Alberta's reliance on contract nurses could further erode health-care system, critics say

Alberta hospitals and health-care centres have become increasingly dependent on contract nurses and other workers to stay functional — a trend that critics say must stop before it erodes an already beleaguered public workforce.

Contract data publicly posted by Alberta Health Services shows the province's largest health-care provider has increased its spending on staffing agencies more than tenfold during the last seven years.

"This is indicative of just how bad things really are," Heather Smith, president of the United Nurses of Alberta, said in an interview. "There's no short-term relief. There's no magic bullet to turn it around overnight."

Smith said Alberta's 30,000 registered and registered psychiatric nurses (RNs and RPNs) are increasingly being told to work mandatory overtime and fielding desperate calls to come in on their days off.

Those nurses are also getting text messages from recruiters, offering them work with private agencies, Smith said.

The perks can be substantial, she said. Higher pay. Better work-life balance. Vacation time that won't be cancelled.

"We're getting more and more requests [from nurses] all the time," said Heather Pringle, owner of staffing agency Nurse Relief, Inc. "People wanting out of the regular position and being able to take charge of their own career and be their own boss."

Nurse Relief provides RNs, licensed practical nurses (LPNs) and health-care aides to facilities in several provinces. For two years, the company has been one of the major contractors supplying AHS with relief staff.

In 2015-16, AHS spent less than $400,000 on two 12-month contracts with two staffing agencies to provide urgently needed workers.

By 2021-22, AHS had 15 contracts signed with 10 agencies that were ready to provide RNs, LPNs and health-care aides when necessary. AHS spent nearly $5.2 million on those contracts.

AHS contracts do not include facilities operated by Covenant Health, which runs Alberta's Catholic hospitals and health-care centres.

CBC made four information requests to Covenant Health in three months. On Friday, Covenant Health provided aggregated data on its staffing agency expenses dating back to November 2020.

In the 2021-22 fiscal year, Covenant Health paid more than $259,000 to five staffing agencies.

In the nine-month period from April to December 2022, that spending jumped to $2.2 million with seven agencies.

As of Jan. 6, Covenant Health had 35 private-agency RNs and LPNs working in rural hospitals and continuing-care facilities, which was about one per cent of their nursing workforce, said communications adviser Carla Howatt in an email.

The global competition for workers has pushed Covenant to use more agencies than in the past, she said. 

AHS's reliance on agencies escalated when COVID-19 arrived in Alberta in spring 2020, a spokesperson said.

A report prepared for the Alberta government a year ago by EY Canada on the sustainability of the health system shows health-care workers in the province are quitting, working overtime and calling in sick at dramatically higher rates than a few years earlier.

Vacancy rates for RNs, LPNs and other health professionals jumped up between 2019 and 2021.

Agency owners and academics say the trend is similar across Canada and in some other developed countries.

Smith, the UNA president, said that in previous years, agency employees — sometimes called travel nurses — were dispatched mainly to rural and remote hospitals short of staff.

When nurses started seeing them in Edmonton and Calgary emergency rooms and intensive care units in 2022, the union began asking AHS for routine reports on where agency nurses were working.

A compilation of those reports from July to December 2022 shows as many as 41 agency nurses placed at Grande Prairie Regional Hospital, 39 at Edmonton's University of Alberta Hospital and up to 20 at Red Deer Regional Hospital.

The number of contract nurses fluctuates.

In May 2022, AHS tallied 220 total agency workers on the job. That jumped to 341 in October. As of Jan. 5, it dipped down to 231. AHS did not keep track of contract nurses across all sites before May 2022.

AHS spokesperson Kerry Williamson said the increase in the fall was almost entirely outside of Edmonton and Calgary, where it's harder to recruit workers.

Yet, even with contractors filling the gaps, hospitals and health centres are still closing beds and temporarily shutting their doors, said Chris Gallaway, executive director of the advocacy group Friends of Medicare.

As of Jan. 31, AHS listed 31 "temporary service disruptions" in facilities across the province.

"We are in a staffing crisis," Gallaway said. "And we're not seeing a response that's treating it like a crisis."

Flexibility and pay are big draws

UNA's collective agreement has a pay scale of $38 to $51 an hour for RNs without management responsibilities.

CBC News found travel nurse advertisements for placements in rural and remote Alberta locations paying up to $85 an hour.

Since the employees come from across the country, agencies also pay for workers' travel and accommodation.

AHS wouldn't release details about its contracts, including how many hours of work they included or the rates agencies charge.

Melanie Olsen owns Burnaby, B.C.-based Select Medical Connections — one of the agencies supplying workers to AHS. She has around 400 workers dispatched to all but three Canadian provinces and territories.

Olsen said demand for nurses, LPNs and health-care aides has been growing for about 15 years. It accelerated during the pandemic.

Deciding how much to charge depends on market forces and the location, she said. She said rates in some places have shot up because of the demand.

"We have kept some nurses in the profession that were otherwise considering their options," Olsen said.

Her agency does not headhunt working nurses to lure them from the public system, she said.

Pringle, the owner of Nurse Relief, founded her Edmonton-based agency in 2008 after working seven years as a contract nurse herself. She said she was drawn to contracting because it allowed her to keep more of her earnings.

Agency workers need higher rates of pay to buy private medical insurance, and to cover employment insurance and pension contributions, she said.

Pringle sets her rates by asking with the nurse what pay they would need to consider accepting a posting.

"It's easier to find nurses when you're going to offer them exactly what they're worth," she said.

Quebec's cautionary tale

Jason Sutherland, a professor of public health at the University of British Columbia, said employing full-time workers is generally more cost-effective than relying on contract nurses from staffing agencies.

Although the growing demand could lead to a proliferation of health staffing agencies, it could also give health-care workers more leverage to demand better working conditions and compensation, Sutherland said.

"The balance of power has shifted away from the larger employer into the hands of the nurses right now."

Damien Contandriopoulos, a University of Victoria nursing professor who is from Quebec, says that province's experience with agency nurses should be a cautionary tale for the rest of the country.

No rules prevented frustrated nurses in Quebec's public system from taking private agency jobs with higher pay and better working conditions — then returning to work in the same hospitals, he said.

The hemorrhaging of nurses to the private sector led to more expensive health care, a decline in quality of care and major Montreal emergency rooms so bereft of staff, they've had temporary closures, he said.

"This should really be alarm bells ringing for citizens and government," Contandriopoulos said. "They tried. It failed miserably. Don't do it."

Quebec politicians have promised to introduce legislation limiting the use of health staffing agencies in the province.

But in December, the Quebec government posted tenders for companies to provide the equivalent service of 4,600 full-time health-care workers.

"Once the toothpaste is out of the tube, it's very very hard to put it back in," Contandriopoulos said.

Alberta wants to curtail agency use

Both AHS and Covenant Health say they are emphasizing staff recruitment and retention so they are not so reliant on agencies. As of Feb. 1, AHS had nearly 2,300 jobs posted — 78 per cent of them in front-line care.

Williamson said employees of AHS (or its subsidiaries and partners) who resign or retire and then go to work for a staffing agency cannot work in any AHS facility within six months of leaving the organization.

Steve Buick, press secretary to Health Minister Jason Copping, said Alberta's reliance on agencies should decrease as the government pushes to train and import more health-care workers.

The government is funding 2,500 more post-secondary seats in health-care fields, to be added over three years. It's also funding a bridging program for internationally trained nurses.

Since 2019, AHS has increased its numbers of permanently employed RNs, LPNs and health-care aides, Buick said.

AHS said agency workers make up a tiny fraction of its front-line workforce.

As of November, AHS had 341 agency-supplied RNs, LPNs and health-care aides working across the province, out of a total of about 50,000 staff in those professions. The agency staff included 232 RNs — under one per cent of the total AHS workforce of more than 30,000 RNs, Williamson said.

UNA president Smith said that response dismisses the seriousness of the understaffing situation.

With no provincial health human resources plan prepared since 2008, hospitals are left scrambling for unsustainable solutions like agencies, she said.

"It's a Band-Aid on a gaping wound."