For the past two and a half weeks, public health nurses of Windsor-Essex have been on the picket lines after a year-long struggle to negotiate a pay increase.
Currently, these 86 nurses remain without a contract, striking with the hope they might eventually receive a wage that reflects the rising cost of living in their area.
But as this particular group stands firm in its request, many other nurses of Windsor Ont., are abandoning the Canadian healthcare sector for more attractive jobs in the United States.
Chris Al-Youssef is a registered nurse and a recent graduate of University of Windsor’s nursing program. He said it was a no-brainer for him to take a job in Detroit, even after he obtained all of his practical training in the local Windsor hospitals.
“I have no regrets,” he said. “There are so many advantages to working over in the U.S.”
In 2017, there were 3,114 registered Ontario nurses working in the United States, according to membership statistics from the College of Nurses of Ontario. In the Erie St. Clair region, which borders Michigan, there were 4,891 nursing positions. Meanwhile, across the border, 2,269 Ontario nurses were registered to work in that state, like Al-Youssef.
The 23-year-old who now works at Detroit’s Henry Ford Hospital said he was four months without a job before American authorities approved his work visa.
“Honestly, it was worth it to wait,” he said. “The American dollar is great when you live in Canada. The hospitals are more collaborative. In my opinion, they run better because they have more money.”
In Canada, the rate of pay for registered nurses is based on a year of service scales. Current data from the Registered Nurses Association of Ontario states the average nurse starts at $21.75 per hour, reaching as high as $40 per hour.
Al-Youssef said he started out at US$30 per hour, which would be just over $40 in Canadian currency with the current exchange rate.
He added that another perk to working in Detroit is the number of full time jobs available.
“It’s well known that the jobs available to new grads at the hospitals are temporary part-time positions,” he said. “I enjoyed working at the Windsor hospital when I had my placements, but not enough to pass up what is being offered in the [United] States.”
A 2013 study published in the Canadian Journal of Nursing Leadership found that the top reason Canadian-educated nurses were migrating to the U.S. for work was because they were unable to find full-time jobs in Canada.
Melissa Simas, manager of Human Resources at the Windsor Regional Hospital, said the hospital’s lack of full-time jobs is due to the unionized work environment.
“It’s not really a threat. It’s more of a challenge because we are very limited to what we can offer to new grads,” she said.
“Anybody new coming into our environment would start typically as a temporary person and then move into a permanent part-time role and then it takes typically anywhere between five and seven years to get a full-time job in our organization.”
The hospital’s full-time positions only go to current staff with the most seniority due to the collective agreement with the union and then when these individuals retire or leave the hospital, the next person in line is the one who fills the full-time position. Hospital departments also have a set budget for staff salaries each year and it is more cost effective to hire a part-time nurse without benefits.
Simas said Windsor Regional still tries to make it enticing to Canadians.
“If they’re working here, they’re working within their community. We have Canadian benefits. We have great pension plans, that we try to sell,” she said.
“But, there’s also a cost to travelling across the border in time and in money,” she added, referencing the commute to Detroit.
And while full-time employment opportunities for nurses are not readily available, Simas said the hospital has still been having a difficult time recruiting staff to fill jobs in speciality areas like the emergency room, operating room and various departments in critical care.
Data released in 2018 by the Canadian Institute for Health Information shows Ontario has the worst registered-nurse-to-population ratio in Canada. In fact, CIHI’s figures revealed there are only 669 registered nurses per 100,000 people. There are an average number of 828 registered nurses per 100,000 across the rest of the country.
Stephanie Miller currently works on a part-time temporary contract in one of the speciality areas at the Windsor Regional. She has asked that her name be changed out of concern for her job.
Like Al-Youssef, Miller said she has no regrets taking a job at the hospital, but said she would not be able to afford working in her hometown without financial support from her family.
“I’ve learned so much and I do love my job, but as a part-timer you’re only guaranteed three shifts in a two-week period,” she said. “It’s great if you can have more, but it’s not always like that.”
Sometimes the Windsorite said she will work two days a week, but other times there will be high demand for her to work six days a week.
After spending about a year in her department, Miller said it has allowed her to gain valuable experience in a specialized area of care, but added that she will soon be looking elsewhere.
“If I stay in Windsor, I will probably be a temporary part time for the next ten years,” she explained. “We have people in my department who have worked there for 15 [to] 20 years who don’t even have permanent full-time positions. There’s no room to grow and you don’t have much job security.”
The University of Windsor works closely with all hospitals in the area for students in their program to make a smooth transition into the workforce. While current policy only allows its nursing students to take their placements in the city’s medical practices, the university’s student success co-ordinator, Fran Meloche, said the school works to ensure its up-and-coming nurses are informed on the options that are available to them.
“Our program does a very good job of giving students the knowledge of what is available, whether it be in the Windsor area or across the border,” she said. “Our job is to help them get access to that.”
Meloche said that the school’s students in the program are recruited equally for positions in Windsor and other cities in Ontario as well as for hospitals in Detroit across the border.
She added that the school views the additional job market in the United States not as a challenge, but as just an alternative career path.
“This is just the reality,” she said. “You have to match what the student really wants for their life after graduation. It’s their decision at the end of the day based on their area of interest.”
Al-Youssef has only been in his current job for about seven weeks, and said he has no plans to leave anytime soon.
“It was the right decision for me — 100 per cent. I feel valued by the people I work with and I really enjoy the work I do here,” he said. “I also know that the full-time opportunities to advance your career are here if you work hard and you want to take advantage of them.”
Correction: March 28, 2019
An earlier version of this article incorrectly stated that in 2017, 40 per cent of Canadian nurses in Ontario chose to work for hospitals in the United States, and that 37.7 per cent of Ontario nurses who work in the U.S. were employed in Michigan. The College of Nurses of Ontario’s membership statistics actually show that 40 per cent of Ontario registered nurses who worked outside the province, were employed in the U.S., and that 37.7 per cent of registered Ontario nurses, who hold U.S. registrations, were registered to work in Michigan.