As the nursing shortage grows worse in Canada’s hospitals and long-term care homes, provinces and territories are paying hundreds of millions of dollars annually to private companies to fill gaps in staffing.
We know that Quebec alone paid staffing agencies at least $960-million last year. In 2022, Ontario spent at least $168-million, B.C. paid $64-million, Manitoba spent $40-million, and Nova Scotia spent $18.4-million in 2021 – with most of this information coming to light thanks to media digging.
In every jurisdiction, these costs have risen exponentially in recent years, particularly since the pandemic hit.
There is very little concrete information on what provinces are getting for their money – how many agency nurses are being used, how many hours are they working, where are they working, how much are they paid, and so on. Governments are tight-lipped, or perhaps embarrassed.
So the Canadian Federation of Nurses’ Unions has commissioned a study into the alarming rise in the use of agency nurses across Canada.
Already, we have a lot of disturbing anecdotal information.
In Canada, unionized nurses make roughly between $36 and $56 an hour (depending on seniority), along with benefits and pensions.
Agency nurses are paid two to three times the wages of staff nurses, and sometimes travel, food and rent allowances, signing bonuses of up to $25,000, and finder fees for recruiting other nurses. There are no benefits or pension plans.
The agencies also get a substantial cut. In some cases, they are making off like bandits, with their fees exceeding the hourly rate for staff nurses.
There are reports of temp nurses costing hospitals up to $300 an hour because of “surge pricing” – for example, a hospital desperately needing a critical care nurse on a Saturday night.
We are witnessing the Uberization of nursing in real time.
The economics of this are insane. Critics argue that we should be using this money to hire more staff nurses instead of funneling it to private staffing agencies.
But there’s the rub.
Hospitals and care homes are struggling to retain the nurses they have, let alone recruit new ones. There are roughly 42,000 unfilled nursing jobs across Canada.
Nurses are fleeing the public health system in droves, largely because of poor work conditions.
The pay is fair to middling and the workload soul-crushing because almost every shift is understaffed. Exhausting overtime hours are the norm and, in some provinces, mandatory. Burnout is rampant.
There is also an incredible rigidity in work arrangements. Most nurses are women, many with young families. Another large cohort is over 50 and approaching retirement. Both these groups want flexible work schedules; they don’t want to spend 12-hour shifts on their feet, let alone double shifts and overtime.
Sixty per cent of nurses work full-time, another 30 per cent part-time, and 10 per cent as casuals.
Hospitals, and to a lesser extent care homes, have used temporary workers and staffing agencies for decades. There is nothing inherently wrong with the policy.
Traditionally, temps have been used mostly in rural and remote areas, to fill in for holidays, maternity leaves and other temporary staffing needs.
But now agency nurses are becoming permanent temporary staff. In some hospital units, like emergency rooms, half the nurses are temps. Again, this makes no sense, and it’s untenable. Continuity matters.
Nurses who jump to agencies are doing it because these businesses offer what public hospitals and care homes do not – control over their hours and enhanced work-life balance. Better pay is a bonus, but it’s not necessarily the principal factor. Nurses don’t worry so much about pensions anymore because they can’t envisage a long career in nursing.
Some jurisdictions, like Quebec, are now backpedaling, trying to restrict agency use. But they are doing so by imposing punitive new rules on nurses, ensuring they get the worst shifts and making it more difficult for them to return to the public system.
Bullying nurses back into the public system isn’t going to work.
There are 459,005 regulated nurses eligible to work in Canada. Roughly 20 to 25 per cent are choosing not to work as nurses.
The nursing shortage we have is a shortage of nurses willing to work in the current conditions.
The only way to recruit and retain these essential health workers is to improve the workplace, and the conditions of care.
We will never buy our way out of this fundamental structural problem with exorbitant rates paid to agencies that serve as little more than costly fingers in the dyke of a troubled system.
André Picard