Section V: Recruitment and Retention Initiatives

As mentioned in the introduction, questions addressing the issue of recruiting and retaining employees in the health field were added to the questionnaire in response to a need expressed by the parties. Questions were designed to determine if the benefits in employee-benefit programs had increased or improved over the last five years and to learn what incentives or benefits had been introduced to address recruitment and retention pressures.

A review of the findings and other relevant documentation revealed that a total of 393 establishments—including 264 establishments in Quebec—had introduced focused recruitment and retention initiatives in the last five years. Presented below is quantitative data as it pertains to these initiatives for different groups covered by the study.

Medical Officers

Thirteen establishments representing 172 employees indicated having implemented the following measures:

• Summer Employment Program offered to first-and second-year medical students to encourage them to consider practicing medicine in rural areas;
• Supernumerary Residency Training Program to subsidize physicians who would complete training in a specialty recognized by the Royal College of Physicians and Surgeons of Canada and for which there is a shortage within the province;
• For positions in Emergency Medicine: $50,000 for a three-year commitment (must work 29 hours per week in a Regional Emergency Department);
• Location Grant Program for newly-recruited physicians and specialists who agree to establish their practice in hard-to-recruit areas ($25,000 - $40,000);
• $6,000 bursaries for medical students offered by the Department of Health to third-and fourth-year medical students who are in financial need. A one-year commitment must be made for each year a bursary is granted.

Pharmacists

Ninety-two establishments representing 734 employees reported having implemented the following initiatives for the Pharmacists group:

• Employees 55 years old or more who are eligible for retirement and decide to continue working are granted five additional days off with pay per year for the first two years and ten additional days off with pay per year for each subsequent year;
• Recruitment and retention bonuses of up to 35% of salary;
• Relocation allowances of up to $25,000 granted to employees who commit to full-time employment with the establishment for a minimum of two years.

Nurses and other health professionals

The following table shows other items which were reported for the above-mentioned groups:

	ND		NU		OP		PH		PS		SW
	#Est.	#Inc.	#Est.	#Inc.	#Est.	#Inc.	#Est.	#Inc.	#Est.	#Inc.	#Est.	#Inc.
HOURS OF WORK
Flexible hours of work	41	209	59	6,694	59	668	59	424	48	81	59	360
Job Sharing	7	6	7	53							7	6
HEALTH RELATED BENEFITS
Access to benefits waiting period waived	6	52			6	122	6	41			6	75
Introduction of health expense account			6	6
Direct pay drug card			8	5
Vision Care – Increased coverage amount for frames to $60 and unlimited cost for lenses (provided they are reasonable and customary)	13	20	13	691	13	120	13	25	6	5	13	45
Dental Care – Improved the different levels of coverage	67	162	68	6,609	68	389	67	197	6	16	62	464
PENSION
Implementation of pension plan			7	65
Enrichment of pension benefits	6	46	6	1,999	6	153	6	56	6	16
EDUCATION
Training sessions for new employees increased			6	24								*
Educational leave – coverage increased to $2,500 (must commit to 18 months of service)			6	708
Education fund introduced for all employees	41	209	59	6,694	59	668	59	424	48	81	59	360
Reimbursement of tuition fees	13	20	13	691	13	120	13	25	6	5	13	45
Education leave now available also when employee requested			7	24
Provincial allowance of up to $2,000 per year towards tuition for health-related students who commit to staying or relocating to the province			6	24
PAID TIME AWAY FROM DUTY BENEFIT
Maternity leave top-up increased from 75% to 84%	13	20	13	691	13	120	13	25	6	5	13	45
Added maternity leave top-up to 75%			7	65
Annual leave - 5 additional days every 5 years	41	209	59	6,694	59	668	59	424	48	81	59	360
Increased vacation allotment	23	72	31	3,005	23	364	18	81	12	21	18	62
Employees of 55 years old or more, eligible to retire, who continue to work granted 5 additional days off with pay/year for the first 2 years and 10 additional days off with pay for each subsequent year	120	540	249	24,210	169	2,752			172	1,068	146	2,194
SIGNING BONUS
$500 signing bonus, plus a $500 retention bonus at the completion of twelve months of service			6	6
Loyalty bonus for positions that are difficult to fill	6	52			6	122	6	41			6	75
Some signing bonuses granted at the local level for particular situations (e.g. out‑migration, shortage, etc.)			249	24,210
RELOCATION ALLOWANCE
Relocation allowance increased – in Canada from $3,000 to $5,000 – Foreign workers from $7,000 to $10,000	49	175			65	815	43	194	22	63	64	335
Maximum of $2,500 with an 18-month service commitment			6	708
Province wide $5,000 grant to new employees from outside the province – requires one-year service commitment	61	116	61	4,508	61	233	61	141			61	278
RETENTION ALLOWANCE
Lump sum payments for continuous employment based on number of years of service.	41	209	59	6,694	59	668	59	424	48	81	59	360
Recruitment and retention wage adjustments of 2.1% yearly	26	89			26	322	26	127	23	88	26	190
Several RN allowances: RNs eligible to retire get bonus of 2% of wages for every year or service completed beyond retirement eligibility New step added to the salary grid specific to these employees (3.5% more than the top step) $500 bonus to retired RNs who work a minimum of 24 shifts a year			38	5,204
OTHER
Employer sponsored third party discounts	49	175	9	8	65	815	43	194	22	63	64	335
Employee referral bonus	12	57	12	1,536	12	157	12	46			6	75
Building relationships within the community to assist in employment opportunities for spouse of transferring employee	7	6	7	53	6	24					7	6
Free Parking	7	6	15	77

Strategies Addressed in Collective Agreements

The study also analyzed a number of collective agreements governing the working conditions of employees in the target occupational groups and found that many of them have introduced specific measures to address the growing recruitment and retention issue. While our study looks at data as of December 31, 2007, we have chosen to report on all identified recruitment and retention measures as they may be of particular value to readers.

We note that some collective agreements simply give a brief statement of the parties’ intention to study the issue. For example, in the Memorandum of Understanding #5 of the collective agreement between the Manitoba Association of Health Care Professionals and the Winnipeg Regional Health Authority (Deer Lodge Centre site), the parties agree to establish a provincial retention and recruitment committee. The purpose of this committee is to consider and make recommendations on recruitment and retention strategies, identify and pursue funding for those strategies and promote professional and facility accreditation standards.

Appendix 16 to the collective agreement between the Health Employers Association of British Columbia and the Health Science Professionals Bargaining Association establishes a labour-management committee. This committee will review issues that may have an impact on the attraction and retention of health science professionals and make recommendations.

In Ontario, the recently renewed master collective agreement between the Ontario Hospital Association and the Ontario Nurses’ Association provides for a labour-management committee to identify best practices pertaining to nursing retention, recruitment and appropriate ratios of full-time and part-time staff.

Financial Incentives

Some collective agreements set out specific measures—often of a monetary nature—for relieving hiring and retention pressures.

Appendix R to the collective agreement between the Health Employers Association of British Columbia and the Nurses’ Bargaining Association provides for an annual incentive payment to nurses in pre-and post-retirement. The incentive is available to employees who have maximized their pensionable service and who are not eligible or elect not to contribute to the Municipal Pension Plan or the Public Service Pension Plan and who continue to work in a regular full-time or a regular part-time position. It is available also to nurses who have retired and are drawing a pension and who return to work in a regular full-time or a regular part-time position. The annual incentive payment is equal to what the employer would have contributed to the above-mentioned pension plans based on earnings over the preceding year (less any required statutory deductions). Any earnings counted toward pensionable service are excluded from the calculation of the incentive payment. The incentive is payable following December 31 of each year that the employee is employed in a regular full-time or regular part-time position and is paid (at the employee’s option), either to a registered retirement savings plan or directly to the employee.

The master collective agreement between the Government of British Columbia and the British Columbia Nurses’ Union introduces a variety of incentives for the duration of the new agreement, including:

• A supplemental payment of $0.30 per hour worked for afternoon shifts;
• A supplemental payment of $1.65 per hour worked for night shifts; and
• A supplemental payment of $1.50 per hour worked between 11 p.m. Friday and 11 p.m. Sunday.

In Alberta, the collective agreement between the Health Board of Alberta Services (HBA Services) and the United Nurses of Alberta details the following incentives:

• In view of current and projected market conditions, nurses will receive the lump-sum payments as follows:
  • 2007-2008: $1,500 paid semi-annually ($750 in October 2007 and $750 in April 2008);
  • 2008-2009: $1,625 paid semi-annually ($812.50 in October 2008 and $812.50 in April 2009); and
  • 2009-2010: $1,750 paid semi-annually ($875 in October 2009 and $875 in April 2010);
• Long-service payment: effective April 1, 2007, 2.0 percent will be added to the basic rate of pay for nurses who have 20 or more years’ experience;
• Supplementary vacation: five additional days’ vacation once every five years upon attaining 25, 30, 35, 40 and 45 years’ continuous service;
• Retirement preparation program: to enhance the retention of experienced nurses, reduction of a portion of their clinical work, dedicating that portion to leadership assignments, projects and research. The clinical hours of work are reduced to no less than a 0.6 point of their full-time equivalent position. The program is open to all employees who are eligible for an unreduced pension and those whose combined age and years of nursing employment equal 77 or more.
• Pre-retirement reduction program. Subject to employer approval, an employee nearing retirement may reduce his or her hours of work but continue to contribute to the pension plan in an unreduced fashion. To qualify for the program, the employee must be eligible for an unreduced pension or have a combined age and years of service of 80. The employee must also reduce his or her hours by no more than a 0.2 point of a full-time equivalent position and to no lower than a 0.6 point of a full-time equivalent position for no longer than a 2.5-year period.

In Saskatchewan, the collective agreement between the Saskatchewan Association of Health Organizations (SAHO) and the Health Sciences Association of Saskatchewan covering occupational and physical therapists, pharmacists and psychologists provides for the following initiatives:

• A retention allowance (effective October 1, 2007) in which Step 5 of each classification range is increased by 2.5 percent;
• A provincial market supplement program reviewed each year by the SAHO Provincial Market Supplement Review Committee;
• A deferred salary leave plan to provide employees with the opportunity to plan and finance a leave of absence by deferring up to one third of their gross salary (employees return to their usual employment at the end of the leave); and
• The transfer of unused sick leave and vacation credits by which an experienced employee newly hired by an employer covered by the collective agreement keeps his or her accumulated sick leave (maximum 30 days) and vacation, while new employees get an advance of five days’ sick leave.

The collective agreement between the SAHO and the Saskatchewan Union of Nurses, which expired in April 2008, contained the following provisions:

• Retention adjustments of 0.5 percent for each year covered by the agreement (2005, 2006 and 2007), plus general adjustments;
• Northern retention allowances ranging from $1,447.03 to $3,472.88 in April 2005, from $1,533.85 to $3,681.25 in April 2006 and from $1,625.88 to $3,902.12 in April 2007, depending on the location;
• A deferred salary leave policy.

This recently renewed collective agreement provides for a 5 percent market adjustment in addition to the general increase for April 2008 and, for employees with 20 years’ experience, a supplemental increase of 2 percent added to the base rate of pay each year for the duration of the agreement, as well as a provincial service-recognition payment of $1,750 each year in 2011 and 2012.

In Manitoba, the province-wide collective agreement between the Regional Health Authorities of Manitoba and the Manitoba Nurses’ Union provides for market adjustments of 2.3 percent for 2007 and 2.7 percent for 2008 in addition to wage increases. The agreement also establishes an interest-arbitration provision. In the event that the maximum hourly rate of the General Duty RN (Nurse II) classification is below fourth place in Canada on October 1, 2008, as compared to similar classifications in other jurisdictions, an interest-arbitration hearing will be triggered. The corresponding wage increase awarded by the arbitrator as a result of that hearing would also be applied to all other classifications represented by the Manitoba Nurses’ Union.

In Nova Scotia, the new collective agreement between the Nova Scotia Nurses’ Union and the Nova Scotia Association of Health Organizations contains several retention initiatives.

• Effective April 1, 2008, the employer will pay a retention bonus to eligible nurses who agree to remain employed for 12 months following their eligibility to retire with an unreduced pension under the terms of the pension plan. The retention bonus is equal to 2 percent of the gross annual base pay. Nurses must apply in writing to participate in the retention bonus program and may apply for a second and subsequent years.
• A trial agreement, under which the employer will allow the creation of temporary regular full-time positions that involve the performance of 80 percent of regular tasks and 20 percent of tasks involving mentoring, research, policy review and other activities to support colleagues and students for a period of between one and six months. Only nurses who are within three years of eligibility to retire on an unreduced pension may apply for these positions, which will be posted within the bargaining unit. A successful applicant may be granted only one of these temporary 80/20 positions in a 12-month period, unless no other qualified applicant is interested.
• A recruitment incentive of $500 per year to any retired nurse who, after retirement, agrees to return to work at least 24 casual shifts in a 12-month period. The $500 will be paid after the completion of at least 1 of the 24 casual shifts.
• Effective April 1, 2008, the creation of a new level on the increment scale for nurses with 25 or more years of service, which will increase the maximum salary by 3.5 percent. All subsequent increases and adjustments will be based on this new level.
• For nurses with 15 or more years of service, the addition of a progressive contribution by the employer to the monthly cost of the retired nurses’ health insurance plan (30 percent in 2006, 40 percent in 2007, 50 percent in 2008 and 65 percent in 2009).
• An option for retired nurses to return to work without losing seniority.

The collective agreement also provides for a 2.1 percent recruitment and retention adjustment, effective April 1, 2009, in addition to wage increases.

In addition to annual wage increases, the new collective agreement between the Capital District Health Authority and the Nova Scotia Government and General Employees Union (NSGEU) Local 42 provides for recruitment and retention adjustments of 2.1 percent effective retroactively to April 1, 2007 and 2.1 percent effective April 1, 2008 for Pharmacists. Moreover, the collective agreement negotiated this year between the same employer and Local 97 of the NSGEU contains the following provisions:

• Effective April 1, 2008, the employer will pay a retention bonus to nurses who, although eligible for retirement, agree to remain employed for the following 12 months. The retention bonus is equal to 2 percent of the gross annual base earnings (exclusive of any premiums). Nurses must apply in writing to participate in the retention bonus program and may participate a second year.
• At the same time, a new step will be added to the top pay level of nurses with 25 years of service. This step will be a salary increment 3.5 percent greater than the highest rate. The employer will recognize previous nursing experience with other employers, provided the nurse has not been away from nursing for more than three consecutive years. To have prior experience recognized and to claim the adjustment, employees must provide relevant documentation and information within the required time frame.

In addition to economic increases, the collective agreement between the Canadian Auto Workers union and the Cape Breton District Health Authority provides for an additional wage adjustment of 2.1 effective October 31, 2007 and 2008 for the recruitment and retention of Pharmacists.

In Quebec, the collective agreements between the Government of Quebec, the Comité patronal de négociation pour le secteur de la santé et des services sociaux and various provincial unions contain the following measures:

• Employees aged 55 years and over who are eligible for retirement and whose positions have been identified as those for which there is a shortage are entitled to an additional five days of paid leave for the first two years in which they remain employed and ten additional days for subsequent years.
• A letter of agreement regarding employees in nursing and cardio-respiratory care provides for an annual budget for the supervision of newly hired employees.
• A letter of agreement regarding health and social services technicians and professionals provides for the creation of a joint advisory committee charged with making recommendations to the Ministère de la santé et des services sociaux on the use of a non-recurring amount of $58.8 million for the duration of the collective agreement. The recommendations concern the adoption of administrative measures aimed at meeting service-delivery needs.
• The Task and Organization of Work Committee will evaluate the effects of various national-level measures on the attraction and retention of personnel entering the profession and the retention of personnel eligible for retirement. The Committee must make recommendations on the development of measures fostering an improvement in labour supply and the attraction and retention of personnel.

Lastly, Canada’s provincial and territorial health departments have adopted a number of recruitment and retention measures to address workforce shortages at the regional and local levels. Many of these measures concern education, offering new training programs, an increase in the number of nursing science openings available at some universities, student bursaries and training grants. Other measures introduce workplace strategies, such as mentoring programs to attract and retain new employees, bonuses and lump-sum payments for relocation, and an increase in the number of full-time positions by facilitating the conversion of casual or part-time positions into full-time positions.

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