N.S. Health says there are no great options as it raises spending on travel nurses by millions

Despite recruitment efforts, Nova Scotia Health's spending on travel nurses provided by private companies jumped by millions of dollars this year and its options to find more staff are limited.

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.

"It's a really hard thing to reconcile," said  Anna Marenick, a vice-president at Nova Scotia Health in charge of human resources.

"If the choice is between hiring agencies and at least making sure that we've got coverage in some of our units so that we have the most number of resources that we can for patient care, versus not hiring travel nursing companies and running even shorter, neither option is great." 

The predecessor of Nova Scotia Health in Halifax, Capital Health, told CBC News it started using travel nurses in 2015, and said at the time, the cost would be about $300,000 for three months and a dozen nurses.

In the 2020-2021 fiscal year, Nova Scotia Health spent $8.16 million on travel nurse services, which included registered nurses (RNs), licensed practical nurses (LPNs), and nurse practitioners (NPs), patient attendants, unit aides and unit clerks. That number was part of $1.7 billion spent on staff compensation in the province. In the 2021-2022 fiscal year the total was $8.89 million.

So far in the current fiscal year, which began in April, it has spent $11.4 million on travel nurse services.

This is in addition to $21.5-million the province of Nova Scotia allocated for travel nurses in long-term care homes, starting in late 2021. 

National report shows increasing staff at agencies

A report from the Canadian Institute for Health Information (CIHI) released Thursday concluded that the overall number of health professionals like doctors, nurses and pharmacists increased between 2020 and 2021, but in some areas of direct patient care their numbers declined. 

The CIHI report found the numbers of nurses in long-term care and community health agencies dropped between 2020 and 2021. At the same time, CIHI concluded there was an increase in nurses working at "private nursing agencies, occupational health centres and self-employment." 

Many nurses say the higher pay and reliable schedules available through travel nursing is attracting staff to move away from public-sector jobs.

The work is particularly tempting for early career staff such as Kevin Cummings, a travel nurse originally from Ontario, who now works in long-term care in Newfoundland on a one-year contract. 

Cummings, 29, made the transition to travel nursing partly to get a better work-life balance. 

He worked through the pandemic as a registered nurse at an Ontario long-term care facility. That's when he saw nurses with many more years of seniority were unable to take a day off when they needed it due to staffing shortages. 

"In order for them to even get a day off they had to call in sick," he said.  

Cummings says he was called in to work when he wasn't scheduled and was unable to get time off even when he asked for it months in advance. He sometimes felt the staffing shortage wasn't safe for him or for the people he was caring for. 

The higher wage for travel nursing was also attractive, with Cummings seeing his hourly pay jump from $35 an hour to $60 an hour. 

"Getting that jump right away was a huge factor in going to travel nursing," he said.  

He puts money aside for the future as his job does not come with workplace benefits or a pension, but he feels in the long run he'll come out even. 

"I have a little bit more of a life now, which is very strange to me," he said. "For the first time in my life I'm like, 'What do I do with all this time?'"

When he reflects on the things that would entice younger nurses to stay in one spot longer, he said an increase in pay and being able to take time off are the top priorities. 

"For me personally, if you are going to give me the respect of, 'Hey, I'm asking for these days off and you're going to give them to me,' I'll pick up other shifts. I'll rearrange my schedule to make sure that whatever needs to get done is going to get done," he said. 

Listening to staff

Marenick, the VP at Nova Scotia Health, said the organization is trying to work with administrators to improve scheduling and give staff more flexibility. She also said N.S. Health wants to listen to what staff have to say.

She said N.S. Health is working on a pilot program in which staff will be offered a "stay" interview where nurses can talk about what would improve working conditions and morale. 

Marenick said the big things she's heard include the same concerns travel nurses have identified about scheduling and wages. But there are also small adjustments that can help including better on-boarding or making sure that housekeeping staff is always available. 

As of October 2022, there were 1,594 nurse vacancies across the acute care system in the province, including registered nurses, licensed practical nurses, and nurse practitioners.

Nova Scotia Health has staffing contracts with the private companies Greenstaff Medical, Select Medical Connections, Northern Nursing Solutions, Northern Medical Connections, Blessed Heart Staffing, Nurse Next Door, Helping Hands Nursing Services and Carecor Health Services.

Of the companies Nova Scotia Health contracts with, the most significant is Carecor Health Services, which announced in 2018 it had won a three-year contract from Nova Scotia Health to provide nursing services to hospitals in the province's central zone. The contract was renewed in April 2022.

Tender documents said the actual number of hours nurses would be called in would depend on "future needs" and therefore the annual costs could only be estimated. But the original amount awarded was valued at $51.2 million.

The IWK Health Centre for children's care in Halifax was not part of the Carecor contract, and it told CBC News that it does not use travel nurses.