N.B. nurses union seeks end of use of travel nurses, cites 'astounding' $57M cost

The New Brunswick Nurses Union is calling on the provincial government to commit to ending the use of travel nurses by the end of 2025, describing the nearly $57 million spent on the private agency nurses in five months as "astounding."

Instead, the government should invest in the retention of New Brunswick nurses and the recruitment of nurses who will work and live in the province, said president Paula Doucet.

"Invest in New Brunswick, invest in New Brunswickers, and invest in New Brunswick nurses. And then maybe we would have a better health-care system for all," she said.

Horizon Health Network will stop using the temporary nurses from private agencies before the union's deadline, according to Greg Doiron, vice-president of clinical services.

"The majority of these contracts will expire at the end of [this month], while critical areas such as [emergency departments, intensive care units] and surgical units will continue through to the end of March 2024 to ensure the continued stability of these vital services," he said in an emailed statement.

Meanwhile Vitalité Health Network is "well positioned to phase out the use of agencies by winter 2026," said spokesperson Anthony Doiron.

"A gradual reduction in agency services is planned, but it would be irresponsible as a health-care organization to phase them out completely at this time, given the immediate needs to be met," he said in an emailed statement.

Doucet described Horizon's goal as "lofty" and worries about the feasibility of Vitalité's target, given its heavy reliance on travel nurses in some regions. She cited as an example the Campbellton Regional Hospital, where agency nurses logged more than 68,000 hours between April and August.

Department of Health spokesperson Sean Hatchard noted travel nurses are contracted by the regional health authorities (RHAs), not the province, and said they're only used when no other nurses are available.

But he said the department will review Nova Scotia's decision this week to limit its use of travel nurses and discuss the issue with the RHAs.

The department is working with the health authorities, the Nurses Association of New Brunswick and other recruitment partners to fill nursing positions as quickly as possible, and has seen some progress, with a net increase of 113 registered nurses in the past seven months, said Hatchard.

He did not clarify whether those are full-time, part-time or temporary positions. Nor did he say how many positions remain vacant.

The government has also taken steps to train more nurses in the province, with the number of students jumping to nearly 1,300 last year, from 888 in 2018, Hatchard said.

Horizon spending jumps fourfold

Between April 1 and Aug. 31, 2023, Horizon spent nearly $23 million on contracts with private companies that supply temporary travel nurses, according to figures obtained by CBC and separately by the union through a Right to Information request.

That's up from about $5 million in 2022-23, the figures show.

Vitalité spent about $34 million between April and August, plus just over $19 million during the previous eight months.

Paid three times or more the N.B. hourly wage

Union leaders say they're appalled by the ballooning expenditures.

It works out to an average cost of $142 per hour, according to Doucet. When expenses such as travel, accommodations and registration fees are included, it jumps to around $300 per hour, she said, but could not immediately detail the formula used.

By comparison, an average hourly wage for a "mid-career" New Brunswick nurse, working six years at "top salary," is $45.67 per hour — one of the lowest paid in the country, after Quebec, she said.

"For a government that is focused on 'value for money,' paying travel nurses three times what a salaried New Brunswick nurse earns makes no sense," said Doucet.

It also makes New Brunswick nurses feel disrespected and devalued, she said.

"The use of travel nurse agencies has to stop."

Doucet noted Finance Minister Ernie Steeves recently announced the $199.6-million budget surplus he was projecting just a couple of months ago has mostly evaporated, largely because health spending is now projected to reach $3.75 billion by the end of March, $162 million over its original allotment.

"Why is it over budget? Here's your data and your proof that they're spending hand-over-fist money, taking out of this province," she said, referring to many of the private, for-profit travel nurse companies being in Ontario or out West.

The union submitted the data request, she said, after hearing from members at its annual general meeting in October that increasing numbers of travel nurses were coming into hospitals across the province.

'Far from ideal,' says Horizon official

Horizon began using travel nurses in October 2022 "as an essential means to ensure continued delivery of safe care," said Greg Doiron, vice-president of clinical services.

He noted health-care organizations across Canada are using them to maintain critical nursing services.

"Although far from ideal, the use of private agency nurses has saved lives and their efforts have helped our health-care system to get through an unprecedented time," he said.

The costs, which include salary, registration and expenses, have escalated significantly, Doiron acknowledged.

"This is mostly due to critical nursing shortages in areas like our emergency departments, ICUs and surgical units," he said, without defining "critical," or providing the number of vacant positions.

Doiron did say Horizon has undertaken "aggressive nursing recruitment strategies which are generating very positive and very real results," with a net gain of 207 registered nurses since April 1, plus 103 internationally educated nurses hired, he said.

According to figures from the Department of Health, Horizon has hired 359 registered nurses since April 1, and Vitalité, 141, for a provincial total of 500.

Of those, 319 are permanent and 181 are temporary/casual, the department spokesperson said.

During that same period, Horizon and Vitalité lost 387 registered nurses, including 192 in permanent positions and 195 in temporary/casual roles, he said.

Vitalité has strategies to 'wean' off

Vitalité's decision to "resort to agency personnel to deal with hospital staffing shortages was taken after a thorough review of health and patient safety risk requirements," said spokesperson Anthony Doiron.

"The use of agency workers is a temporary but necessary measure that has allowed us to save lives, provide relief to our workforce, and reduce the exhaustion of our teams and turnover," he said.

"Numerous strategies are in place to wean ourselves off this need." Doiron did not provide any details, but did say Vitalité's efforts to recruit and retain health-care workers is "already bearing fruit."

N.S. to limit use of travel nurses

The Nova Scotia government is taking steps to end its reliance on private nursing agencies by limiting the amount of time someone employed as a travel nurse can work in the province.

Health Minister Michelle Thompson told CBC Monday that her government decided the money could be better spent on people who are a part of the public system and that the use of agency nurses works against efforts to fill the more than 1,000 vacancies in Nova Scotia.

Under the terms of the policy change, anyone who works in the province as an agency nurse can only work for 180 days before having to wait a year before working there again. Graduates of Nova Scotia nursing schools will not be allowed to work in the province as a travel nurse during their first year after graduation.

Earlier this year the Quebec government passed a bill that will limit the use of health-care staffing agencies, with a goal of banning hospitals from using them by the end of 2025.

New Brunswickers deserve good quality health care, they deserve publicly funded health care, and they deserve for their government to be prudent with taxpayers' money.— Paula Doucet, New Brunswick Nurses Union president

Doucet said New Brunswick is currently "in the eye of the storm" and even relies on the use of travel nurses to keep some hospitals open after failing to heed years of warnings about the need to educate, hire and retain more.

But the union has set a deadline of the end of 2025 to end their use.

The government should focus on supporting registered nurses who want to become nurse practitioners so they don't have to work full-time and study at the same time, and making Bachelor of Nursing and licensed practical nurse courses more accessible and affordable, said Doucet.

Travel nurses were never intended to help keep emergency departments open in urban centres, she said. They were intended to ensure remote communities had access to health care.

"New Brunswickers deserve good quality health care, they deserve publicly funded health care, and they deserve for their government to be prudent with taxpayers' money as they provide the services the people of the province need."