Nurses put on personal protective equipment at the Humber River Hospital in Toronto on Jan. 25, 2022.Nathan Denette/The Canadian Press
The Ontario government isn’t adequately tracking what hospitals and long-term care homes spend on private, for-profit staffing agencies, according to a trio of reports from the auditor-general that reveal the use of temporary nurses has skyrocketed since the pandemic began.
The increase has been particularly steep in northern Ontario, where hospitals went from buying just over 15,000 hours of temporary nursing in 2018-19 to about 391,000 hours in 2022-23 at a cost that is double or triple the hourly wages paid to staff nurses.
Staff at one unidentified northern hospital told auditors they felt like they were running a de facto travel agency for out-of-town nurses. Another hospital bought property to house a rotating cast of travelling health workers, saddling the hospital with responsibilities, “such as paying for property taxes, Internet, furniture, lawn care and snow blowing, which take away resources from the hospital.”
The three reports from Ontario’s acting Auditor-General Nick Stavropoulos, released Wednesday, are the latest to highlight how a national nursing shortage is prompting more hospitals and nursing homes to turn to private agencies – a solution the auditor-general called “costly and unsustainable.”
One of the reports investigated northern Ontario hospitals, another examined the province’s emergency departments, and a third looked into long-term care homes. Each contained a section on the rise of agency nursing.
“It is very damaging to morale,” said Angela Preocanin, first vice-president of the Ontario Nurses’ Association, the main union for nurses in the province. “Why isn’t the government investing that money from the for-profit agencies and putting it back into our publicly funded health care and ensuring that our nurses are getting paid better?”
While some private nursing agencies have existed for decades, their role in the Canadian medical system used to be peripheral: They would shore up hospitals with last-minute fill-in workers, or provide nurses to health facilities in remote communities where it has always been difficult to attract permanent staff.
But since the pandemic sparked an exodus of staff nurses, temporary nurses have become more central to the system.
Just this week, the New Brunswick Nurses Union reiterated its call for an end to agency nursing after an access-to-information request revealed that the province’s French and English health authorities together spent nearly $57-million on travel nurses from April to August of this year. That news came on the heels of the Nova Scotia government announcing a cap on the number of hours that travel nurses can work in the province.
In Ontario, private nursing agencies are not regulated and there is no limit on what they can charge hospitals and nursing homes, a state of affairs that has prompted both opposition parties to float capping their rates.
Ontario Health Minister Sylvia Jones told reporters on Wednesday that her government “cannot take tools away from our hospital partners,” by cracking down on private agencies. She didn’t directly answer questions about capping rates.
“What I am hearing from hospital leadership is the use of agency continues to decrease as we have more nurses coming into the system,” she added, highlighting her government’s efforts to train more nurses locally and bring in others from overseas.
In the case of emergency departments, the A-G noted that agency registered nurses could be paid more than $75 an hour, compared with about $35 to $50 an hour for full-time permanent nurses employed by a hospital. One unidentified hospital spent about $8-million on agency nurses in its emergency room in 2022-23, up from less than $1-million in 2019-20.
The audit team wasn’t able to get a comprehensive picture of how much is being spent on agency nurses inside emergency departments provincewide because, “the Ministry and Ontario Health did not track agency staff costs and instead relied on hospitals to manage their own budgets and make decisions related to agency staffing.”
As for nursing homes, which have long struggled more than hospitals to attract permanent staff, some were relying on agency staff to provide up to half of all their hours of direct care to residents, the auditor-general found.