Newfoundland, eager to shed dependency on expensive travel nurses, launches program for rural communities

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Mark Aylward is a nurse who travels for work, but he’s not a typical travel nurse.

He spent two weeks last year providing primary care at a hospital in St. Anthony, a coastal town of 2,500 near the tip of Newfoundland’s northern peninsula. Mr. Aylward, a nurse practitioner, made the 10-hour drive from his home in Bonavista, N.L., to shore up health care staffing in a community that, like many in rural Canada, has bled permanent nurses since the pandemic.

In return, he received free accommodations, a chance to explore a beautiful corner of his province, and an extra $25 an hour – all without having to quit his day job to join a private staffing agency.

“I just wanted a different experience,” Mr. Aylward explained. “But having said that, undoubtedly the extra premium was certainly nice to receive. It’s probably enticing some more people like myself to travel to these places.”

Mr. Aylward received the premium as part of a pilot project that is supposed to reduce the province’s reliance on expensive, out-of-province travel nurses who work for private staffing companies. The government of Newfoundland and Labrador spent $35.6-million on nurses from for-profit agencies in just five months last year, up from an average of about $1-million a year before the pandemic, The Globe and Mail reported last month in an investigation of Canada’s burgeoning travel nursing industry.

The goal of Newfoundland’s new program, which it has launched with its largest nursing union, is to cut out for-profit middlemen by inviting unionized staff nurses to work as locums, or temporary fill-ins, in understaffed rural health facilities. In exchange, the nurses are given wages that are higher than regular pay, but still far less than what health authorities have been doling out to private companies, which pass on only a portion of those payments to workers.

“Anecdotally, everyone says we’ve saved money and that it’s working,” said Yvette Coffey, president of the Registered Nurses’ Union of Newfoundland and Labrador, the province’s partner on the program.

The Globe reported last month that health authorities in one region of Newfoundland were paying a Toronto-based company, Canadian Health Labs, as much as $312 an hour for each nurse. Unionized hospital registered nurses, by contrast, earn between $37.86 and $47.16 an hour in Newfoundland and Labrador, plus benefits and a pension. That CHL contract with Western Health, now part of an amalgamated authority called Newfoundland and Labrador Health Services, expired at the end of February.

CHL said in a statement last month that its rates, “reflect the extraordinary logistical challenges of getting and keeping health care professionals in rural, remote and underserved communities.”

Other staffing agencies charged Newfoundland between $120 and $159.50 an hour for a nurse, according to contracts obtained through freedom of information requests.

CHL continues to supply nurses to other parts of Newfoundland for $172.22 an hour. Several nurses who worked for CHL in Newfoundland told The Globe they were paid between $85 and $100 an hour. (The Globe is not naming them because they signed non-disclosure agreements with CHL.)

Newfoundland’s travel locum pilot project began in September, 2022, as a one-year agreement between the nurses’ union and the Labrador-Grenfell health authority, which served patients in Labrador and the northern peninsula, where St. Anthony is located. (That health authority has since been amalgamated into Newfoundland and Labrador Health Services.)

More than 100 nurses have participated so far, Ms. Coffey said.

Many are semi-retired, with casual staff jobs and the flexibility to take travel assignments of two weeks or more. Full-time nurses, such as Mr. Aylward, must use vacation days to take part. Nurses who traded their full-time jobs for casual status after the agreement was signed aren’t eligible, and managers have to sign off before any staff are released to work as travel locums.

“We’re not going to rob Peter to pay Paul,” Ms. Coffey said. “We’re not going to leave one place short to staff another place.”

The amount of money the program has saved, and its impact on the use of private agency nurses, is yet to be determined. Newfoundland and Labrador Health Services is conducting a financial evaluation and a survey of participating nurses, said Tina Coffey, a spokesperson for the province’s Department of Health and Community Services. But the government and union have already agreed to extend the pilot to January, 2025.

“NL Health Services and the Department of Health and Community Services have received positive feedback noting that the pilot program has helped service delivery significantly in Labrador,” Ms. Coffey said.

A similar approach is working well in Alberta, where the province’s health authority pays an extra $25 an hour to bridge staffing gaps in the north, according to Heather Smith, president of United Nurses of Alberta. The program functions like an internal nursing agency, one where workers are accountable to the public-health system instead of a private company.

Alberta Health Services said in a statement that its northern locum program has reduced costs and improved the work-life balance for permanent nurses in places where health care facilities otherwise wouldn’t have much relief coverage.

“It’s a win-win, from my perspective, in terms of having a predictable work force that you can deploy to sites that are experiencing staffing issues,” Ms. Smith said.

For Mr. Aylward, the locum opportunity in St. Anthony was less about the money than it was about shaking off the doldrums of his day job and experiencing a new place. Prior to his time there, he worked two stints in Nain, the northernmost permanent settlement in Labrador, before the advent of the $25 premium.

After each day working in the Nain clinic, Mr. Aylward would leave his apartment attached to the community’s health centre to hike and visit locals. “It was unbelievable how many things, like salmon and char, were given to me as gifts,” he said. “So it was a wonderful, beautiful experience in that way.”

Rae Lynn Strangemore hopes to be similarly entranced when she works as a travel locum in a Labrador community – if she can ever get away. She has applied to the program, but hasn’t been granted leave from her day job as patient care co-ordinator for the inpatient units at her hometown hospital in St. Anthony, where staffing, she said, is a “daily struggle.”

Her predicament is a reminder that the travel locum program is no panacea for a province that simply doesn’t have enough trained health workers to care for its aging population. But every little bit helps, Ms. Strangemore said.

“I must say, the permanent, full-time nurses are very grateful for the travel locum because it gives them an opportunity to get a day off, or to know they are going in and not working short,” she said.

Ms. Coffey, the union president, conceded that permanent nurses often consider it a “very sore point” to work alongside higher-paid travel nurses. “However, it is a lot more palatable to have your own members making $25 an hour extra to come and help you when you’re in crisis than it is to pay a private agency double or triple that amount.”