“Doug Ford and Sylvia Jones should spend a day in scrubs”: A nursing advocate on privatization, Bill 124 and critical staff shortages

Last week, Doug Ford announced that his government would make it easier for out-of-province nurses to come work in Ontario. The news came just days after the province went public with its plan to significantly increase the use of for-profit clinics to perform low-risk procedures like cataract surgeries and MRIs. The premier claims that both measures will help address staffing shortages and ballooning surgical backlogs.

But some Ontario nurses aren’t buying it. “This is just another example of a total lack of respect for health care workers in general and nurses in particular,” says Amie Archibald-Varley, an RN who left her role at Niagara Health last November after working in emergency rooms throughout most of the pandemic. She’s now working as a health equity specialist—consulting on issues related to equity and antiracism in hospital practices—but advocating for nurses remains one of her top priorities. With contract negotiations beginning this week, she says it’s time for Ontario hospital nurses to start demanding better wages and working conditions.

Everyone knows that the current system is in crisis: a surgical backlog of more than 200,000 patients, 22-hour ER wait times and a massive staffing exodus, particularly among nurses. The Ford government says its plan to divert certain low-risk procedures to private clinics will take some of the pressure off the public system. You don’t agree? I don’t know whom Doug Ford is speaking to right now, but it’s definitely not nurses. If it was, they would tell him that what he’s saying doesn’t make sense. The surgical backlog that has amassed during the pandemic is a major crisis, but the problem isn’t a lack of space—it’s a lack of staff. There’s plenty of existing space in Ontario’s public hospitals. Most of the operating rooms in the province are booked from around 7 a.m. to 3 p.m. After that, the rooms are empty unless there are emergency cases. I worked at one hospital in particular where there were three floors of empty space. Why aren’t we doing cataract surgeries in those spaces? We should be booking procedures around the clock, but we can’t because space isn’t the problem—we just don’t have the people. As you said, nurses are leaving the profession in record numbers, and the government’s plan won’t help that.

The president of the Ontario Medical Association was on TVO’s The Agenda the other night saying that privatization would help solve the staffing crisis. I saw that, and I was gobsmacked! What she actually said was that, when the public system offloads surgeries to private clinics, the staff would follow the patients to the clinics. That explains how the clinics would be staffed, but how does that help the public system? Doesn’t that just deplete our already depleted ranks?

Do you think a lot of nurses will leave to work at private clinics for higher pay and better hours?
I do, and you certainly can’t blame them. This whole saga with Bill 124 has been such a slap in the face. It’s about the money, but it’s also about the lack of respect: call health care workers heroes, but then cap their wage increases at one per cent for three years.

We’ve already seen nurses leaving the public system to work at private staffing services, which are like temp agencies for health care workers. That’s how hospitals have been filling the gaps. It means you have a public-system nurse who is working around the clock for $33 an hour, and then in comes a temp nurse who is making two or three times that amount and working more reasonable hours.

Private clinics also bring the promise of improved working conditions. Nurse-to-patient ratios at hospitals are supposed to be one-to-four—maybe one-to-six during very busy times—but I’ve heard from colleagues who are responsible for 12 cases at once. It is totally unmanageable. On the floor, we joke about our iron bladders, but it’s really not that funny. I’ve worked a 12-hour shift without a bathroom break, and I’m not alone. 

People hear that staffing shortages mean corners are being cut, but what does that actually look like on the ground? People may think it just means that a patient has to wait for a bath—and I don’t want to minimize the importance of that—but, in reality, we’re talking about medication not being delivered or people waiting in ambulances for hours, so they’re not getting the care they need and the paramedics looking after them aren’t able to take new calls. We’ve seen patients die in ER waiting rooms, waiting to be seen. Nurses can’t leave those experiences behind at the hospital at the end of the day, whenever that time comes—the trauma sticks with us. It leads to burnout beyond just being exhausted, which we are. It’s also the anxiety and the moral distress that comes with knowing that these terrible things are happening to our patients.

The premier has said that the procedures performed at private clinics will be paid for by the province: “OHIP cards not credit cards.” Sure, but who do you think pays for OHIP? We don’t need to guess at this—there is evidence proving that the proposed model will cost more. The cost of privatization may not show up on your credit card statement right away, but it will be on your tax return. Private clinics have a bottom line to consider—they have shareholders. And then you look at the potential for upselling. For example, you may be in for a cataract surgery, and OHIP covers a basic type of lens, but there could also be a better lens that costs $300 more and is available only to people who can afford it. People with more money will get better care. Upselling is already happening in the public system, but it stands to get a lot worse when the people doing the billing are working in a for-profit model.

The NDP says the government has been deliberately underfunding the public system to build a case for moving toward a private system. What do you think? Absolutely. We know that the government has underfunded health care by hundreds of millions, which is straight out of the privatization playbook. My husband is a philosopher and a fan of Noam Chomsky, who said that the first step toward privatization is to break the existing system. Then people will complain and the government can start taking other small steps in that direction, which is what we are seeing now. If this was really just about addressing a backlog, why are these changes permanent? Why is the government funding these private clinics rather than putting that money back where it is needed?

What do you think of Ford’s plan to recruit nurses from other provinces by fast-tracking the employment process? I am all for anything that increases the labour force, but in this case, it’s a bit like using your Visa to pay off your Mastercard. The medical staffing crisis is national—I was out in Saskatchewan recently, speaking to a group of nurses about how to turn health care advocacy into action, and their stories were the same.

So what would make a difference? Imagine you had a magic wand... I think nurses would like to feel like their government isn’t actively working to undermine us or deny what we have gone through over the past few years. Last year, Ontario Health Minister Sylvia Jones told the media that there was no health care crisis. For nurses, that felt like gaslighting. Repealing Bill 124 is an obvious and important step, but the majority of nurses I speak with want to see legislation around the nurse-to-patient ratios that I mentioned. I think that would bring people back to the public system faster than any other measure.

The Ontario Nurses Association began contract negotiations on Monday. Are you hopeful that salary and working conditions will be addressed? I am hopeful, and maybe Ford’s private clinic plan will give nurses in the public system a little bargaining power. But what I’d really like to see is a stronger stance. I saw a tweet from the ONA claiming that the organization was making “big asks.” How are safe working environments and reasonable wages big asks? These should be basic demands, and if they’re not met, we need to be prepared to take stronger labour actions and refuse to back down.

I swear, if Doug Ford or Sylvia Jones spent even a day in a set of scrubs, they would see things differently. The way nurses are being treated is just—well, let me share a story. I was at my dog groomer’s a couple of weeks ago, and it turned out that she had also recently quit her job as a nurse, to become a groomer full time. How come? She said, “People treat dogs better than they treat people.”

This interview has been edited for length and clarity.