N.S. spending tens of millions of dollars on private nursing companies for long-term care

As Nova Scotia tries to deal with a shortage of health-care professionals that has put the entire health system under strain, the province is devoting tens of millions of dollars toward the services of "travel nurses."

The provincial government is paying the private contract nurses at least double the hourly wage of public-sector nurses. The higher pay often comes with greater flexibility in scheduling, which some nurses say is attracting many early career staff to move out of the public sector — even as health officials grapple with recruitment and retention.

Travel nurses, who are sometimes known as "agency" or "locum" staff, are health-care workers who are employed by private companies that provide extra nursing staff where they're needed.

Many companies will fly nurses around the country on short- or long-term contracts, often working within public-sector hospitals and long-term care homes. The nurses are required to be registered and licensed to work in the province where they're sent, including in Nova Scotia.

But in some provinces where travel nurses are being employed, unionized nurses have raised concerns about the practice.

COVID-19 added to staffing shortages

Starting in late 2021, in the midst of the COVID-19 pandemic, Nova Scotia's Department of Seniors and Long-term Care turned to travel nurses to supplement staffing at long-term care homes around the province.

"We had a lot of staffing shortages historically in this sector, and Omicron just made it that much more difficult," Barbara Adams, the minister of seniors and long-term care, said, referring to the highly contagious Omicron variant of COVID-19.

The department allocated $3.1 million in December 2021 for travel nurses. After the Omicron wave began, the department had to increase the amount by $18.4 million, which Adams said is on track to be completely spent within this budget year.

"We had a lot of beds closed in the sector, and that was creating problems for the acute care sector," the minister told CBC News in a recent interview.

According to a briefing note obtained by CBC News, by March 11, 2022, there were 247 long-term care beds closed due to staffing issues. This was around the time an increasing number of health-care staff were off sick due to COVID-19. At least 296 patients were waiting in hospital for a nursing home bed placement.

The Department of Seniors and Long-term Care said that as of Nov. 15, 36 long-term care beds were closed due to staffing. As of late September, there were 284 people waiting in hospital for a long-term care placement.

"What we needed to do was to bring in travel nurses wherever they're needed across the province so that we can keep our nursing home beds open," Adams said.

The move has drawn the attention of the Nova Scotia Nurses' Union.

"Travel nurses have been around for several years but not used very much, mostly in acute care and mostly in our rural settings," union president Janet Hazelton said. In the last two years, she said she's seen an increased reliance on travel nurses.

Hazelton said she hasn't known them to work regularly in long-term care before.

"This is a new thing for us," she said. "It's something that is a concern for sure, for all of the nurse unions across the country." 

$134 vs. $40 hourly wages

The province's fund for travel nurses in long-term care is administered by the Halifax care home Northwood, the largest not-for-profit care home in Nova Scotia. It's responsible for hiring and co-ordinating the travel nurses through Toronto-based medical staffing agency Magnus.

According to letters released to CBC News under access-to-information legislation, the province approved funding up until the end of March 2022 for up to 31 licensed practical nurses (LPNs), six registered nurses (RNs) and 60 personal support workers (PSWs).

They worked in at least 14 homes, including in Yarmouth, Kentville, Bridgewater, Halifax, Antigonish, Berwick, Shelburne and various other locations.

The hourly wage for LPNs was set at $124.80, for RNs at between $134 and $138.60, and for PSWs at $96.80. Each travel nurse was also approved for up to $3,000 per month for accommodations and up to $1,000 in travel expenses such as a vehicle rental, and was given a Northwood-issued cellphone.

The province also approved $280,000 for administrative costs. No overtime, incidentals or meals were covered.

It is not clear from the letters whether the nurses received the full hourly amount specified, or whether some of their fee went toward their company. Travel nurses typically don't receive a pension, and in some cases they don't have workplace benefits.

Hazelton of the nurses' union said these rates can be $70 to $100 more an hour than the rates paid to her members, which is a concern.

Unionized RNs at the top of the pay scale with at least 25 years of service in long-term care can earn about $40 an hour, while the top-end LPNs make less than $30 an hour.

"Many of our nurses don't believe that that's fair that they get paid so much less than the travel nurses. But that's the reality when you hire a company to provide you with nurses," she said.

Adams, the seniors minister, acknowledged there is a gap in pay, but said from her own personal experience as a physiotherapist who worked in a long-term care home during the pandemic, the greater problem for morale among regular staff is having too few people on the floor.

"They know that the value of having the sufficient staff more than makes up for the fact that it does happen to cost a little bit more than what it normally does," she said. "This is all about staff safety and residents getting the care that they need. And so everybody understands that that's the necessary step." 

Travel nurses a 'Band-Aid,' union says

Adams said she could not provide exact numbers of how many travel nurses are working in long-term care, as the number fluctuates, but it increased in the summer to give regular staff their vacations and has stayed at about the same level since then. She anticipated it will stay the same through the Christmas vacation period.

The added cost to taxpayers of hiring travel nurses is "not ideal," she said, and noted that the province is taking steps to expand the number of nursing school seats to get more staff, but in the meantime she declined to put any kind of end date on the travel nurse program.

"We're going to continue that program until such time as we don't need it anymore," she said.

Hazelton agreed that patient safety is important but said it should be achieved through educating and attracting more full-time nurses in the public sector.

"We need to look at a longer, more sustainable fix than this," she said. "Travel nurses are not the answer. They may be a Band-Aid, but they're not the answer. We need a better solution than that."

Hazelton said some nurses who have worked in the public system are moving to travel nursing to achieve a better work-life balance. She said she thinks the provincial government must talk directly to those nurses to understand why.

"Those are the young men and women that have the solutions, and they can tell us what it's going to take for them to stay and work and live in Nova Scotia part time or full time," she said. 

System offers flexibility, chance to save money

Julie McCutcheon is an RN who has been working as a travel nurse mostly in emergency rooms since 2010. She works  casually in the public sector but said the cost of housing for one person was probably her "most driving force" in getting into travel nursing.

McCutcheon's home community is Peterborough, Ont., a city that has seen some of the fastest-rising housing prices in Canada.

"I wanted my own place," she said. She investigated travel nursing and decided to pack up her car and take a contract in another province.

"I just had a desire to travel and a sense of adventure," she said. McCutcheon has worked all over Canada, including two contracts in Digby and one in Sydney, N.S. She's now back in Ontario.

McCutcheon said travel nursing has given her the ability to choose her own schedule, to take vacation time and to participate in hobbies she loved but lost because of work, such as figure skating.

And the higher pay she gets working as a travel nurse has allowed her to afford her to save toward the cost of a down payment on a house.

McCutcheon said she would someday love to settle down in her home province and take a full-time job, but she wants to be able to afford her own home.

She facilitates a growing Facebook group for working and aspiring travel nurses, with roughly 8,000 members, and said housing is an important factor for many of them.

"A lot of these girls are ages 23 to 35, and their public-sector wage just allows them to live paycheque to paycheque," she said.

"Many have said they're choosing travel nursing because they are a single, young health professional, and they can no longer afford to live in their Canadian community."

McCutcheon said travel nursing can give nurses a taste or a "dry run" of a community, and she hopes facilities will talk directly to nurses.

"Ask them what they want. If it's a better schedule, offer them that better schedule," she said. "If it's a housing incentive to get them to move to more rural areas of Nova Scotia or within Atlantic Canada, perhaps offer an incentive.

"Housing is provided for visiting travel nursing, so why not do it for your own to help entice someone to your community or your facility?"