is the actual demand. as of 2019, there were limited statistics on the nursing labour market, particularly as related to vacancies. shortage of nurse educators a 2014 study in canada and another in 2019 confirmed that along with the shortage of nurses in canada, there was also a national shortage in nursing educator in higher learning, which reflects the global shortage identified in 2011 by the institute of medicine and in 2020 by the world health organization (who). a 1967 journal article in canadian nurse predicted a severe future shortage of nurses in canada unless the shortage of nursing faculty in undergraduate and graduate programs was remedied. in the mid-1960s some of the factors that contributed to a lack of retention and growth in nursing faculty included the rate at which professors reaching retirement age being matched by new and younger hires. there were much higher salaries for these individuals in non-academic professions. the workload for nursing faculty was excessive. covid-19 pandemic-related nursing shortages while the covid-19 pandemic "spotlighted" issues related to canada's nationwide nursing shortage, it did not cause the shortage, according to the cfnu. critical care, for example in icus, emergency services, long-term care (ltc), and all clinical settings have been affected by the nursing shortage. lakehead university's nursing school director, kristen jones-bonofiglio, said that the covid-19 pandemic exposed ways in which canada's health care was unsustainable. she said that academic literature described how scarcity had become normalized in health care–an "ideology of scarcity". canadian nurses association president, sylvain brousseau, said that changes in the working environment, where nurses' values are no longer reflected, and where they no longer feel welcome, has led to an exodus of "burned-out, late-career nurses". brousseau said this has contributed more to the pandemic-related increase in the nursing shortage than nurses unable to work because they contracted covid. a 2022 review of how the pandemic impacted the 400,000 nurses in canada, sponsored by the royal society of canada and published in the facets journal said that by 2021, health job vacancies had increased by 56.9% since 2019 in canada to a "record high of 100,300. the highest vacancy rate was experienced by hospitals. the report found that for decades, the "nursing labour market" was "under stress" but "widespread systemic change" did not occur. the pandemic-related workload increase combined with chronic stress represented a "tipping point of systemic burnout". some of factors leading to the exodus of the nursing labour force included "workload, burnout, lack of structural value, the need for leadership and mentorship, and lack of flexibility, autonomy and voice laced with overt racism, discrimination, and gendered inequities," according to annette elliott rose, one of the study's authors. due to a shortage of nurses, in march 2022, during the covid-19 pandemic in canada, the first of many unplanned closures of emergency rooms took place—the first such occurrence since 2006. by september 2022, across canada there were "dozens of forced closures of emergency rooms took place because of insufficient staff. by may, ontario health reported emergency department "record-high wait times and patient volumes." hospital administrators said that one of the reasons for hospital staff shortages is the retirement since 2018 of many healthcare workers who are over the age of fifty who cited "the pandemic and burnout as top reasons." other administrators said staffing issues were a concern before the pandemic. while some raised concerns that nurses who left their profession because of the vaccine mandate had contributed to the shortage, one hospital ceo said the number of those who left for that reason was so small, it was a "non-issue". a september 2022, new york times article said that nurses in canada left the profession because of "unsafe working conditions, wage dissatisfaction, and burnout from the pandemic". sixteen emergency departments had to close in september because of nursing shortages in canada's "most populous province", ontario. ontario council of hospital unions president said in august that the work force which had been working through the pandemic in an unsafe work environment, and had their wages cut, was "exhausted" and "demoralized". due to shortages in staffing, intensive care units (icu) reached full capacity in august 2022, forcing the uhn to announce a 'critical care bed alert' at the toronto general hospital affecting the cardiovascular (cvicu), cardiac (cicu), and medical surgical intensive care units (msicu). on 28 october the uhn announced that the toronto general hospital was again under a 'critical care bed alert' with the three intensive care units—cvicu, cardiac cicu, and msicu—at total bed capacity. in 2019, one icu bed in alberta represented more than $1,000 a day just for nursing costs. per icu bed day in august 2022, with the province of ontario facing the peak of the seventh wave of covid-19, the university health network (uhn) in toronto, which operates the largest hospital in the city—toronto general–said that there were so understaffed that they were calling in nursing students. they put out a call for "volunteers" to fill nursing shifts. during the sixth wave they were forced to do this several times. in august, some patients waited 33 hours in er to get an inpatient bed in toronto. canadian federation of nurses unions (cfnu) said on twitter on 31 october 2022, that it had become normalized for hospitals to operate understaffed at overcapacity, with nurses regularly working 16 hour shifts—two nurses recently worked 30 hour shifts. by mid-october 2022, prior to the beginning of the "traditional flu season", across canada emergency departments were "under intense pressure". concerns were raised as in europe an eighth covid-19 wave was beginning. in the province of quebec, there were staff shortages of all health care personnel—but mainly nursing personnel—negatively affected all of the province's health-care network." largely because of the ongoing covid-19 pandemic, emergency departments were operating at overcapacity, which in montreal reached up to 200%. on 14 october, there were 4,000 health-care workers on leave because of covid. according to a june 2022 statistics canada's report on the results of the survey on health care workers' experiences during the pandemic (shcwep), 92% of nurses—compared to approximately 83% of other health care workers—said they felt more work-related stress. in response to the shcwep, 83.7% of nurses reported increased workload as nurses, related to acute care settings and the nature of hands-on care. as well there was an increase in demand for nurses during the pandemic. shcwep results also showed that the shcwep results show that 70.9% of nurses—compared to other 60.6% of health care workers, who were "not intending to retire" were thinking of "leaving their job or changing jobs". university of ottawa's ivy bourgeault, who is currently the canada research chair in comparative health labour policy, said in a 13 december 2022 interview, that hospitals in canada were in a "really vicious", "crisis situation", precipitated by a combination of the ongoing shortage of health care workers and the increase in cases of respiratory syncytial virus, the seasonal flu, and covid-19 requiring hospitalization and emergency services. pediatric icus have been overwhelmed in ontario, alberta, british columbia, manitoba, and in multiple other provinces. this has resulted in longer er wait times and hospital closures. by october 2022, with some rural hospitals in ontario facing closures because of a shortage of nurses, the debate over the potential role of unvaccinated nurses became more spirited. at a tense town hall meeting, four hundred residents of chesley raised concerns about the two-month-long forced closure of their local er as the severity of nursing shortage had increased. an unvaccinated nurse who spoke up at the meeting saying she was ready to work pending permission, was met with calls for her rehiring. in response, the south bruce grey health centre (sbghc) rural health network reviewed its covid-19 vaccination policy and was publicly considering abandoning its vaccine policy, making it the first in ontario to do so. on 10 december, the ontario hospital association (oha)—which has the jurisdiction over 140 hospitals in ontario—sent an internal memo to sbghc management restating the oha's support for the existing provincial covid-19 vaccination policies within hospitals, as "they offer the highest level of protection for patients and health care workers". health care networks in british columbia, nova scotia and ontario continue to enforce vaccine mandates for health care workers, while in some places in canada, unvaccinated health-care workers were already rehired in 2022, such as in alberta, manitoba, newfoundland, new brunswick, saskatchewan, and in the yukon, according to a ctv report. emergency departments overloaded during the seventh wave of the covid-19 pandemic, the lack of health care personnel, particularly nurses, along with the health system's backlog and a resurgence of hospitalized covid-19 patients were some of the factors contributing to the overloading of emergency departments and lengthening of ambulance off-loading times. by 27 october there were 1,921 covid-19 hospitalizations in ontario and 121 more covid-19 deaths. prior to that, the last time the numbers were so high was on 9 february with 2,059 hospitalized with covid-19. nurse shortages in rural communities critical nurse shortages were one of the major factors in the unplanned closures of emergency rooms in ontario rural communities. this raised concerns among the future of rural health systems where emergency health care options are limited. a canadian association of emergency physicians representative said that an "unprecedented" number of nurses left for "less stressful and better paying jobs". seventeen of the 160 departments that experienced these closures were rural. nursing force retention and exit rates by 2021, many in the nursing workforce considered taking a leave of absence or leaving the profession for good; others had already left. the factors causing the exit included work environments that were too demanding, understaffing that was chronic not acute, physical and moral injuries, burnout, and concerns for their mental health. in october 2022, following a meeting with collaborative action-oriented government coalition with canadian federation of nurses unions (cfnu), provincial nurse union leaders, prime minister justin trudeau, minister of health jean-yves duclos, and minister of seniors kamal khera health care workers, and advocates the health canada coalition was formed with a mandate to respond to the nursing workforce exit rate. nurses wages and benefits since 2018, the number of nurses leaving ontario for the united states doubled as wages are higher there and the work environment less stressful—full-time permanent positions are paid $15-$20 more than similar jobs in canada. they can also earn sign-on bonuses from $10,000 to $20,000, as well as housing and relocation assistance. the u.s.-based commission on graduates of foreign nursing schools (cgfns) said that in 2018, 801 canadian nurses applied for credential transfers; in 2019 there were 1,300 applications; in 2019 there were 1,300; and by october 2022, the number had increased to 1,700. frank mortimer of cgfns said the number of canadian nurses approved to work in the u.s. has doubled over the last five years and could be at an all-time high in 2019, during the pandemic, under the premiership of doug ford, bill 124—protecting a sustainable public sector for future generations act was enacted placing an annual cap of 1% for three years on most public sector employees, including nurses. this is lower than the inflation rate and according to opposition critics, represented a cut in salary. according to health care workers' unions, this contributed to the staff shortages. according to a 17 july 2022 financial accountability office (fao) report, in ontario the government spent "$7.2 billion less than planned across all programs", including health. in 2019, the ford administration capped the wages of most public sector employees, including nurses, causing staff shortages, according to health care workers' unions. in ontario, since 2019 with the passage of bill 124, there has been a "major increase" in nurses relocating to the us. internationally educated nurses (iens) the cfnu and chwn 2022 report called on the federal and provincial governments as well as employers to improve the integration of internationally educated nurses into the canadian health workforce.