New research led by Queen’s nursing professor Dr. Joan Almost has revealed that public healthcare spending on nursing agencies has ballooned to more than a billion in the last fiscal year.
Dr. Almost’s research came together through a partnership with The Canadian Federation of Nurses Unions (CFNU) and points towards a trend of reliance on for-profit nursing agencies, with public spending expected to reach $1.5 billion by the end of the 2023/24 fiscal year.
In a release, CFNU President Linda Silas said the research clearly points towards how unsustainable reliance on these agencies is to address the nationwide nursing shortage.
“While governments, employers and unions have been working to fix workplaces and solve the healthcare crisis, corporate stakeholders have been taking advantage of the hardship facing our healthcare system,” Silas said.
“One thing is now crystal clear: for-profit nursing agencies are not a sustainable solution to Canada’s staffing crisis.”
Dr. Joan Almost, who led the research, said that while nursing agencies have existed for a long time in Canada, the COVID-19 pandemic resulted in organizations using their services much more frequently, and even now their usage has not slowed significantly.
She says the report’s goal was to paint a picture of the national landscape of nursing agency usage.
“There’s not a lot out there around nursing agencies in Canada, except for the media articles,” Dr. Almost said.
“It’s wanting to more look at a national picture of where are these agencies… is this a problem across the country, and how much is being spent?”
She says certain information, like comparing reliance across provinces, is difficult to ascertain as there simply isn’t much data out there on nursing agencies.
That lack of information and lack of overall regulation is part of the problem with agencies, she says, and right now there’s no simple answer to how much more hospitals spend on agency provided nurses compared to nurses on staff.
“This study tried to find a simple answer to solve that because it’s really a bit of an enigma about what they’re getting,” Dr. Almost said.
“It really varies across agencies. That’s the challenge of not having any regulation or oversight of these agencies that they can charge their own cost pretty much.”
The variance on those costs can be great, and research from the Ontario Nurses’ Association for example pointed towards a range of $53 to $260 an hour charged to the employer for an agency provided general Registered Nurse.
The salary that nurses receive from that cost also tends to vary.
While the primary driving force leading nurses to agencies is a difference in pay, Dr. Almost says it’s not the only factor, and simply put hospitals will never be able to directly match the salaries offered by agencies.
She says nurses want more flexibility in their scheduling that agencies are able to offer them, and to feel more valued within their workplace.
“Nurses don’t feel valued, they don’t feel listened to,” Dr. Almost said.
“They don’t feel like their voices are being heard on possible solutions or even change. They’re having change made to them rather than with them.”
Kingston Health Sciences Centre (KHSC) was often forced to rely on nursing agencies throughout the pandemic, and still continue to rely on them to some degree.
In a statement however, KHSC says they are making progress towards reducing that reliance.
“As part of our recovery efforts, we have been actively working to reduce reliance on agency nurses. For example, we have not utilized any agency nurses in our Emergency Department since Q1,” the statement reads.
“For Q3 we are projecting a 29.5% reduction in the number of agency nurses compared to Q1, with a reduction from 61 to 43 nurses. This is a clear indicator of our ongoing commitment to stabilizing our staffing levels with KHSC-employed nurses.”
While right now it’s up to employers to handle reducing the number of agency provided nurses in the workplace, Dr. Almost says there needs to be support from governments as well.
She says developing and launching a plan to phase out the use of agencies is a logical first step that needs to be made sooner than later.
“They need to start reining them in, in some ways, and then develop strategies of how they’re going to do it,” Dr. Almost said.
“And then also look into developing an alternative for employers to use.”
Dr. Almost said Manitoba is a good example of a province that has started to provide government run alternatives to nursing agencies, where nurses are receiving pay that’s more comparable to that offered by agencies but with the benefits of being in the public system like pension.
Ultimately the report points to 3 main recommendations: governments must immediately work towards phasing out nursing agencies, governments and employers must establish a human resources plan to address the ongoing nursing shortage, and until agencies can be phased out regulations and oversight need to be implemented.
