tuition, compulsory fees, books, other

direct educational costs) for students studying in priority programs (including

practical nursing, bachelor in nursing/bachelor of science in nursing, master’s

programs in nursing and postgraduate nursing diploma programs) in priority

communities in Ontario. This program requires recipients to learn and work in the

region where they study (minimum of six months for every year of study funded

by the grant).

• Nursing Education Initiative

This program accepts applications from RNs, NPs and RPNs registered to practise

in Ontario and employed in a ministry of health and long-term care priority area

for grants of up to $1,500 per year to support their education and professional

development.

• Tuition support for nurses

This program provides tuition reimbursement to recent nursing graduates

(within one year of graduation) from rural and remote communities who are

new CNO registrants (RN, NP, or RPN) and who choose to do a return-of-service

in an eligible community.

Appendix A

Ontario government supports for nursing retention and recruitment

Nursing Career Pathways | 2023 35

• Grow Your Own Nurse Practitioner Initiative

This program involves re-purposing government funds allocated to an NP

position, to allow a community to sponsor an RN to complete their post-

graduate Primary Health Care NP education. Funds are provided for salary

continuance and tuition, in exchange for a return of service agreement with the

sponsoring organization.

• BEGIN program

This program provides grants to reimburse eligible participants enrolled in

an approved and accredited PSW-RPN or RPN-RN program for some tuition

expenses (up to $6,000 per year to a maximum of $15,000 for eligible PSWs; up

to $10,000 per year to a maximum of $30,000 for eligible RPNs.) Upon graduation,

program participants must commit to one year of employment in the Ontario

long-term care or home and community care sector for every year they receive

funding.

Ontario government pledges and commitments for nursing education:

The Ontario government has also made several commitments over the past few

years, including:

Increase in nursing education seats

• investing $35 million in 2021/2022 to increase enrollment in nursing education

programs in publicly-assisted colleges and universities across the province, to

introduce approximately 1,130 new practical nurses and 870 registered nurses

into the health care system

• pledging to invest $145.5 million to increase the number of nurse education seats

by 1,500 which will add 2,000 nurses to the system by 2025–26

• dedicating more than $400,000 in a one-time increase to train an additional 38

nurse practitioners starting in 2022–23

• committing in 2022-2023 to start investing $41.4 million annually to support the

clinical education component in Ontario’s nursing education programs

• pledging to add 150 more education seats for Nurse Practitioners starting in

2023–2024

Nursing Career Pathways | 2023 36

Temporary supports for entry or return to practice by retired or internationally

educated nurses

In the 2022 fall economic statement, the Ontario government pledged to work

with the College of Nurses of Ontario (CNO) to provide up to $1,500 to temporarily

cover the costs of examinations, applications or registration fees to help retired

or internationally educated nurses with nancial barriers that hinder them from

beginning or returning to practice. Note: At the time of preparing this appendix in

February 2023, it was unclear whether such a program had yet been administered.

Each of the above programs must be scaled up to allow more

nurses to partake in these opportunities. Although these

initiatives represent a positive start, many more programs and

funding initiatives – at a larger scale – are required in order to

attract nurses back into Ontario’s nursing workforce, and to

retain existing nurses in Ontario’s nursing workforce.

Nursing Career Pathways | 2023 37

Appendix B

Nursing Career Pathways – RNAO consultations

The purpose of the “domains” (Figure A) and “sectors” (Figure B) graphics is to

provide a clear snapshot of the domains and sectors that nurses are currently

working within, so that the potential educational and career pathways for nurses

can be easily understood. We shared these graphics through a broad consultation

process, and used our ndings to inform next iterations of these graphics.

These consultations also informed our work on a third graphic (Figure C) intended

to illustrate the barriers and opportunities that inuence nurses’ career pathway

trajectories.

From November 2022 to February 2023, RNAO consulted the following groups for

feedback on the “Nursing Career Pathways” documents related to “domains” and

“sectors” as well as the accompanying explanatory notes (Appendix C):

1. RNAO’s Board of Directors and Assembly of Leaders

2. RNAO members (through a webinar hosted by RNAO)

3. Nursing organizations in Ontario:

• Joint Provincial Nursing Committee

• Assistant Deputy Minister of Health and Chief of Nursing and Professional

Practice

• Chief Nurse Executive and Clinical Institute and Quality Program Executive

• College of Nurses of Ontario

• Colleges of Applied Arts and Technology

• Council of Ontario University Programs in Nursing

• Ontario Nurses’ Association

• WeRPN

Nursing Career Pathways | 2023 38

We collected and synthesized feedback as follows:

1. Technical feedback

Feedback RNAO response

We have broken NPs and master’s-prepared RNs into

two distinct groups on the graphics to report the data in

separate quadrants for domains and sectors.

We adopted this feedback to more accurately

encompass both professional doctorates (DN/DNP) and

PhDs as terminal degree options for nurses.

We made changes to represent IENs – one of the main

pools of prospective nurses – as part of an entry pool

on the third “Nursing Career Pathways” graphic. Several

IENs are also encompassed within the current CNO

registrant pool and the Ontario nursing workforce.

Our report goes into detail about the different pools

of nurses who are registered with the CNO but are not

employed in nursing in Ontario. This pool of nurses is

presently represented in CNO data but not in Ontario

nursing workforce data.

We developed a narrative report to provide context and

esh out the data captured in the graphics.

We removed arrows from the consultation drafts of

the graphics, as many nurses do not opt to pursue

additional educational or career pathways outside

of their original role. This also helps better represent

that nursing education and career pathways are not

unidirectional.

Separate nurse practitioners

(NP) and master’s-prepared

RNs on the graphics

Change “PhD” to “doctorate”

on graphics.

Clarify where internationally

educated nurses (IEN) enter

the system

Report on the number of

nurses who are registered

with the CNO but not

employed in nursing in

Ontario

Provide greater context/

explanation of the graphics

Be more inclusive of all

potential career pathways

Nursing Career Pathways | 2023 39

Feedback RNAO response

Due to data analysis processes, we can only presently

report on the non-nursing graduate degrees of

nurses who have at minimum 1. completed a nursing

baccalaureate degree; and 2. registered with the CNO

as an RN or NP.

The intention is not to compare the two pieces of data.

Rather, the purpose of including data on nursing school

graduates and licensing exam passes is to report on

both indicators, as they represent steps that are fullled

prior to nursing registration. This provides insight about

the incoming pools of prospective registrants.

Nursing graduates are a more immediate predictor of

potential nursing registrants than enrollees. At present

we have decided to report only on nursing graduates

for this reason. We expect that the number of graduates

will increase over time as enrolments increase.

Consider representing non-

nursing degrees that some

RPNs hold

Why compare nursing

school graduates with

licensing exam passes?

Consider reporting on

nursing school enrolments

Note: As a result of consultation feedback, we changed the data source for CNO

registrants (numbers represented in orange on the graphics) from CNO “Registration

Totals at a Glance” (November 2022) to CNO (2022b).

Nursing Career Pathways | 2023 40

2. Feedback related to utility of the graphics

Feedback on how the

graphics could be used

Examples

• “This could be used by provincial HHR tables,

including that led by Ontario Health North”

• “Helpful to determine points of advocacy based on

available trends.”

• “Opportunity to advocate for more consistent and

readily available data.”

• “I can see bringing this when visiting with MPP’s to

assist with explanations”

• “Helpful for government ofcials to understand that

“a nurse is not a nurse is not a nurse””

• “The information needs to be simple and available

to students in elementary schools who will see and

better understand that nursing is a profession that

should be considered.”

• “it is a good presentation to highlight nursing

profession and its various pathways. It could

be used in colleges and universities to highlight

various options in healthcare leading up to nursing

and beyond.”

• “This could be brought to high schools during

career day to differentiate roles”

• “Would be a helpful tool for guidance counsellors,

or careers counsellors for immigrants. Most do not

know the many levels of entry into the profession.”

• “From a student perspective, it’s helpful to

understand what the school options are and how

that can be translated to real life.”

Can be used for political

advocacy

Can be used by teachers/

students

Note: To preserve the integrity of the consultation process, RNAO presents the original

consultation feedback as provided by participants in the “Examples” column of this

table, without any edits.

Nursing Career Pathways | 2023 41

Feedback on how the

graphics could be used

Examples

• “This is helpful for researchers.”

• “This information is extremely valuable to me as

I am an assistant professor in nursing and my

research program encompasses nursing health

human resource issues. Thank you for this excellent

summary!”

• “There is a wealth of information available in the

graphic, but I like that there is the legend which

helps to synthesize the information.”

• “ I like that it includes numbers and percentages

and that it is visually easy to see at a glance where

RPNs and RNs are distributed in our system.”

• “First opportunity to actually see where I fall in

the great scheme of things (nursing)! Great

perspective.”

• “Helpful to see the career development

possibilities.”

• “Encouraging to see the number of providers

seeking advancements.”

• “I liked learning about all the Career choices

available to Nurses.”

• “The information is vital for nurses and decision

makers to understand.”

Can be used by researchers

Can be used by nurses

Nursing Career Pathways | 2023 42

3. Recommendations elicited for graphic 3

Examples

Feedback on how to

build nursing career

pathways in Ontario

• “Not only should PhD nursing students be fully

funded in Canada but so too should all NP

students. They should all be fully funded including

a salary.”

• “There are still many RN college grads who would

pursue the degree and further education if there

were more available and affordable programs

similar to in the US.”

• “I think it is difcult to obtain further education

when paying for the cost of living in ON these days.”

• “it is extremely difcult to try to work full time

while being enrolled in a full time program. Work

life balance is so important and trying to attend

full time studies while trying to maintain nancial

stability can be really detrimental to mental health

and lead to burnout.”

• “Canada needs to be more creative in what

options are available for a female dominated

profession to have affordable access to excellent

nursing education that promotes advanced

nursing education.”

• “What is the motivation to get a master or PHD

when the salary is the same sometimes less with a

lot of more responsibilities than bedsides RN.”

Funding supports for nursing

education and professional

development

Better pay/benets for

nurses

Nursing Career Pathways | 2023 43

Examples

Feedback on how to

build nursing career

pathways in Ontario

• “I personally believe that if someone is to go

through the process of completing a masters or

a phd, they should be compensated accordingly,

whether nancial gain was the goal or not.

These programs create highly knowledgeable,

experienced professionals who invested a lot

into their education and career. In addition, as

previously mentioned, people with more education

are typically given more responsibility. This is

something recognized in other professions, I am

not sure why it should be different in nursing.”

• “most nurses start in the acute care sector, but if

you want to explore other areas in the health care

system that often means a pay cut and loss of

benets.”

• “I know a few colleagues going to the states. I

believe the cost of living in ON drives people to

move to other areas of work and other countries.

The government needs to make it affordable for

healthcare providers.”

• “I think there should be an opportunity for PSW’s

to bridge and transition into RPN>RN’s (and of

course NP’s if they choose) there needs to be

ample support for them to upgrade their courses

ie math, chemistry, sciences etc...we have an

insurmountable gap in our education system

in our Northern communities and this needs

to be considered. Bring the program(s) to the

communities especially in our First Nations to

provide those opportunities. Hybrid approaches

could be integrated as well..”

• “I want to know how to advise my daughter who

wants to fast track (with nancial support) to RPN/

RN”

Better pay/benets for

nurses

Improved nursing education

pathways

Nursing Career Pathways | 2023 44

Examples

Feedback on how to

build nursing career

pathways in Ontario

• “for an RN to pursue BScN they are often required to

take the bulk of the program (and cost) and very

limited pathways available.”

• “There are also many Continuing Education

Programs that would be very useful for Nurses to

help advance your career.”

• “There are many front line nurses with a wealth

of knowledge who would like to pursue further

education, to continue learning and providing the

best care. There needs to be more reasonable

opportunities for them to do so if we want to keep

them in this profession. With rising cost of living

and family commitments it is challenging. We also

need more online options for courses.”

• “we need to nd ways to keep nurses at the

bedside with quality work places, and make

sure that nurses with higher education nd their

place in clinical practice with great recognition,

opportunities and independence!!”

• “The more nurses at the bedside with advanced

certication and education the better for excellent

patient care”

• “I am sometimes made to feel like I am less for not

moving past BSN and bedside. I love what I bring to

the bedside! Families remind me everyday,”

• “This discussion re working at the “patient side”

really reinforces the need to make the work

environment much more healthy for nurses,

especially those who are working directly with

patients.”

• “our Nursing circle is strong, alive and well! We

must pave the way for the next generation of

nurses!! Sustain, support those of us who are in the

roles we are in now and encourage more nurses to

join the profession!”

Improved nursing education

pathways

Importance of nurses in all

roles across the system

Nursing Career Pathways | 2023 45

Appendix C

Nursing Career Pathways explanatory notes

The explanatory notes below provide a detailed description of the data found in

the “Nursing Career Pathways: Domains” and “Nursing Career Pathways: Sectors”

graphics.

Nursing education (represented in pink):

• BScN/BSN=5,180 (+ 851): Total number of baccalaureate nursing degrees

awarded in Ontario in the 2021 calendar year. Increase of 851 baccalaureate

nursing degrees compared to the 2020 calendar year.*

• MScN/MN=300 (+ 109): Total number of master’s in nursing degrees awarded

in Ontario in the 2021 calendar year. Increase of 109 master’s in nursing degrees

compared to the 2020 calendar year.*

• MN NP=289 (+ 79): Total number of nurse practitioner (NP) program graduates

in Ontario in the 2021 calendar year. Increase of 79 NP program graduates

compared to the 2020 calendar year.* NOTE: NP programs may be combined

with or integrated into master’s degree programs, and schools may or may

not report separ ate data for these integrated programs. Where the data are

reported separately, it is recorded under the NP program.

• PhD (Nursing)=20 (- 8): Total number of PhD degrees (in nursing) awarded

in Ontario in the 2021 calendar year. Decrease of 8 PhD degrees in nursing,

compared to the 2020 calendar year.*

*Based on Canadian Association of Schools of Nursing (2022)

NOTE: The number of RPN diploma graduates was not reported for Ontario in 2021.

Nursing Career Pathways | 2023 46

Education (incl. nursing and non-nursing graduate degrees) (represented in brown)

and Licensing Exams (represented in teal):

• RPN Exam (6,636): Total number of registered practical nurse (RPN) applicants

to the College of Nurses of Ontario (CNO) who passed the Canadian Practical

Nurse Registration Examination (CPNRE) in 2021.**

• RN NCLEX (6,104): Total number of registered nurse (RN) applicants to CNO

who passed the National Council Licensure Examination for Registered Nurses

(NCLEX-RN) in 2021.**

• Master’s Degree (+ 551): Yearly change in the number of master’s-prepared RNs

(including NP program) registered to practise in Ontario (2021-2022).***

• NP Exam (386): Total number of NP applicants to CNO who passed one of the NP

exams in 2021.**

• PhD (+ 18): Yearly change in the number of PhD prepared (incl. professional

doctorate) RNs (including NPs) registered to practise in Ontario (2021-2022).***

**Based on CNO (2022a).

***Based on CNO data request (received Nov. 14, 2022) examining Primary Employer

Data by Nurse Type, Highest Education Level, and Primary Employment Position (self-

reported). Note: This data request was from the same data set as that used in CNO

(2022b).

Number of nurses registered to practise in Ontario (represented in orange):

• 188,592 nurses: total number of nurses registered to practise in Ontario in 2022

(including non-practicing RNs, NPs, RPNs). ***

• RPN = 61,482 (+ 1,984): total number of RPNs registered to practise in Ontario

in 2022 (including non-practicing RPNs). Increase of 1,984 RPNs compared to

2021.***

• RN (incl. 4,352 NPs) = 127,110 (+ 2,174 RNs, + 317 NPs): total number of RNs and

NPs registered to practise in Ontario in 2022 (including non-practicing RNs and

NPs). Increase of 2,174 RNs and 317 NPs compared to 2021 ***

***Based on CNO data request (received Nov. 14, 2022) examining “Primary Employer

Data by Nurse Type”, “Highest Education Level”, and “Primary Employment Position

(self-reported)”.

Nursing Career Pathways | 2023 47

Number of nurses employed in Ontario (represented in blue):

• 155,604 nurses: total number of nurses employed in nursing in Ontario in 2022.***

• RPNs = 51,414: total number of RPNs employed in nursing in Ontario in 2022.***

• RNs = 89,948: total number of RNs employed in nursing in Ontario in 2022.***

• Master’s prepared RNs = 13,323: total number of Master’s prepared RNs

(including 3,893 NPs) employed in nursing in Ontario in 2022.***

• PhD prepared RNs = 919: total number of PhD prepared RNs (including 121 NPs)

employed in nursing in Ontario in 2022.***

***Based on CNO data request (received Nov. 14, 2022) examining “Primary Employer

Data by Nurse Type”, “Highest Education Level”, and “Primary Employment Position

(self-reported)”.

Domains of practice classications (represented in blue on page 1)***:

• Nursing and advanced practice nursing- includes nurses working in any of the

following primary positions in 2022:

• Visiting Nurse

• Staff Nurse

• Public Health Nurse

• Outpost Nurse

• Ofce Nurse

• Occupational Health Nurse

• Infection Control Nurse

• Consultant

• Case Manager

• Advanced Practice Nurse – CNS (only RNs or NPs)

• Advanced Practice Nurse – Other (only RNs or NPs)

• Nurse Practitioner (NP) (only NPs)

• Clinical Education and nursing/clinical education- includes nurses working in

any of the following primary positions in 2022:

• Educator/Faculty

• Clinical Educator

• Research, nursing/clinical research and advanced nursing/clinical research-

includes nurses working in any of the following primary positions in 2022:

• Researcher

• Policy Analyst

• Informatics Analyst

Nursing Career Pathways | 2023 48

• Management (LTC), clinical leadership/management, senior clinical

leadership/management, and executive leadership/management- includes

nurses working in any of the following primary positions in 2022:

• Senior Manager

• Middle Manager

• Other- includes nurses working in the following primary positions in 2022:

• Volunteer

• Sales/Marketing Representative

• Other

• Not Stated

Health care sector classications (represented in blue on page 2)***:

• Hospital- includes nurses working in any of the following primary employment

settings in 2022:

• Acute Care Hospital

• Addiction & Mental Health Centre/Psychiatric Hospital

• Complex Continuing Care Hospital

• Rehabilitation hospital

• Other Hospital

• Primary care- includes nurses working in any of the following primary

employment settings in 2022:

• Community Health Centre (CHC)

• Family Health Team (FHT)

• Nurse Practitioner Led Clinic

• Physician’s Ofce

• Remote Nursing Station

• Public health- includes nurses working in any of the following primary

employment settings in 2022:

• Public Health Unit/Department

• Home and community care- includes nurses working in any of the following

primary employment settings in 2022:

• Client’s Environment

• Local Health Integration Network (LHIN) home and community care services

• Nursing/Stafng Agency

• Hospice

• Blood Transfusion Centre

• Cancer Centre

• Children Treatment Centre (CTC)

• Community Mental Health Program

• Diabetes Education Centre (DEC)

• School

Nursing Career Pathways | 2023 49

• Other community- includes nurses working in any of the following primary

employment settings in 2022:

• Industry (Not Health-Related)

• Correctional Facility

• Health-Related Business/Industry

• Spa

• Telephone Health Advisory Services

• Other Community

• Long-term care facility- includes nurses working in any of the following primary

employment settings in 2022:

• Long-Term Care Facility

• Other Long-Term Care Facility

• Retirement home- includes nurses working in any of the following primary

employment settings in 2022:

• Retirement Home

• College/university- includes nurses working in any of the following primary

employment settings in 2022:

• College/University

• Government/professional organization- includes nurses working in any of the

following primary employment settings in 2022:

• Government/Association/Regulatory Body/Union

• Other- includes nurses working in any of the following primary employment

settings in 2022:

• Other

***Based on CNO data request (received Nov. 14, 2022) examining “Primary Employer

Data by Nurse Type”, “Highest Education Level”, and “Primary Employment Position

(self-reported)”.

Nursing Career Pathways | 2023 50

Appendix D

Canadian Nurses Association specialty chart

Specialty

Number of valid CNA

certications in Ontario

Cardiovascular nursing*

Community health nursing*

Critical Care nursing (adult)*

Critical care pediatric nursing*

Emergency nursing*

Gastroenterology nursing

Gerontological (RN/NP) nursing*

Gerontological (LPN/RPN) nursing**

Hospice palliative care nursing*

Medical surgical (RN/NP) nursing*

Medical surgical (LPN/RPN) nursing**

Neonatal nursing*

Nephrology nursing*

Neuroscience nursing

145

302

493

351

682

516

479

122

Nursing Career Pathways | 2023 51

Specialty

Number of valid CNA

certications in Ontario

Occupational health nursing*

Oncology nursing*

Orthopaedic nursing

Pediatric nursing*

PeriAnesthesia nursing

Perinatal nursing*

Perioperative nursing*

Psychiatric and mental health nursing*

Rehabilitation nursing

Wound, ostomy and continence*

For RNs and NPs*, For RPNs**

Source: Canadian Nurses Association. (2021). Number of Valid CNA Certications by

Specialty/Area of Nursing Practice and Province or Territory. March 15, 2021.

Grand total:

249

919

194

414

1164

117

6587