Ontario hospitals and LTC homes are filling workforce gaps with nurses and other contract agency workers at a cost of more than double the hourly rate staff earn.
The problem was bubbling under the surface, particularly in the Toronto area and northern Ontario, but has now come to the fore across the province as Ontario grapples with a health care staffing crisis.
“If I was making $112 an hour and you were making $45, what do you think that would be like?” said Cathryn Hoy, president of the Ontario Nurses Association, which represents more than 68,000 registered nurses and other health professionals.
Employment agencies have provided temporary staff to hospitals for years to fill vacancies. But the pandemic has increased reliance on agencies to provide nurses and other workers to fill vacancies, which will add to higher costs and has drawn workers away from their jobs, nurses unions say.
“I have spoken with nurses who have been offered $112 an hour to work in the same ICU,” Hoy said.
Nathalie Mehra, executive director of the Ontario Health Coalition, said the network of more than 400 community-based organizations has advocated against staffing the agency for years and is now calling for it to be banned altogether.
“It is corrosive. They are raising prices,” she said.
The Canadian Federation of Nurses Unions has requested that the Auditor General of Canada, along with her provincial counterparts, conduct an audit of private companies hired to fill nursing positions, including the total amount spent and average pay rates over the past few years. five years.
“Where do public dollars go? There is a complete lack of transparency about how much the agency nurses are paid and how much the agency is paid,” said Linda Silas, president of the federation, which has about 200,000 members.
One problem is that there is little public information on how much is spent on agency staff, and most of it is anecdotal.
in a twitter videoBefore COVID, agencies charged hospitals $65 an hour, said Dr. Michael Warner, an ICU physician at Michael Garron Hospital in Toronto. Now they are charging $110 an hour, he said.
“I think this is exploitative and predatory. There is one company that even offers bump pricing, so if the shift is booked right before the shift starts, the price goes up to $140 an hour,” he said.
The nurse doesn’t keep it all. But the amount they keep is much higher than what they would get on a union salary, even when other factors like vacation pay and pension are taken into account, Warner said.
Last year the agencies charged double what the staff earned. Now it’s more than that, said Lisa Levin, executive director of AdvantAge Ontario, which represents more than 200 nonprofit and municipal households.
Some LTC households have no choice but to use money earmarked for other purposes to pay agency staff, he said.
“At the start of COVID, agencies helped households a lot. It seems that after the first waves, prices went up. We’ve heard a lot about hospitals, but the problem is with the entire health care system,” Levin said.
“Agencies are scamming and targeting staff and offering them higher salaries. Our households are having a much harder time finding people.”
Today he aims to publish figures soon that will offer an idea of the scope of the problem. Hospitals that use agency personnel must pay a fine to the ONA. Some checks are four times what they have been in the past, she said. ONA is compiling information on a hospital-by-hospital basis and plans to publish it next month.
The agency’s nurses can help out in a pinch, but should only be used as a short-term stopgap, said Ivy Bourgeault, a research professor of gender, diversity and the professions at the University of Ottawa.
“If you’re working right next to someone else, and they’re making more than you, it’s a built-in pay gap. It causes resentment,” Bourgeault said, “it can solve immediate personnel problems, but it creates long-term resentment in the system.”
Solutions to get people back would include better working conditions, a better workplace culture, and support from supervisors, managers, and administrators. Nurses face high levels of workplace violence, for example, she said.
“We all thought it was about pay,” Silas said. “But it’s about flexibility and getting away from the politics of a hospital. Agency nurses are not employees. They do their job, wash their hands and leave.”
They all focus on recruiting, but it’s more important to focus on retention, Bourgeault said.
“You can’t recruit people into a system that is bleeding. Why can’t you pay more for the nurses who are there and offer incentives to those who have left?
Nurses’ unions and others argue that House Bill 124, which restricts wage increases to one percent per year for a period of three years, should be repealed. They also argue that nurses should have pay parity with police officers.
In the meantime, there is a need for a cadre of workers who are mobile. Being part of that mobile workforce should be incentivized, Bourgeault said.
It is also necessary to bring everyone to the table to discuss the human resources crisis, he said. Newfoundland and Labrador, for example, recently convened a stakeholder expert group, she said. It also means figuring out what incentives will be needed to bring nurses back.
“We need to support them, not vilify them. We need to know what it would take to bring them back.”
In Ottawa, closing the staffing gap with agency workers appears to be used less frequently than in other parts of the province.
Queensway Carleton Hospital and CHEO say they have not hired agency nurses. The four municipal nursing homes in Ottawa have also not hired agency nurses or PSWs.
An Ottawa Hospital spokesman said the hospital has used a small number of agency hours from the Ottawa Community Health Registry over the past five years as part of a long-standing agreement to offload ambulances to emergency departments. But aside from this, the hospital has not contracted with any nursing hour agency.
The Perth and and Smiths Falls District Hospital closed the emergency room at its Perth site for about three weeks earlier this summer. A A couple of the agency’s nurses have been hired, said Dr. Alan Drummond, an emergency room physician at the hospital and co-chair of public affairs for the Canadian Association of Emergency Physicians.
Drummond said he wasn’t enthusiastic about the solution at first, but the nurses have worked well.
“Would our emergency room be open without them? Probably not.”
Rachel Muir, who runs the Ontario Nurses Association unit at the hospital, believes agency nurse recruitment is inevitable in Ottawa.
“We are so short of nurses and have so many unfilled vacancies that there are not enough nurses to safely provide the care patients deserve and there is significant reluctance to close beds or reduce services that are currently provided,” she said.
Speaking to reporters last week, Prime Minister Doug Ford said he can’t control the prices charged by private-sector agencies.
“Can I dictate to any private company, should you pay this to your employees, should you pay that? I just can’t,” she said.