I'm happy to start, and I invite Anne and others to join in. I'll be very quick.
With regard to staff mix, CNA does have an evidence-based staff mix review tool which it has published. I have personally used that in my practice, most recently in the past year when we were looking at our patient population.
I work in a mental health tertiary hospital where our patient criteria or patient characteristics changed, so we applied this evidence-based process to look at whether we had the right staff mix. In one of our units, we found that we had poor nurse satisfaction. The nurses were not satisfied with their roles, because they were doing a fair bit of non-nurse work, work that could be done by others. We had a patient population that had become extraordinarily complex over the years, and that really directed us then to add registered nurses to that mix.
In the same hospital at the same time, we took a second unit, went through the same process, and found that in fact we needed more licensed practical nurses, or RPNs as they are called in Ontario, for the same reasons. There is an imperative today to use the evidence-based tools to look at our staff mix, always with a focus on patient needs. Staff mix, I believe, is a constantly dynamic function.
The HHR strategy pieces basically speak to nurse employment. Nurse employment is a complex combination of several factors. Number one, again, is needs of patients. Do we have a consistent number of patients in a setting? Do we have an ebb and flow of patients coming and going? How many do we need at what point? When we look at health system funding, that's always an issue.
Another factor is nurses' choices themselves. Some nurses do actually choose to be contract or to not take full-time jobs because doing so gives them greater flexibility in planning their lives.
It's a combination of those three complex factors.
I would leave it at that.