'Burned out': Nurses join travel nursing agencies for more flexibility, higher pay

As Nova Scotia grapples with a health-care system under strain, some nurses in the province are signing contracts with travel nursing agencies to work elsewhere in Canada.

Higher pay and more flexible schedules are two reasons early career nurses are leaving Nova Scotia hospitals, as Nova Scotia Health struggles to fill 1,024 vacant nursing positions and concerns about working conditions persist. 

Some Nova Scotian travel nurses say there are no retention strategies in place to keep nurses here and alleviate staffing shortages. And there are no incentives for travel nurses to return to full-time staff positions, they say, because they are paid at least double the hourly wage of public-sector nurses and can take unlimited time off between four- to six-week contracts.

Hugh Gillis, vice-president of the Nova Scotia Government and General Employees Union, said the health authority needs to address these issues to keep nurses on staff. 

"Our nurses are burned out because recruitment and retention issues have been ignored for so long, they're unable to get time off when they need it," Gillis said. 

"If you're working 16-hour days, five to six days a week, there's no future in that," he said. "It's not sustainable over the long term.

"It's about work-life balance, and if you push people hard enough, they're simply going to go elsewhere." 

Balance lacking

Nicole Horechuk started travel nursing only two years into her career.

She worked full-time staff positions in two different Nova Scotia emergency rooms, but quickly found she was working so many hours she had no time to enjoy other activities.

"I was granted little to no vacation time," she said. "So I dropped to a casual position and started travel nursing."

Horechuk saw it as a learning opportunity to practise her skills in rural hospitals while seeing different parts of Canada — plus it paid a lot more money.

"I have definitely asked myself, am I part of the problem? But the answer is no," Horechuk said. "If I wasn't doing travel nursing, I wouldn't be able to do this job at the bedside at all. I would be feeling too burned out. 

"This way, I'm still working in an emergency department. I'm still at the bedside. I'm still providing direct patient care in an area that is short staffed," she said. 

Some nurses choose not to stay at all.

Horechuk noticed nurses moving from high-stress jobs in critical care to jobs in research facilities, private clinics or even cosmetic services.

"People don't want to be experiencing burnout and poor work-life balance for the same wage when you could have a great work-life balance and a lower-stress job," she said.

Horechuk has heard travel nurses say they don't know if they would return to a full-time position in Nova Scotia because of the pay cut, lack of vacation time and gruelling hours.

"If they could correct those things, they would see a return back to full time," she said. "But until then, people might stick with their agency jobs."

Difficult locations

But travel nursing isn't always easy. 

"You're usually going somewhere where if they're short staffed, it's not going to be a great place to work, or it might be really busy," said Jenna Arsenault, a former travel nurse from Sydney, N.S. 

She worked in British Columbia, Manitoba, Newfoundland and Labrador, and even Bridgewater, N.S., as a travel nurse. 

Many of the rural hospitals she worked at were almost fully staffed by travel nurses. They couldn't get people to stay due to the location or the nature of the job.

When staff are leaving in droves, Arsenault says it could signal a larger problem with the unit. 

"If staff aren't getting breaks, if they're super understaffed, most people are just going to leave," she said. "And then you end up needing more travel nurses."

A 'vicious cycle'

This is playing out in Nova Scotia hospitals, too, as the health authority brings on temporary staff to fill vacancy rates ranging between 50 and 80 per cent in some units.

They are spending millions more on temporary workers in recent years. 

In the 2021-2022 fiscal year, Nova Scotia Health spent $8.89 million on travel nurse services, which includes registered nurses (RNs), licensed practical nurses (LPNs), nurse practitioners, patient attendants, unit aides and unit clerks.

So far this fiscal year, the health authority has already spent around double that amount — between April 1 and Dec. 31, 2022, it spent $16.3-million on agency RNs.

Janet Hazelton, president of the Nova Scotia Nurses' Union, says it's a vicious cycle.

"They can't get time off, so they leave," she said. "It just makes the shortage worse."

Hazelton says federal and provincial governments across the country need to come together to address the shortages as provinces poach nurses from each other. 

"We have to pay nurses more money to come from other provinces to work here as a travel nurse and yet, some of our own nurses are leaving this province to go to other provinces to be travel nurses," she said. 

"We need to get together as a country and decide, OK, how are we going to deal with these shortages?" 

Retention efforts underway

NSH spokesperson Brendan Elliott said in an email the health authority's focus is to recruit new nurses and to retain those they already have.

One new approach is conducting "stay interviews" — a different take on an exit interview — to determine what it would take for nurses to stay with the authority. 

"It doesn't make sense for us to find out what wasn't working as a nurse is walking out the door," Elliott wrote. "Instead, let's capture that while they're still employed by us, and do what we can to satisfy those concerns."