Ontario Liberal MPP introduces bill to address 'price gouging' by temporary nursing agencies

A new private member's bill tabled at Queen's Park Thursday would impose strict rules on staffing agencies that recruit and employ nurses for temporary work.

Hospitals, long-term care homes and other health-care facilities have relied for years on private, for-profit agencies to provide nurses, personal support workers and other staff to cover vacancies. However, critics say the model is costly, unfair and lures workers away from permanent jobs.

Liberal MPP Adil Shamji's bill, the Temporary Nursing Agency Licensing and Regulation Act, includes mandatory licensing for temporary nursing agencies, a ban on "unconscionable pricing," and restrictions on how they can recruit.

CBC Toronto was provided with an advance copy.

"What I'm proposing with this bill is to take aim at some of the most outrageous, some of the most predatory hiring and recruitment practices that are employed by these temporary, for-profit nursing agencies," Shamji, a former emergency physician, told CBC Toronto in an interview.

The bill comes as Ontario politicians debate ways to address a severe staffing shortage in the health-care system, which has caused wait times for hospital care to increase dramatically, thousands of surgeries to be cancelled or delayed, and emergency rooms to temporarily close. 

More than 25,000 vacancies, nurses' union says

Nurses have been leaving the profession in droves amid chronic understaffing, overwork, burnout and a cap on wage increases during the COVID-19 pandemic.  

Angela Preocanin, first vice-president with the Ontario Nurses' Association (ONA), the province's largest nurses' union, said there are more than 25,000 vacant nursing positions in Ontario.

She said some nurses quit their staff jobs at hospitals to work for temporary agencies because they provide flexible scheduling and often pay more, with agencies charging hospitals between $80 and $150 an hour. 

"There's some surge pricing. If they know it's a weekend and they desperately need someone, the price automatically drives up," she said. "It's an Uber-ization of our nursing work."

Reliance on temporary staff has driven up costs for hospitals.

The Toronto Star published an investigation last year that showed spending on temporary nursing staff soared by millions of dollars at some of Ontario's largest hospitals compared to the pre-pandemic period.

Toronto's University Health Network (UHN) confirmed to CBC Toronto that agency nurse expenditures increased to $6.74 million in the fiscal year ending March 2022 from $775,926 in fiscal 2021, $828,699 in 2020, $915,786 in 2019 and $1.04 million in 2018.

"The pandemic, illness amongst staff, and the overtime worked by staff have all taken their toll on health-care workers," UHN spokesperson Gillian Howard said in a statement.

"Staffing from agencies has always helped ensure that units are staffed, but the pressures of the pandemic have meant that agency use has increased over the past five years."

CBC Toronto reported earlier this week that the provincial association representing a majority of the province's not-for-profit and municipal long-term care homes said staffing agencies are "exploiting the health human resource crisis," forcing not-for-profit long-term care homes to also spend millions of dollars on temporary staff.

A not-for-profit long-term care home executive told CBC some agencies even send their staff members to wait in the home's parking lot to recruit employees as they leave work.

'Rampant price gouging'

Shamji said his bill uses the same language the Ontario government used when it passed legislation to ban price gouging on masks and personal protective equipment at the beginning of the pandemic.

The bill proposes to require licensed agencies to establish "consistent and predictable fees." It would also ban agencies from employing "dynamic pricing," and force them to be transparent about their profits.

As a measure to prevent nurses from quitting their staff jobs only to be sent back to the same hospital as a temporary worker, it would restrict agencies from assigning nurses where they've worked in the past six months.

Violations of the rules would be punishable by fines of up to $50,000 for individuals and $100,000 for corporations. 

Private members' bills, which are brought forward by MPPs who aren't cabinet ministers, rarely pass, particularly those proposed by members of the opposition when a majority government is in power. But they can draw attention to an issue.

In question period Wednesday, Shamji accused the government of enabling for-profit agencies to "siphon" health-care workers out of the public health-care system.

"Many of these agencies engage in unscrupulous recruiting practices, like hiring out of parking lots, or they institute harmful contractual obligations that stop nurses from working in the location of their choice," he said.

"Others engage in rampant price gouging."

Ontario Health Minister Sylvia Jones responded by saying nursing agencies have had the option to hire agency nurses to address their staffing needs for years, but she didn't address the issues of rising costs, recruitment or contracts.

"Nursing agencies and health-care agencies have been in operation for many, many decades in Ontario," Jones said. "They are a way to deal with surges and challenges that we have when we see a disproportionate rise in illness or issues."

In a follow-up statement, a spokesperson for Jones said the proportion of agency nurses decreased to 3.2 per cent in 2021 from 3.8 per cent in 2017, and they account for less than one per cent of the total hours worked in hospitals.