StatCan COVID-19: Data to Insights for a Better CanadaOvertime work among professional nurses during the COVID-19 pandemic

The COVID-19 pandemic is expected to affect the workloads of health care workers (Government of Canada 2020), such as nurses, but the magnitude of such effects has not been quantified. Compiling data about nurses’ working conditions is important because excessive workload and overtime hours have been linked to decreased well-being and have implications for the long-term health of workers and for health service delivery (Wilkins 2007; Tourangeau et al. 2010; Zeytinoglu et al. 2006). To shed light on this issue, this study compares nurses’ overtime work hours^{Note  Note}  before and after the onset of the COVID-19 pandemic.^Note 

About one-quarter of nurses worked overtime in April and May 2020

Unlike the proportion of people working overtime in other occupations, which declined, the proportion of nurses working overtime remained constant from 2019 to 2020 in April and May. About 26% of all people employed in professional nursing occupations worked overtime.

For those in professional occupations other than nursing,^Note  the proportion working overtime dropped significantly to about 20% in 2020, from 28% in 2019.

These differences by occupation reflect increased demand for nursing work, while many other occupations experienced reduced workload because of COVID-19 (Deng et al. 2020). Increased demand for some occupations, such as in health care, may have increased the need for overtime hours, while this may not have been the case for other occupations.

Nurses who worked overtime worked up to five more hours per week in April and May 2020 than in 2019

Nurses who worked overtime significantly increased their hours in April and May 2020, compared with 2019. Nurses’ weekly overtime hours increased from 6.6 hours in April 2019 to 9.7 hours in April 2020 and from 5.8 hours in May 2019 to 10.3 hours in May 2020.

Other professional workers who worked overtime increased their weekly overtime hours to a much lesser extent. These other workers’ weekly overtime hours for April and May 2019 were 8.3 and 8.1, respectively, compared with 9.4 and 8.9, respectively, in 2020.

These significant changes to average weekly overtime hours from 2019 to 2020 among nurses working overtime were consistent with changes to total actual hours worked for all nurses (i.e., working overtime or not) from 2019 to 2020 (data available upon request).

Responses of provincial and federal governments to the pandemic included increasing health care capacity through postponement of non-urgent scheduled surgeries. Hospitals and health care facilities reoriented their priorities to intake only urgent and emergency procedures in 2020 (Government of Canada 2020). While this means the health care system in 2020 was operating differently compared to the same reported months in 2019, it also suggests that these reported increases to nurses’ overtime hours during the pandemic may be conservative estimates  and that the increases to overtime could have been even greater had those responses not been implemented.

Increases in nurses’ average weekly overtime hours from 2019 to 2020 depended on the province. Average overtime hours increased in Quebec and Ontario but not in the rest of Canada. In Quebec, average overtime hours increased significantly from 6.2 hours in May 2019 to 16.9 in May 2020. In Ontario, nurses’ average overtime hours increased significantly from 4.7 hours in May 2019 to 9.8 in May 2020. These two provinces had the largest increases in the number of COVID-19 cases in April and May.

Overtime hours doubled for the oldest age groups

Among nurses working overtime, average weekly overtime hours doubled from May 2019 to May 2020 for those aged 35 to 54. Overtime hours also doubled over the same period (from 4.3 hours to 8.3) for those aged 55 and older. This may reflect the use of more experienced nurses to manage emerging case complexities related to COVID-19 or a strategy to reintegrate retired nurses into the workforce to meet demand (Government of Manitoba 2020; Registered Nurses’ Association of Ontario 2020; Vogel 2020). Such practices have been described elsewhere in strategies for pandemic planning (Abir et al. 2020).

Work characteristics have implications for well-being

Work characteristics, including overtime work, have been linked to health. In Canada, findings from national data suggest associations between nurses’ work demands and health outcomes. Results from the Canadian Community Health Survey^Note  showed that even though job satisfaction did not differ between nurses and other workers and job insecurity was lower for nurses, almost half of nurses (48.5%) reported high work stress. They also reported high levels of psychological demands and physical exertion. These outcomes were significantly different from those for other workers, and this pattern has persisted over time (Bourgeault et al. forthcoming).

Limitations

Labour Force Survey results for the territories were excluded for jurisdictional analyses. Specific reasons for patients’ accessing nurses’ care (e.g. diagnosis, confirmation of COVID-19 infection) are not available from these data. Licensed practical nurses are not included in the NOC code used to define professional occupations in nursing. The specific scope of nursing practice (e.g., nurse practitioner, community nurse) and facility type (e.g., long-term care facility, hospital) could not be comprehensively distinguished for this analysis. Therefore, presented results may not be generalizable to every type of nursing work or care facility.

Conclusion

These findings underscore some of the increased work demands placed on nurses during the COVID-19 pandemic. The prevalence of overtime work and increased overtime hours, combined with findings that highlight associations between work factors and significant impacts on well-being for nurses, warrant attention to manage the risk of health care demands over the short and long term. In addition, these need to be monitored and tracked over time.

Methodology

Data source

Data from Statistics Canada’s Labour Force Survey were used to report the prevalence of working overtime^Note  and average weekly overtime hours worked (paid and unpaid) for professional occupations in nursing.^Note ,^Note 

Pre-pandemic national population-based data from the 2016 Census were used to profile nurses’ demographics and, together with published evidence of health outcomes from Statistics Canada’s national Canadian Community Health Survey^Note  and other referenced, published research on the work circumstances of nurses of different ages to draw out implications for the well-being of nurses of any changes reported here to work patterns based on the Labour Force Survey in 2020 and 2019.^Note 

The authors would like to acknowledge the helpful reviews of earlier versions by Health Canada, the Public Health Agency of Canada, Ivy Bourgeault, Sébastien LaRochelle-Côté, René Morissette, Vincent Hardy and Jeremiah Hwee.

References

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Bourgeault, I., J. Park, D. Kohen, J. Atanackovic, and Y. James. “Healthy professional workers: A gendered analysis of mental health, work and stress.” Work, Employment and Society. Forthcoming.

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Deng, Z., R. Morissette, and D. Messacar. 2020. “Running the economy remotely: Potential for working from home during and after COVID-19.” STATCAN COVID-19: Data to Insights for a Better Canada, no. 26. Statistics Canada Catalogue no. 45280001. Ottawa: Statistics Canada.

Government of Canada. “Planning for optimal use of health care workers.” In COVID-19 Pandemic Guidance for the Health Care Sector. (accessed April 16, 2020).

Government of Manitoba. 2020. Manitoba Government Permitting Former Nurses to Practice During COVID-19 Pandemic. Ministry of Health, Seniors and Active Living. News release. April 1. (accessed May 16, 2020). 

Registered Nurses’ Association of Ontario. 70 Years of RN Effectiveness.  (accessed May 12, 2020).

Tourangeau, A.E., G. Cummings, L.A. Cranley, E.M. Ferron, and S. Harvey. 2010. “Determinants of hospital nurse intention to remain employed: Broadening our understanding.” Journal of Advanced Nursing 66 (1): 22–32.

Vogel, L. 2020. “COVID-19: A timeline of Canada’s first-wave response.” CMAJ News. (accessed August 6, 2020).

Wilkins, K. 2007. “Work stress among health care providers.” Health Reports 18 (4): 33–36. Statistics Canada Catalogue no. 82-003-XWE. Ottawa: Statistics Canada.

Zeytinoglu, U., M. Denton, S. Davies, A. Baumann, J. Blyth, and L. Boos. 2006. “Retaining nurses in their employing hospitals and in the profession: Effects of job preference, unpaid overtime, importance of earnings and stress.” Health Policy 79 (1): 57–72.