With last week’s confirmation from Ontario’s auditor general of a steep increase in spending on agency nurses in some hospitals, others say they’ve managed to steer clear of the trend altogether.
Auditor General Nick Stavropoulos’s report found some hospitals more than tripled their spending on agency nurses from 2021-22 to 2022-23, while hospitals in northern Ontario saw a 25-fold increase in their use of agency nurses over a four-year stretch.
The reason? Many nurses have retired or have left the profession thanks to burnout and hospitals are increasingly short-staffed and dependent on agency nurses, who are typically paid at an hourly rate that far outpaces the rate for staff nurses, sometimes by two or three times.
Ottawa’s Queensway Carleton Hospital has done hard work to work with its budget and not hire agency nurses, said its vice-president of patient care and chief nursing executive.
“[The nurses’] biggest challenge is schedules,” said Yvonne Wilson. “We started working with a third-party company to create innovative schedules that really helps balance out their work life balance.”
For instance, some nurses now have access to a seven-day stretch without working.
Retention is the absolute key.– Yvonne Wilson, Queensway Carleton Hospital
Wilson started at the hospital two years ago after a long career at The Ottawa Hospital and made recruitment and retention her focus.
“Retention is the absolute key,” she said.
The hospital invested $250,000 in education to offer nurses more training in their areas of focus, said Wilson, and committed to a massive recruitment drive in 2022.
That year it hired 250 nurses to its staff of about 900, nearly double its hires in 2020.
The Cornwall Community Hospital is another smaller hospital going without agency nurses.
“Thanks to our dedicated team of health-care professionals and ongoing recruitment efforts, Cornwall Community Hospital does not employ agency nurses,” said hospital spokesperson Taylor Campbell.
According to The Ottawa Hospital, it only hires nurses to help offload patients from ambulances.
“We have a small number of agency nurses that work one or two shifts per day at the Civic and General Campus as part of this agreement. This helps support nursing levels to ensure patients get the care they need, and ambulances can return to the community in a timely manner,” said spokesperson Rebecca Abelson
That amounts to just two to four nurses across the whole hospital system each day, she said.
Agency nurses new for some hospitals
The Kingston Health Sciences Centre (KHSC) only recently began hiring agency nurses.
“KHSC averages roughly 15 agency nurses per 24-hour period. KHSC started utilizing agency nurses last December with a focus on high need areas within the hospital such as internal medicine and critical care,” said a hospital spokesperson.
The hospital employs 1,838 nurses, he said.
“When we move to privatized staffing it’s temporarily a great thing for the nurse, but we lose all those hard-fought things that we had: benefits, pension plan; the thought of risking all of that is something else that nurses should be considering,” said Registered Practical Nurses Association of Ontario CEO Dianne Martin, who also spent 30 years as as a nurse working in hospitals.
The auditor general’s report said hospitals are paying staffing agencies anywhere from $99 to $106 an hour for a registered nurse to work in the emergency department of a hospital in southern Ontario, while hospitals in northern Ontario pay anywhere from $100 to $160 an hour.
Do the math and Ontario hospitals spent at least $170 million on agency nurses last year.
“Many of those millions are going into the pockets of the people who own the agency, not the nurses,” said Martin.
WATCH | A look at the problem earlier this year:
Canadian hospitals are facing a nursing shortage partly because many nurses have left for more flexible, higher paying nursing agencies. CBC’s Christine Birak found out why the cost to the public system is more than just financial and what it would take for nurses to come back.
Nurses facing burnout
“I’ve been nursing 29 years and I’m feeling that moral distress that other nurses are feeling,” said KHSC cardiac nurse Wendy Schleger, who worries a dwindling nursing staff is affecting patient outcomes.
“The ultimate issue is our patients aren’t always safe,” the 52-year-old nurse said through tears in a recent interview on CBC Radio’s call-in program Ontario Today.
“There are people dying. I feel there are people that we could save, that we can’t get to the bedside to help them in time. And it breaks my heart.”
It’s also bothersome that agency nurses, who are often young and inexperienced, are earning more than she does, admitted Schleger.
“They don’t know the charting. They don’t necessarily know the supply rooms. They don’t know a lot of the procedures that come with experience, and sometimes just knowing where the bathroom is,” she said.
[Agency nurses]don’t know a lot of the procedures that come with experience, and sometimes just knowing where the bathroom is.– Wendy Schleger, nuse
So far there is “no legislation that caps the amount these private, for-profit companies can charge hospitals,” the auditor general’s report says, recommending the government consider regulating the rates.
“Once the government figures out how much money is being spent on agency nurses, they are going to shut it down because it is very, very expensive,” said Schleger.
However, during a news conference last week Health Minister Sylvia Jones said “We do not want to limit hospitals and operators in home and community care to actually provide the staff and the services they need.”
Instead, the government is investing in the nursing education system and clearing the path for internationally trained nurses to gain accreditation, she said.
Jumping ship for agencies
“We already knew why nurses were going,” said Martin. “You can’t blame them for making [the decision to work for an agency], but we also knew the impact that it was having, exactly as the reports says.”
While longtime Oshawa nurse Jo Amenta enjoys the stability of working in a hospital with a pension and benefits, she said she understands why some nurses jump ship for a private staffing agency.
“It is very very tempting,” said Amenta, who these days works in home care. Controlling her own schedule and earning more money are attractive prospects, but so far it’s not enough to lure her away from a publicly funded job.
Agency nurses are often inexperienced, she said. “The sad reality is they’re not catching some of the problems that are going on with the patients before they become catastrophes.”
Some of that work is falling to the more experienced staff members — nurses who are dwindling in number, said Amenta.