Private nursing agencies could cost Canadian health-care facilities approximately $1.5 billion in 2023-24, according to a new report commissioned by the Canadian Federation of Nurses Unions.
The study, authored by Dr. Joan Almost of Queen’s University, examined the use of for-profit nursing agencies over the past several years. According to the report, the amount of public spending on private agencies has gone up six-fold since 2020-21, when spending was just $248 million.
The $1.5 billion for 2023-24 is projected and includes $1.3 billion that is based on available data.
What are agency nurses?
Most nurses employed by agencies work in hospitals (51.6 per cent), the report says. Other examples of agency work include long-term care and personal care homes (24.5 per cent), community and home care (10.5 per cent), and rural and remote work (4.1 per cent). Others work at outposts, clinics, public health units, correction facilities, rehab centres and other locations.
The report says agencies play “key roles in the delivery of home care and community services,” but they “were never intended to fill a chronic nationwide full‑time nursing staff shortage.”
While agency nurses, or “travel nurses,” have long existed, they were historically limited to supplying remote or underserved hospitals and clinics. However, the report says private agencies have expanded their role by recruiting registered nurses who want higher pay and more freedom to select shifts.
According to Almost, these temporary nurses have become a mainstay in many long-term care homes, critical care hospital units and emergency departments.
The contrast between agency and staff nurses is “destabilizing,” Almost said. The other problem is that agency nurses are what she calls “drop in” and often don’t stay for extended periods.
“Contracts themselves are short, and they’re just getting into the system and understanding the policies and everything, and then they’re gone again,” she said. “It disrupts the health-care team which is impacting patient care.”
More vacancies, more agency hours
Nursing job vacancies in Canada have gone up steadily over the past decade. In 2015, there were around 6,000 vacant positions for registered nurses and psychiatric nurses. At the end of 2023, that number was more than 28,000, the report says, citing Statistics Canada.
The number of agency hours logged by registered nurses has climbed over the past years as well, jumping from approximately 1.1 million hours in 2020-21 to a projected 3.2 million hours in 2023-24.
According to theBritish Columbia Nurses’ Union, the total number of agency hours has skyrocketedin the province. In 2016-17, around 23,000 agency hours were reported in the first quarter of the year. In the third quarter of 2023-24, that number was more than 550,000.
Source: British Columbia Nurses’ Union using data provided by the Health Employers Association of British ColumbiaAmong nurses who report agencies as their primary workplaces, the majority are in Quebec and Ontario, the report says. Out of 4,208 agency nurses in Canada in 2021, 1,736 worked in Quebec and 1,762 worked in Ontario.
According to Hannah Jensen, a spokesperson for the Ontario Ministry of Health, the proportion of agency nurses in the province has gone down over the past few years, from 3.8 per cent of total nurses in 2017 to 3.0 per cent in 2022-23.
Jensen told CTV News that the Ontario government itself “does not have any contracts with healthcare worker agencies, including nursing and [personal support worker] agencies,” and that “hospitals have always had the tool to use agency nurses,” including under past governments.
Jensen said since 2018, 80,000 new nurses have been registered in the province.