Alberta nurses' escalating overtime is pushing some of their pay sky high
Top-earning nurse in 2022 brought home $510,000
Alberta's top-paid registered nurse earned more than $510,000 in 2022, according to public compensation lists recently posted online.
The nurse was one of six public-sector nurses working for Alberta Health Services (AHS) and Covenant Health who earned more than $300,000 in total compensation last year — a result that nursing leaders say is only possible from working excessive overtime and on-call shifts during staff shortages.
"I don't think we've seen numbers like that, ever," United Nurses of Alberta (UNA) president Heather Smith said.
The total compensation figure does not include other non-monetary benefits or severance.
Before counting benefits and perks, the top-paid RN was paid more than the president and CEO of AHS or any other executives.
The nurse did not respond to CBC's request for an interview to explain how they had earned the record-breaking pay.
An RN at the top of UNA's salary grid would have to work an average of 77 hours of overtime per week, every week, beyond a 37.5-hour work week, to earn $510,000 in a year, CBC News calculates.
Nurses can also earn premiums working nights, weekends and statutory holidays, and their pay can be more depending whether they have a specialty or if they work in a remote location.
Depending on where they work, and their experience and training, a full-time Alberta RN typically earns about $80,000 to $100,000 a year, Smith said.
A search of AHS and Covenant's salary disclosure tables, which are also called sunshine lists, show record numbers of nurses earning more than $150,000 in total compensation last year. All public agencies, boards and commissions must publish sunshine lists by June 30 annually.
Before 2019, no one listed as a registered nurse with AHS or Covenant Health was earning more than $250,000.
In 2017, 122 nurses earned more than $150,000 a year. Last year, five times the number of nurses surpassed that bar.
The counts do not include people classified as nurse managers or registered psychiatric nurses.
Smith said contractual pay increases cannot account for the growth in the number of high earners, and that voluntarily, coerced and mandatory overtime must be driving the trend.
"It's not sustainable," she said. "These individuals cannot continue that level, that intensity of work without rest for a very long time."
Previously, the only nurses logging hundreds of hours of overtime pay were working in remote communities with few other health professionals, she said.
Racking up overtime
AHS provided CBC News data showing employees worked 2.3 times as much overtime in 2022-23 compared to three years earlier. In the most recent year, workers logged nearly 4.7 million hours of OT due to system pressures related to the pandemic, more demand for services, and staffing challenges, AHS spokesperson James Wood said in an email.
Overtime accounted for 3.7 per cent of the number of total hours worked.
Covenant Health data shows staff there are even more crunched. In 2022-23, overtime made up 10.5 per cent of employees' total hours worked, up from 4.2 per cent in 2019-20, according to spokesperson Karen Diaper. Covenant did not have a total number of OT hours worked.
Labour force survey data from Statistics Canada also suggest all Alberta nurses' overtime is increasing. In 2016, the numbers suggest Alberta nurses were working less overtime than the national average. That advantage has now evaporated.
In 2016, about 23 per cent of Albertans working in nursing professions reported overtime hours. By 2022, that number jumped to 32 per cent. The upward trend coincides with the COVID-19 pandemic.
Relying on overtime is also an inefficient use of public dollars. In a review of AHS commissioned by the UCP government in 2019, consultants Ernst and Young (EY) said the organization could save millions of dollars per year by reducing OT across the province.
AHS spokesperson Kerry Williamson said in an email last week the organization won't comment on individual employees or salaries. He said managers review the pay of any in-scope employee who earns more than $300,000 per year to understand their compensation. It could include overtime, on-call pay, sick pay, shift premiums or vacation pay.
Trying to fill the vacancies
As of June, AHS's vacancy rate for RN jobs was about 14 per cent — the equivalent of more than 2,400 full-time jobs. Wood said vacancies peaked last September and they're now hiring faster than they're losing workers.
AHS has also increased the number of nursing positions over the past four years to meet increased demand for services, Wood said.
Covenant Health has about 161 full-time RN vacancies, leaving about 11 per cent of jobs unfilled. Diaper said this rate has been consistent for the last year.
She pointed to growing global health-care market demand, an aging demographic of workers heading for retirement and efforts to support exhausted employees who are seeking more work-life balance.
"We have a robust workforce strategy that is aimed at addressing the workforce challenges that we are currently facing," she said in an email.
Smith said it's also hard to know the true number of vacant front-line health-care jobs in Alberta, as employers will sometimes delay job postings.
The shortages have prompted hospitals and care centres to increasingly rely on agency nurses to fill the gaps. A June 22 report from AHS tallied 375 agency nurses working in facilities across Alberta.
Staff shortages have hit smaller towns and rural areas particularly hard, prompting the temporary closure of emergency rooms, labour and delivery services, and operating rooms, among others disruptions.
Staff also saw their vacations cancelled during the pandemic's peaks to keep up with demand.
"Now is far from normal circumstances," Smith said.
A safety risk
Health-care workers slogging through excessive overtime puts both employees and patients at risk, said Canadian Nurses Association president Sylvain Brousseau, who is also a Université du Québec en Outaouais professor researching nurses' quality of life.
Those long hours increase the likelihood of a nurse making errors, he said.
"When you finish your shift, you always ask yourself, 'Did I forget this? Did this patient get what he was supposed to have?'" Brousseau said.
UNA's contract stipulates nurses are not allowed to work more than 16 hours in each 24 hour period.
AHS spokesperson Williamson said any additional or overtime hours are monitored by managers to ensure they follow collective agreements and won't compromise patient or staff safety.
He said aside from those guardrails, there are no limits on how many overtime hours an employee can work.
The Alberta government has pledged to train and hire more nurses by creating more post-secondary nursing seats and making it easier for foreign-trained nurses to work in Alberta.
Brousseau says the biggest challenge isn't hiring nurses, but retaining them. Governments have a moral obligation to create better working conditions to keep nurses in the most taxing jobs and prevent them from leaving the profession, he said.
Hiring more health-care workers, such as licensed practical nurses, care aides, clerical and housekeeping staff, would lead to nurses' time being spent more effectively, he said.
Last month, Premier Danielle Smith said her hand-picked AHS administrator, Dr. John Cowell, will shake up the management structure of AHS to speed up health-care improvements.
UNA president Smith called that message "unsettling." She said destabilizing AHS would be "irresponsible."
"That just multiplies the concerns and the likelihood that we will see more loss of workers in the system," she said.
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