For Patients, Not Profit

UNION STRONG Jennifer Martin joined BC’s public travel nursing program after witnessing the negative effects of agency nursing in a local long-term care home.

For-profit nursing agencies are costing the province millions while impacting patient care

Jennifer Martin didn’t think she would ever be a nurse, let alone one who specialized in geriatrics, working with residents at a long-term care home in her hometown of Sechelt. From the close-knit group of nurses she enjoyed working with, to the one-on-one relationships she built with the elderly residents living at the home, she says the experience was rewarding and eye-opening.

“I ended up loving it,” she explains. “I loved how close the nursing team was. It’s like working with an extended family because all of you are focused not just on the residents’ medical needs, but their quality of life, comfort and making their experiences worthwhile.”

For a year, Martin dedicated herself to providing compassionate care at Silvestone Care Centre, a privately owned long-term care home built by Trellis Seniors Services in 2017. Vancouver Coastal Health commissioned the centre to replace the community’s two older, publicly owned long-term care homes: Shorncliffe and Totem Lodge.

While she enjoyed forming deep connections with Silverstone’s residents and their families, she became increasingly frustrated by the facility’s growing reliance on agency nurses – temporary nursing staff contracted by for-profit staffing agencies. When Shorncliffe and Totem Lodge operated, the facilities employed dozens of unionized workers. Today, only a handful remain.

“It definitely impacts the continuity of care.”

- Jennifer Martin

Martin made the difficult decision to leave, trading the uncertainty of agency-heavy staffing for the stability of GoHealth BC, the province’s in-house travel nurse program.

Today, she is providing care across BC while enjoying the security and benefits of a collective agreement.

Growing Reliance on Agency Nurses Driving up Costs

Across BC, the use of agency nurses has become a widespread trend in long-term care facilities and hospitals struggling with staffing shortages. While these temporary nurses play a crucial role in filling gaps, overreliance on agency staffing comes with significant drawbacks, ultimately driving nurses like Martin to seek a different path.

“When we have nurses at the home long term, they end up really getting familiar with the residents,” she explains. “But when we have a high turnover, they don’t know the residents’ routines or the nuances of their family members, and they don’t have a thorough history of why things are the way they are.

“It definitely impacts the continuity of care.”

The ballooning costs associated with agency nursing have raised alarms among policymakers and health-care advocates, including BCNU.

Union President Adriane Gear says that while agency nurses should be a short-term solution, in many facilities they’ve become the norm.

“Agency nurses cost disproportionately more than full-time staff nurses, and it’s an extremely inefficient use of taxpayer dollars,” she explains. “Rather than investing in long-term recruitment and retention strategies, health authorities funnel money into short-term fixes that do nothing to address the root causes of nurse shortages.”

BC has spent hundreds of millions of dollars on agency nurses in the last few years, and the trend shows no signs of slowing down. In the 2022–2023 fiscal year, the province spent a whopping $162 million on agency staffing compared to $8.2 mil- lion in 2018–2019 (Figure One). Each health authority saw massive jumps in costs, with Vancouver Coastal

Health spending $24.5 million, Fraser Health $14 million, Interior Health $34 million and Northern Health Authority a whopping $52.3 million in 2022–2023 (Figure Two).

“At my former workplace, it reached a point where agency nurses were making up a significant portion of the staff on any given shift. That created a lot of issues for continuity of care and teamwork,” says Martin.

Because they have less stability and security than unionized nurses, she says agency nurses are less empowered to offer critical feedback to their employers that keeps their coworkers and patients safe.

“My nursing licence requires me to speak up for patients and identify practice concerns, but that can be intimidating,” says Martin. “To certain employers, agency nurses are expendable. Out of fear of losing their work contracts, agency nurses often don’t speak up to report concerns.

“Knowing that my union is backing me up and encouraging me to use my voice helps me to act as an advocate and sound the alarm when I have to,” she says.

One of the biggest challenges of agency nursing is the lack of consistency. Because agency nurses are brought in on short notice and may only work a handful of shifts before moving on to a different worksite, residents often struggle to form meaningful connections with their caregivers. For elderly patients, particularly those with dementia or other cognitive challenges, seeing new faces day after day can be distressing.

“There is a specific type of work we do in long-term care that requires collaborative conversations and the use of assessment skills to figure out what residents need, sometimes without them always saying it,” says Martin. “Relying on temporary staff can prove difficult when providing patient care. We found that was one of the biggest challenges when there’s a large number of agency nurses.”

For-profit agency nursing can also harm workplace morale. Permanent staff members often find themselves taking on additional responsibilities, such as orienting agency nurses to facility policies and procedures. This extra workload, combined with frustration over wage disparities – since agency nurses are often paid significantly more per hour than permanent staff – can lead to resentment and burnout.

“In small, rural sites, bringing in an agency nurse can often mean the difference between an open or closed emergency department,” says Gear.

“However, I know that in many cases, permanent staff members feel as if they are doing more for less than their temporary counterparts.”

Seeking Sustainable Staffing Solutions

The increasing dependence on for- profit agency nurses is a symptom of deeper systemic challenges across the country – including retention struggles, inadequate funding and burnout among permanent staff.

A recent report commissioned by the Canadian Federation of Nurses Unions (CFNU) and Queens University has helped to shine a light on the skyrocketing use of for-profit agencies across Canada. Opening the Black Box: Unpacking the use of Nursing Agencies in Canada unveiled a sharp increase in agency spending and a concerning lack of regulations and transparency over how these companies operate.

The report found that more than $1.5 billion in public health dol- lars are projected to be paid out to for-profit nursing agencies in the 2023-2024 fiscal year. The rise in spending has been rapid, with a sixfold increase over just three years, up from $247.9 million in 2020–2021 (Figure Three). These estimates are based on available data but given the lack of transparency around the prevalence of for-profit agency nursing, the real costs are likely much higher.

The report outlines several key recommendations to address the costly trend, including immediately phasing out private for-profit nurse staffing agencies, implementing new regulations and oversight and addressing the nurse staffing shortage.

“While we’ve seen the cost associated with agency nursing balloon here in BC, it’s clear this is a trend occurring across the country,” says Gear. “The solution shouldn’t be more agency nurses. Rather, it’s supporting and valuing permanent staff. We must ensure nurses feel valued, have the resources they need and see a future in their profession.

A Better Alternative: GoHealth BC

For nurses like Martin who want the flexibility of travel nursing without sacrificing stability, the province’s GoHealth Travel Nurse program is an ideal alternative. Launched by the provincial government, GoHealth BC offers health-care workers the opportunity to experience rural and remote health-care work with more control over their schedules.

Additionally, GoHealth BC’s travel nursing opportunities are within the public health system, ensuring that nurses receive the wages, benefits and pension security afforded by collective agreements.

GoHealth BC deploys nurses to communities in need across Northern Health, Interior Health and the Vancouver Island Health Authority. From Masset to Salt Spring Island, the model ensures that regions facing critical shortages receive support from skilled nurses while maintaining the standards and protections of unionized employment. Unlike agency work, where assignments can be unpredictable and benefits are often nonexistent, GoHealth BC nurses enjoy fair wages and consistent scheduling.

Martin recently returned home from a short stint in Chetwynd, where she enjoyed meeting community members and providing care at the Chetwynd Hospital and Health Centre. This site has seen repeated emergency department closures due to a lack of staff.

In January, Northern Health placed Chetwynd’s ER on diversion for 10 hours. In 2024, a lack of doctors and nurses led to service adaptations that forced patients to drive over an hour to the nearest hospital.

“The GoHealth BC travel nurse program comes with a pension, benefits, union rights and a lot more protection,” says Martin. “When you arrive, you are much more a part of the teams you’re with, and you have a lot more power behind your license, which we should embrace because it’s an honour to have that.”

Martin’s next deployment will be in Tumbler Ridge. She looks for- ward to doing her part for patients and working alongside fellow nurse colleagues – all with the protection and security of being a union member.

“GoHealth BC brings people into the workforce who are part of the union and part of the team,” says Martin. “Even though they live far away, their integration into the team brings more comfort and confidence when advocating for patients and colleagues.”

Looking Ahead

Martin’s journey from working in a private long-term care home to providing care through the province’s GoHealth BC travel nurse program reflects the challenges and opportunities facing BC nurses today.

While agency nursing may offer short-term relief for staffing shortages, it is not a sustainable solution. By prioritizing stable, unionized employment and investing in programs like GoHealth BC, the province can ensure better outcomes for nurses and patients alike.

“As BC continues to navigate its health-care staffing crisis, the government must invest in a stable, well-supported nursing workforce,” says Gear. “The future of patient care depends on it.” •

UPDATE (Spring 2025)