I keep hearing that Ontario’s nursing shortage is improving, that the worst is behind us, that staffing numbers are trending the right way. Some of that is true if you look at certain data points and squint. But I’ve been following what actually happened to nursing workforce since 2019, and the recovery story has some holes in it you could drive an ambulance through.
Over 20,000 nursing positions sat unfilled across Ontario at peak, around 2022-2023. That’s not a shortage. It’s a collapse.
What Bill 124 Did
Context: Bill 124, the Protecting a Sustainable Public Sector for Future Generations Act, passed in 2019. It capped wage increases for public sector workers at one percent per year for three-year “moderation periods.” The cap applied to collective agreements and arbitration awards, meaning unions couldn’t negotiate around it.
The Ford government sold Bill 124 as fiscal restraint, and on paper it applied broadly across the public sector. Nurses got hit harder than most because timing was terrible, the bill landed right before a pandemic. Suddenly Ontario was asking nurses to work double shifts in full PPE for wages which couldn’t keep up with inflation.
One percent. With inflation running at 4-7%. I keep doing the math on this and it doesn’t get better. Over three years nurses were taking a real pay cut, everyone on floor knew it, government knew it. Patients stuck in hallway beds while units ran short-staffed knew it too.
What happens when you tell your healthcare workforce they’re worth one percent during the worst public health crisis in a century? You find out how many nurses were staying out of obligation, and how many will leave the moment something better comes along.
My read is pretty simple. Nurses did what any worker does when the math stops working, they left. Some moved to agencies which weren’t bound by the wage cap and could pay $75 to $100 an hour, compared to the roughly $35-48 staff nurses were getting. Some went to other provinces. Alberta and BC were running active recruitment campaigns targeting Ontario nurses during this period (good luck with your retention strategy when competing provinces are buying billboard space). Some just left nursing altogether.
Not a trickle. An exodus.
The Courts Said No
Ontario Superior Court Justice Markus Koehnen struck down Bill 124 in November 2022, and I’ve read most of the ruling. It ran over 100 pages, basically said the government couldn’t prove fiscal necessity for the wage cap. Violated Charter right to collective bargaining. Full stop.
The Ford government appealed, lost again in February 2024 when Ontario Court of Appeal upheld the ruling. Bill 124 was unconstitutional.
After that the government decided not to take it to the Supreme Court, and retroactive pay started flowing. The total bill was estimated at $3 billion or more. If you’re keeping score that is a lot of money to spend cleaning up a restraint measure which didn’t actually restrain anything once courts got done with it.
The Agency Problem
Here’s where I’ll give the government some credit though. They recognized the crisis, launched recruitment programs. The Learn and Stay Grant offered tuition support for nursing students who commit to working in underserved communities. International recruitment ramped up. There were retention bonuses.
The thing is, losing a big chunk of your nursing workforce creates gaps which don’t wait for new recruits to graduate. Hospitals needed nurses yesterday, they turned to staffing agencies.
Hourly Nursing Pay Comparison (Estimated)
I keep coming back to the economics because they’re kind of absurd when you spell them out. A hospital loses a staff nurse making $48 an hour, then pays an agency $100 or more per hour to fill same shift. Ontario hospitals collectively spent hundreds of millions on agency staffing in 2023-2024, money which could have gone to permanent wages or better working conditions, the kind of things which might have kept nurses from leaving.
What does fiscal restraint even mean when you end up paying more than you saved? The Ontario Nurses’ Association has been asking this since 2021. Nobody in government seems to find it as funny as they do.
Where Things Stand
Context: The Registered Nurses’ Association of Ontario (RNAO) represents RNs, NPs, and nursing students. The Ontario Nurses’ Association (ONA) is the union for 68,000 nurses and healthcare workers. Both have called for higher base wages, mandatory staffing ratios, and limits on agency nursing use.
Nursing enrollment is up at Ontario colleges and universities. That is genuinely good news and I don’t want to brush it off. But here’s the catch, a nursing degree takes four years, and new graduates need mentorship from experienced nurses who are already running on fumes. You can’t just swap a fresh cohort in and expect same results when the senior workforce burned out between 2020 and 2023. Doesn’t work like that.
The 44th Parliament hasn’t brought in any major nursing-specific legislation as of early 2026. Working for Workers acts included some healthcare-adjacent provisions, nothing which targets workforce recovery directly. Sylvia Jones, Health Minister for her second term now, has focused more on private surgical clinic expansion and hospital capital builds than on staffing pipeline which those same facilities need to operate.
68,000 nurses represented by ONA. Roughly 48,000 RNs and nursing students through RNAO. When both organizations keep saying the same thing about state of the profession, I’d say that’s a signal you ignore at some risk.
The Sequence
What gets me about the Bill 124 story isn’t the bill itself. It’s the chain reaction. Government passed a wage cap, pandemic arrived and made it exponentially worse, nurses left, courts struck the cap down, retroactive pay cost billions, agency spending exploded, and now province is running recruitment campaigns to bring nurses back to a profession it spent three years underpaying.
Every step created conditions for the next. Not deliberately. But effect is the same.
Vacancy rates have come down from their peak but they’re still well above pre-pandemic levels, and rural and northern hospitals are carrying the worst of it. Some emergency departments in smaller communities have had to close temporarily because they can’t staff them, this has happened in places like Clinton, Seaforth, and Listowel. That’s not a statistic. That’s a town without an ER.
The government says they’re investing more in healthcare than any previous Ontario government, and by raw dollar amounts that’s probably true. But less of those dollars are reaching the nurses who deliver care, and more are flowing to agencies which profit from a shortage the government’s own policy helped create.
That’s the cycle. Three years after Bill 124 got struck down and it’s still spinning.
Sources and verification: Bill 124 court rulings are public record (Ontario Superior Court, Nov 2022; Court of Appeal, Feb 2024). The 20,000+ vacancy figure has been cited by RNAO and reported in the Toronto Star and Globe and Mail but should be verified against current College of Nurses of Ontario registration data. Agency nursing costs are based on hospital financial reports and union estimates; exact provincial totals should be checked against Ontario Hospital Association figures. Hourly wage ranges are approximate and vary by hospital, region, and experience level. The $3B+ retroactive pay estimate was widely reported but final disbursement figures may differ.
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