TORONTO -- The Ontario Nurses' Association is sounding the alarm about layoffs of Registered Nurses by cash-strapped hospitals, and warns patients will pay the price.

The union, which represents 60,000 registered nurses, says there were 770 RN positions cut across Ontario last year, and hospitals in Windsor and Kitchener have already announced more RN layoffs this month.

The hospitals decided to "risk the health outcomes of patients by cutting RNs to balance the budget," said ONA president Linda Haslam-Stroud.

Windsor Regional Hospital cut about 120 RN positions this week, but said it plans to hire 80 registered practical nurses, who do not need a university degree. The Grand River Hospital in Kitchener cut 38 RN jobs this week.

Part of the problem is the government's funding formula favours hospitals in high growth areas like Toronto, Markham, Richmond Hill and Barrie, which means less money for Windsor-Essex, said WRH president and CEO David Musyj.

"Generally this is where we have been penalized as a hospital and region," Musyj said in a note to staff announcing the layoffs.

"Just for this fiscal year, we are being told we will receive approximately $10 million dollars less in funding due to the formula."

Hospitals are not allowed to run deficits, and Musyj said Windsor Regional "will return to balanced or surplus budgets" with the staff changes.

ONA said "hardly a day goes by" where it doesn't get a call from nurses at a hospital who say they've been told to expect layoffs.

A four-year funding freeze means hospitals have less money for patient care because of inflationary pressures on wages and other costs such as heating and electricity, so they're laying off nurses, said ONA vice-president Vicki McKenna McKenna.

"I absolutely believe that this is all being driven by budget cuts," she said.

Health Minister Eric Hoskins issued a statement saying hospitals are responsible for their own staffing decisions.

"Our expectation remains that they work closely with the LHINs to determine how best to manage their budget concerns in a way that sustains quality health services for the future and does not impact patient care," he said.

A spokesman for Hoskins said the government consulted 500 "health system leaders, clinicians and experts" on the design and implementation of the funding formula.

"Hospitals, long-term care and community care providers are funded based on how many patients they look after, the services they deliver, and the specific needs of the population they serve," said press secretary Shae Greenfield.

Ontario hospitals are in crisis because of the funding freeze, and nurses are being targeted while patients get decreased levels of care, said Progressive Conservative health critic Jeff Yurek.

"When you do frontline heath care cuts, the patient does suffer, care does diminish, because nursing is the backbone of the health care system, particularly in hospitals," he said.

The New Democrats said freezing hospital budgets led to nursing cuts that directly impact patients.

"I would tell the government: stop the cuts to frontline care," said NDP health critic France Gelinas. "I don't want to be alarmist, but this will put patients at risk."

Gelinas is concerned that the push to home- and community-based care means diverting scarce health care dollars to for-profit companies contracted to provide those services, and said patients can wait up to 200 days for treatment.

"The money that goes to profit does not go to care, but it comes out of the same pie," she said.