This column by Armine Yalnizyan was originally published by the Toronto Star on Wednesday June 15, 2022. Armine is a Contributing Columnist to Toronto Star Business featured bi-weekly.
“Laura” spoke to me on condition of anonymity, for fear of workplace reprisals. We were talking about the skyrocketing use of agency nurses, the temporary workers hired to fill in when there are staffing shortages in hospitals, long-term care facilities and community clinics, including remote health stations.
She said “agency nursing is bad for the community and bad for patient care because there is no consistency, it fragments health delivery.”
Laura is an agency nurse.
Until last year, she was paid directly by the public health-care system, earning $35 an hour (about $75,000 a year), with a generous pension and benefits. Overtime pay to cover short-staffing added another $40,000.
She’s doing the same nursing work she’s always done, but chose to do it through an agency because she had lost control of her life as a health-care worker during the COVID-19 pandemic.
As a public employee, overtime had become mandatory; she lost planned vacations repeatedly during the pandemic; understaffing was endemic; she and her colleagues were burned out.
Laura now works when she wants and how much she wants. The agency she works for lets her know what’s available, and she accepts or turns down the assignment. She earns $50 an hour, and she gets paid overtime at twice the pay on both Saturday and Sunday instead of just Sunday.
She is paid to travel to an assignment at the same pay rate ($50 an hour), or her taxi costs are covered by the agency. She gets no pension or benefits, and no sick pay, but she chooses where she works, and the type of work she does.
Her story is a ticking time bomb for our system of public health care, and for the amount and quality of care we will all be able to access.
Agency nursing has become a permanent short-term solution to address a crisis that’s been decades in the making; the conditions of the pandemic have accelerated its use.
Systemic data on the problem is almost non-existent, and the only reporting I’ve seen comes from Saskatchewan.
So I reached out to Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU), who said rates go as high as $125 an hour for an agency nurse, which may include agency fees. All these new costs are paid by the public purse, or in some cases by private long-term-care facilities.
“The patchwork solution is agency nursing. The long-term solution is agency nursing. Nobody is thinking about sustainability. There’s no light at the end of the tunnel.”
It was unclear how big the incentives were for nurses to “go agency,” so CFNU decided to poll its members. Full disclosure: I helped them design the questionnaire.
About 150 respondents provided clues about what is happening and why: younger nurses use agencies most because they have less seniority, the secret sauce to controlling your hours and assignments.
It’s more about time than money, but it certainly is about both.
Also, the majority of responses were from Manitoba and Ontario. Manitoba froze nurses’ pay for over four years. Ontario capped wage increases to one per cent throughout the pandemic and amid soaring inflation. Ontario is now offering “up to $5,000” retention bonuses, but the deed is done.
Based on conversations, a registered nurse in Ontario making $45 an hour as an employee (plus pension, benefits and sick pay) can be working next to agency nurses making $90 or $100 an hour.
Hundreds of temporary nursing agencies emerged in Ontario as nursing labour shortages grew, and now digital apps are appearing, too.
It’s the Uberization of health care: just-in-time labour on your phone, convenience, and close-to-instant gratification for most of your care needs.
Who needs governments or regulations when you can just directly contact the person whose labour you want? Who needs unions or employers when you can make more and worry less?
So nurses are quitting in droves to find better wages and working conditions, and agencies and digital platforms are happily taking a cut of the hourly wage paid by the service provider to help them do just that.
How much of a cut is unclear, as this information is shielded by corporate confidentiality, making it difficult to audit trends, but you and I are paying far more, for far less.
The irony is if any government spent just a fraction of what they’re spending on agencies to improve wages and working conditions, they’d solve the problem.
Instead, in long-term-care facilities across Canada, the military was called in. Starting with Quebec last August, Canadian public and private sector care providers can now hire more temporary foreign workers to meet needs in the care sector.
And the accelerating drainage of public funds to private agencies and apps for the same work with less continuity undermines the very provision of care.
The stories abound: in the GTA, 21 nurses quit, went to work for agencies, and came back to the same intensive care unit at double their salaries.
“It’s not sustainable,” Silas says. “The pandemic was a free-for-all, surgeries being cancelled, can’t hold the hand of dying parents. And we’re still in that mindset. Sustainability is not on anybody’s mind.”
Worried that there are no strategic approaches across the country, no data to draw upon and no forward planning, Silas says: “What is now framed as a stopgap measure is crystallizing into the solution. It’s worse than tunnel vision. It’s no vision at all.”
In hospitals, wait lists for surgeries because of the pandemic have grown. The bottleneck isn’t doctors doing the surgeries, but nursing care for the patient after the surgery is done. Nurses are often yanked from one department to another, redeployed just to have a body in place.
The pattern is underutilizing nurses’ often hard-earned competencies and raising risks just to put names on staffing rosters. Nurses who are just slotted into place simply can’t know that what is happening to the patient today is related to what happened to them yesterday.
Every solution on the table today is temporary, but our problems are permanent.
Patients need more care and consistent care. Workers providing that care need more respect. Getting there requires a long-term plan, one that is national in strategy and scope.
I’m ready to leave Noplanistan, are you?
We did it before, when we created Medicare in 1966. Surely, with our economy 42 times bigger than it was 56 years ago, we can come up with a plan that sustains Medicare now.