N.B. defends costly use of travel nurses as 'necessary at the time'

The New Brunswick government is defending the use of travel nurses in the face of criticism over the high cost to taxpayers.

Meanwhile, Vitalité, the regional health authority that has made the most use of the private agency nurses, acknowledged in a statement to CBC News that "the billing level for these services deserves questioning."

"These costs represent a significant financial burden for our citizens," CEO Dr. France Desrosiers said in an email. "They also create inequality between network health-care workers and agency staff.

"However, the decision was unavoidable in the short term," she said, citing staffing shortages created by departures and early retirements from 2020 to 2022 during the COVID-19 pandemic.

Deputy health minister Eric Beaulieu was grilled about the controversial practice when he appeared before the legislature's public accounts committee on Wednesday.

'Gouging taxpayers'

Liberal health critic Rob McKee questioned the "heavy reliance on expensive out-of-town nurses facilitated by private agencies."

These agencies included Toronto-based Canadian Health Labs, which charges "exorbitant rates" of more than $300 an hour — roughly six times what a local staff nurse earns, McKee said, citing a recent investigation by the Globe and Mail.

"This is nothing more than gouging taxpayers," McKee said. "It's a result of the Higgs government's mismanagement of the health-care crisis."

New Brunswick's two regional health authorities, Horizon and Vitalité, spent a combined $56.8 million in the first five months of 2023-24 on the costs associated with travel nurses, according to figures obtained by CBC News and separately by the New Brunswick Nurses Union through a right to information request late last year.

But the Globe found the actual cost is much higher. The national newspaper obtained copies of three contracts between Vitalité and Canadian Health Labs. The first, which ran from July 29, 2022, until Sept. 23, 2023, for a maximum of $20  million, provided a mix of registered nurses and licensed practical nurses at the equivalent of $300.72 an hour.

A second contract, worth a maximum of $45 million, supplied personal support workers at $162.29 an hour, while the third, which went into effect on Dec. 2, 2022, and runs until February 2026, with a cap of $93 million, effectively charges Vitalité $306.70 an hour per nurse.

Vitalité faced closures

The contracts between Vitalité and Canadian Health Labs were "done at a time when Vitalité was facing either closure of services or closure — in their words — closure of facilities related to staffing shortages," Beaulieu told McKee.

The department has been working with both Vitalité and Horizon in reducing the use of travel nurses across the province, he said.

"It is not an aspect that either the department, the minister, or the RHAs wish to continue long term, but I will say it was a necessary at the time they were signed."

Beaulieu expects Horizon to eliminate the use of travel nurses this spring. "There may be a short delay in some very specific areas, but the overall volume would be quite minimal."

Vitalité will take longer because of the challenges with francophone recruitment and the Canadian Health Labs contract,  which runs until 2026.

Unions seek audit

The New Brunswick Nurses Union and the Canadian Federation of Nurses Unions intend to send a joint letter to Auditor General Paul Martin, calling on him to investigate.

The Auditor General's Office says the use of private nursing agencies "has been added to the list of potential future audits."

Premier Blaine Higgs told reporters the use of travel nurses "is not the future for nursing" in New Brunswick.

"We know that. … It's not a situation we want to keep at all."

It was a short-term solution to nursing shortages, he said.

"Because we had a situation there where nurses were working extended hours, six, seven days a week, and you can't keep that up — not taking vacation, not being out with their family."

'Very limited number' of francophone options

According to the head of Vitalité, the level of care hours per patient had been reduced to a "critical threshold" by the summer of 2022, and more than 100 beds had to be closed.

"We were at a crossroads," said Desrosiers.

The decision to resort to agency staff was made only after a thorough examination of the risks to the health and safety of patients, she said.

"Several plans to reduce services with dramatic consequences were considered before this choice was made," Desrosiers said, without elaborating.

The use of travel nurses ensured the continuity of essential services by maintaining a minimum safe threshold of care hours for patients.

"This temporary but necessary measure allowed us to save lives, relieve our staff by reducing team exhaustion and turnover."

Only a "very limited number" of agencies were able to provide the necessary francophone or bilingual resources in a timely manner to maintain services, Desrosiers said.

Being a minority French-language health-care network has "worked against" Vitalité, with a limited recruitment pool and a higher number of vacant positions, resulting in a lower average number of care hours, she said.

In 2019, the median age of the population exclusively served by Vitalité was 52, compared to 44 for Horizon. The proportion of the population aged 65 or older for Vitalité was 26 per cent, compared to 20 per cent for Horizon, said Desrosiers, noting the rate of chronic illnesses among elderly people is higher, and the needs for health-care services is greater.

Recruitment and retention efforts are yielding results and Vitalité has already begun to gradually reduce the use of agency services, she said.

"But it would be irresponsible to do away with them completely at this time, considering immediate needs."

Department aware of only 1 of 3 Vitalité contracts

The government was aware of Vitalité's first contract with Canadian Health Labs, according to Beaulieu. It was informed of the other two after the fact, late in the 2022-23 fiscal year.

Beaulieu said he believes all three were awarded without requests for proposals first.

The regional health authorities are responsible for service delivery so the Health Department would not necessarily have direct oversight on contacts signed throughout a year.

With these types of contracts, however, "given the magnitude of them, the duration and the dollar figure, they would normally be things that would involve [the] department."

McKee asked if there are repercussions for acting outside the normal practice of involving the department.

"What we tried to focus on is that issues like this do not reproduce in the future," replied Beaulieu.

The department had the impression the $20 million that Vitalité spent on travel nurses in 2022-23 and the $5 million Horizon spent, was "going to be reducing quite significantly," he said. When that didn't happen, it instituted biweekly reports on travel nurses, including costs and hours.

Nurses feel disrespected, not valued

McKee suggested the money would have been better spent trying to retain nurses. He noted nurses called last year for a retention bonus, which neighbouring provinces were offering, but they were denied.

"How do you justify … saying no to our own people that are leaving, but then paying six times more to bring people [from] out of town?"

Beaulieu reiterated the government was not involved in the negotiation of the contracts.

"I believe what the RHAs would have done is they would have balanced out the need to protect services as the number one issue at that point in time."

Green Party health critic Megan Mitton asked whether the government calculated how much it would have cost to match the retention payments offered by other provinces, such as Nova Scotia.

"We know millions and millions of dollars have been spent through these private travel nursing agencies," she said.

"But we have nurses who work here, who want to work here, but have felt …  disrespected or that they're not valued because they haven't haven't received" the same types of bonuses."

Beaulieu initially said it would have cost New Brunswick "over a billion dollars" to match Nova Scotia's $10,000 bonus, but later said he misspoke.

There are about 10,000 nurses in New Brunswick, including the ones who work in long-term care, so the cost would be about $100 million, he said.

'Making gains' through recruitment

The government continues to focus on recruitment, according to Beaulieu. Since April 2023, Horizon has recruited 278 permanent nurses, for a net increase of 125, he said.

At Vitalité, new hires have exceeded the departures since June 2022, said Desrosiers.

The government is also focused on nursing education, he said, noting enrolment in 2023 was the highest it's been in 20 years with more than 16,150 students in nursing programs.

That's up from about 900 four years ago, thanks to a number of steps, such as adding up to 85 new nursing seats at the University of New Brunswick, Maine's Beale University starting a program in Sackville with 100 seats, and offering licensed practical nurses the opportunity to become registered nurses through the launch of the Learn Where You Live program in Moncton and Miramichi.

Higgs also stressed the efforts with recruitment and education.

"We have hired, I think it's about 800 more nurses than have retired. … And that'll suspend any future requirement for the travel nurse."