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Hamilton nurses are logging excessive overtime. Advocates say it’s ‘unreasonable,’ ‘unsustainable’ and ‘dangerous’ for patients and workers
Posted: April 25, 2025
(April 25, 2025) by: Joanna Frketich, The Hamilton Spectator
One Hamilton hospital nurse worked 24 hours straight.
Another worked the equivalent of nearly 63 hours a week for an entire year.
Three nurses worked so many hours that it added up to more than one and a half full-time jobs each.
The increasing amount of excessive overtime logged at Hamilton’s understaffed hospitals since the pandemic is deeply disturbing to unions and patient advocates, who question why there are no limits to how many hours a nurse can work.
“It’s dangerous,” said Natalie Mehra, executive director of the Ontario Health Coalition, which is an advocacy group.
“That is completely unreasonable and unsafe for the worker and for the patients,” Mehra said. “It means more accidents and injuries. It means more medical errors. Who wants to be the patient who’s being treated on the 50th hour of that person’s work week when they’re exhausted?”
Data obtained by The Spectator through a freedom of information (FOI) request showed that even part-time nurses have worked the equivalent of more than 50 hours a week for a full year.
“We’re not supposed to be driving their bodies into the ground to provide health care for people,” Mehra said. “It is unsustainable. Nursing is a job where you are on your feet, working physically, working all the time. It’s a very tough job.”
The troubling amounts of overtime at Hamilton Health Sciences (HHS) and St. Joseph’s Healthcare from April 1, 2019, to March 31, 2023, came to light after The Spectator submitted an FOI request for the highest number of hours worked by registered nurses (RNs), and paid nearly $1,100 for the data.
One nurse at HHS worked almost 3,270 hours in a year — a full-time job is 1,950 — while the highest at St. Joseph’s was nearly 2,970 hours. HHS had a part-time nurse who worked 2,734 hours while St. Joseph’s had one who worked 2,649.
Such instances were called overtime “outliers” by Michael Heenan, president of St. Joseph’s Healthcare. In an interview with The Spectator, he emphasized that care provided at hospitals is “not just about one nurse,” but about a team working together.
“I’m comfortable that we’re not putting patients at risk,” Heenan said.
HHS declined an interview about overtime, but provided a statement saying it has an “exceptional approach to patient safety.”
“Our top priority is to make sure our patients receive the high-quality care they need,” spokesperson Aaron Levo stated.
The FOI documents show overtime was already high leading up to the pandemic, but shot up in the fiscal year that started April 1, 2021. It wasn’t just one nurse putting in excessive amounts of overtime. During that period, for instance, the nurse working the fifth-highest amount at HHS jumped to nearly 660 overtime hours compared to 462 pre-COVID. Overtime escalated again just one year later to almost 835 hours for the nurse working the fifth-highest amount in 2022-23.
The surge in overtime coincided with Canadian nurses leaving the profession in droves during the pandemic. Hospitals were already short-staffed before COVID, and the pandemic pushed them over the edge to burnout. This led to unprecedented numbers of unfilled jobs in health care across Canada; Hamilton’s hospitals alone were short 1,000 nurses by July 2023.
“Understaffing begets understaffing. When you have too few staff, the remaining staff have to cover all of the shifts,” Mehra said. “The evidence is very clear that as there are shortages of staff, there are more injuries, there’s more absence and illness and that creates more staffing shortages.”
The rapid rise in excessive overtime raises questions about why there are no limits to the number of hours nurses can work in a shift, in a week or in a year at Hamilton’s hospitals. Ontario’s Ministry of Health and the provincial regulatory college also have no restrictions on the hours Ontario nurses work. In addition, there are no federal regulations providing safeguards.
The lack of rules is such a long-standing problem that two separate reports by nursing associations — one in 2011 and one in 2023 — raised the alarm about the danger of excessive overtime and the need for legislation and regulatory limits, like in other professions with life-and-death consequences such as aviation, transportation and nuclear industries.
Having no regulations is “a recipe for disaster, for someone to make an error that could be devastating for a patient,” said Sara Labelle, chair of the hospital professionals division at the Ontario Public Service Employees Union (OPSEU).
“It’s not safe for anybody,” Labelle said. “You need sleep or people do not function. They tell you not to drive when you have not had enough sleep, because it’s the same as driving under the influence.”
Overtime doubles salaries
Public sector salary disclosure suggests high amounts of overtime continued into 2024.
Hamilton’s highest paid RN made $287,241 in salary and taxable benefits last year, which is more than two and a half times the earnings of a hospital nurse getting the highest wage set out in the provincially negotiated contract.
While Ontario’s top earning hospital nurses make about $109,200 a year under that contract, Hamilton’s hospitals had 44 RNs making $165,000 or more in 2024, including six above $200,000.
St. Joseph’s reported that nursing overtime cost the hospital network roughly $5.9 million in the fiscal year that ended March 31, 2024.
The highest number of hours worked by an individual RN also increased in 2023-24 at St. Joseph’s to 2,998. HHS did not provide data for 2024.
Nursing union president Erin Ariss said nurses are “showing up in a time of need to provide care to Ontarians.”
“We are 25,000 nurses short in the province, I can just imagine that they are maxed out and working in some cases double what they should be,” said Ariss, president of the Ontario Nurses’ Association (ONA). “Nurses are running into dangerous situations. They’re working beyond their capacity.”
St. Joseph’s is looking for ways to address overtime “outliers,” Brooke Cowell, chief nursing executive, said in an interview with The Spectator.
“What I can say, first and foremost, is that safety of our staff, our patients and our physicians is our top priority,” Cowell said. “We do have comprehensive checks and balances that are in place.”
Risks to patients
Nursing shortages and excessive overtime have long been flagged as an urgent problem going back years before the pandemic. A report on overtime by the Registered Nurses’ Association of Ontario (RNAO) in 2011 included stark warnings about “overwhelming evidence” that fatigue was “linked to patient safety risks, performance, errors, personal health, and recruitment and retention of nurses.”
“It is imperative that the critical relationship between nurse fatigue and patient safety be addressed,” stated the report by the professional association. “Organizations must develop and implement programs and strategies that mitigate fatigue to protect nurses and their patients.”
The report also advocated that “the number of registered nurses be increased in order to address both current and projected shortages, and to maintain the health of the nursing workforce.”
Despite the report’s dire predictions of burnout, the Hamilton FOI data showed nurses working hundreds of extra hours in the year leading up to the pandemic.
The most overtime hours worked by a single full-time nurse was just over 662 at St. Joseph’s and nearly 592 at HHS for the fiscal year that started April 1, 2019.
The extra time raised their work to around 50 hours a week for an entire year, from the typical 37.5 hours. St. Joseph’s also had a part-time nurse working around 50 hours a week.
By the time COVID hit in March 2020, the RNAO’s predictions about burnout became a reality.
“It’s a really bad cycle because the more the burnout, the more you will have other people doing overtime because you get a sick call,” said Doris Grinspun, CEO of RNAO. “If that repeats and repeats, at some point I will say to you, ‘Goodbye, I cannot do this anymore.’”
Nurses left the profession in droves after the pandemic hit, concluded a September 2024 report funded by the Canadian Federation of Nurses Unions (CFNU).
“While nursing shortages and deteriorating working conditions predate the pandemic, a tsunami has taken place across the country with many nurses deciding that they have had enough, spurring them to retire early, leave the public system or leave the profession,” stated the report.
The Canadian Institute for Health Information (CIHI) reported about 120,140 unfilled jobs in health care in Canada in the fiscal year that ended March 31, 2023 — twice as many there were in the year before the pandemic, and quadruple the number there were in the fiscal year that ended March 31, 2016. Nearly one-quarter of those vacancies were for nurses.
Hamilton was also experiencing an unprecedented hospital staffing crisis that spiked to nearly 2,700 unfilled jobs at HHS and St. Joseph’s combined by July 2023, up from 675 one year earlier.
“You can’t continually starve a system of nurses and rely on those that are working twice as much as they ought to be and expect that that’s sustainable,” said union president Ariss. “We’re exhausted.”
The result of massive staff shortages was a staggering rise in overtime. CIHI reported a 53 per cent increase in the number of overtime hours worked by Canadian nurses and other hospital health workers on inpatient units in the fiscal year that ended March 31, 2022. They worked 14.2 million hours of overtime, or the equivalent of over 7,000 full-time positions.
Hamilton saw a similar jump, with one HHS nurse alone working the equivalent of two-thirds of a full-time job just in overtime both in 2021-22 and 2022-23.
“Care is affected by that,” Ariss said. It leaves the nurse at “real significant risk of injury, both psychological and physical.”
Exhausted nurses
At HHS, the most overtime worked by a nurse more than doubled after the pandemic to nearly 1,320 hours for the fiscal year that started April 1, 2021 — about 25 hours per week on top of their full-time job. The next highest at HHS worked nearly 754 extra hours while St. Joseph’s had a full-time nurse work almost 1,000 hours of overtime that fiscal year.
“Working that level of overtime will be physically, emotionally, psychologically exhausting,” said Michael Hurley, president of the Ontario Council of Hospital Unions, which is part of the Canadian Union of Public Employees (CUPE). “Operating at peak efficiency for such a long period of time is impossible. You see in environments where people are working extensive overtime consistently that they start to crack.”
By the next fiscal year, HHS had two nurses working more than 1,000 hours of overtime and St. Joseph’s had one. At least five more worked over 830 hours of overtime.
In addition, at least nine part-time Hamilton nurses worked more than 2,000 hours in total that fiscal year. That’s more than a full-time job.
Some nurses were working so much overtime at Hamilton’s hospitals that they were making more than double a full-time salary, a November 2023 Spectator investigation found.
“How can they deliver the care the patient needs? They’re exhausted,” said Grinspun of the RNAO.
Levo said in the HHS statement that this level of overtime is “on par with other hospitals in Ontario” and the hospital network is “working hard to reduce its use.”
Both hospital networks say the extra hours are completely voluntary — as opposed to compulsory overtime that can occur to ensure patients are not left abandoned.
“Nurses have the choice to pick up overtime shifts,” said Cowell, executive vice president of clinical operations at St. Joseph’s. “They have to use their professional judgment, whether they have the capacity to work. They assess themselves independently … We don’t place a limit on overtime hours.”
But restrictions are badly needed, concluded a December 2023 CFNU report on safe working hours, which advocated for legislation and regulatory limits on consecutive working hours for nurses similar to pilots, air traffic controllers, commercial transportation, railway operators and the nuclear industry. The report said the safety of patients should matter as much as the safety of passengers.
“Research shows that fatigue is similar to the effects of alcohol intoxication,” stated the report. “It has been linked to work-related injuries in nurses … Moreover, there is a growing body of evidence linking fatigue to safety incidents in health care.”
The report stated working more than 40 hours per week was associated with an increased risk of adverse effects. Overtime doubled the odds of making at least one error. Medication mistakes and needlestick injuries went up significantly after more than four hours of overtime. Risks to patients went up by as much as 50 per cent by the fourth 12-hour shift in a row.
Despite increasing evidence of the dangers of too much overtime, nurses described in the report being asked to work extra every day and feeling obligated to pick up shifts. Some said they were so tired they couldn’t drive themselves home after work.
“It is not safe for us; it is not safe for our patients,” stated a hospital nurse in the report.
Excessively long shifts of 16 to 24 hours were also flagged in the report, with more than one nurse describing becoming confused around the 20-hour mark.
Marathon shifts
The FOI data shows these marathon shifts have been going on for years in Hamilton, even before the pandemic. In the fiscal year leading up to COVID, the longest shift by a nurse at HHS was 23 hours. In the next three fiscal years, it ranged from 21 to 24 hours.
“That’s a disaster,” said Grinspun of the RNAO. “I don’t know how they can do that, nor do I think it’s responsible for that employer to have this … It’s unsafe.”
HHS did not answer questions about the long shifts that Hurley of CUPE called “a crisis.”
“It’s ridiculous,” said Hurley. “No one functions at that level.”
The head of Ontario’s nursing union said to work 16 to 24 hours straight, “You can imagine what a predicament that nurse would have been in.”
“It’s inhumane,” said Ariss of ONA. “You have been there for 16 hours, providing life-saving care to people, where there is no room for error.”
At St. Joseph’s, the longest nursing shifts for the same fiscal years were between 13 and 15 hours. That is still longer than the maximum of 12.5 hours recommended by the CFNU report, that found the risk of safety incidents increases after eight hours of work, doubles by 12 hours and as much as triples by 16 hours.
“The majority of nursing shifts here would be 11.25 hours,” said Cowell from St. Joseph’s. “Those times where it goes beyond would be exceptional circumstances.”
Cowell stressed overtime at hospitals is bound by collective agreements negotiated provincially with the Ontario Hospital Association, while president Heenan said St. Joseph’s would be “happy to participate” in any provincial discussions about creating regulations.
However, legislation or regulatory limits don’t appear to be on the horizon.
The College of Nurses of Ontario, which regulates the profession, said in a statement that it does not set rules for “labour issues such as staffing matters, which include overtime.”
Ontario’s Ministry of Health also said in a statement that it’s not involved in labour contracts for nurses.
Stabilizing staffing
St. Joseph’s says it is working to reduce overtime by getting its number of unfilled vacancies for all staff down to 79 in March from 361 in 2023 with the help of a number of provincial programs aimed at recruitment and retention.
“We’re starting to see a lot more stabilization in terms of our overall staffing levels,” said Cowell. “When we look to our past year in comparison, in February, we were at a 14.9 per cent vacancy rate, and this February we’re down to 5.8 per cent, so huge improvements.”
Decreasing overtime and staff shortages are key to creating an environment where people want to work, said Cowell.
“As you’re seeing decreases in overtime and times where staff are working short, they’re more comfortable, they’re more confident and they want to come to work,” Cowell said. “We’re really seeing a positive uptick in that.”
HHS says vacancies for all staff have decreased to 922 in March from more than 2,300 in 2023. However, the hospital network expected to finish the fiscal year on March 31 with a deficit of $40 million — the fourth year in a row HHS has been short. It’s a drastically different situation than at St. Joseph’s, which is among a minority of Ontario hospitals to finish the past two fiscal years with a budget surplus.
The year-after-year shortfalls have led to HHS “reviewing all vacant positions” up until May 1. Unions have been accusing the cash-strapped hospital network for the last six months of pulling job postings or leaving positions vacant.
In addition, recruiting is still a challenge in a province that ONA says will be short 33,000 nurses by 2028.
“The sad reality is that in terms of staffing, we’re running on empty,” said Hurley from CUPE. “There needs to be a vigorous policy to retain existing staff and to recruit, train new ones, otherwise you can only expect people to work at this level for so long before they just crack.”
ONA has been advocating for mandatory nurse-to-patient ratios to attract nurses, create better working conditions and improve safety.
“We’re not asking for the world, we’re asking to be safe,” Ariss said. “We’re asking to have adequate staffing so that we can provide the best care — that’s what we show up to do every day. It can happen. It just has to be a priority.”
Without change, Hurley from CUPE says the system will keep losing staff to what is known as “moral injury.”
“They go to work, they’re given a patient load which is impossible to complete, they don’t feel like they’ve done a good job, this isn’t what they were trained to do, they feel like they’re failing, they feel guilty,” Hurley said. “Some people quit as a result and a lot are really burning out because of the impossibility of actually doing a good job.”
Working excessive amounts of overtime only adds to that moral distress.
“You can be the best employee in the world and the best at your profession, but you will eventually make an error when you’re that sleep-deprived,” said Labelle of OPSEU. “It’s unsafe.”
