Ontario nursing associations say the province should phase out health-care staffing agencies if it wants to prevent untrained people from working in places like long-term care homes.
The Ontario Nurses’ Association (ONA) and the Registered Practical Nurses Association of Ontario (WeRPN) told CBC Hamilton agencies bring a host of problems and have little oversight — which is especially problematic given recent criminal charges laid against a fake nurse who worked in three long-term care homes for months after an agency, and the homes, didn’t properly check her credentials.
While the homes and the agency involved said they’ve made changes to prevent future errors, the unions say there must be more oversight and more investment into the public health-care system to curb a growing reliance on for-profit agencies. The homes and agency declined to comment when contacted for this story.
“It’s the wild west out there and it’s unacceptable,” Erin Ariss, provincial president of ONA, said.
“Taxpayers pay for a publicly-funded, publicly-operated health-care system and yet those dollars are being used to fund the privatization of nursing,” added Ariss, whose association represents 68,000 nurses and health-care workers.
Ariss said the province has created a “revolving door” of staff in the sector due to a lack of adequate pay and unsafe work conditions.
Dianne Martin, WeRPN’s chief executive officer, agreed.
“If we’re losing more nurses than we’re bringing in, we’re going to be in for some real tough times,” she said.
Auditor general has raised concerns about agencies
Last year, Ontario’s auditor general raised concerns about the use of agency staff in health-care facilities.
An auditor general report on long-term care found that, due to their temporary nature, agency staff were “unable to provide residents with the same continuity of care as permanent staff” and agency staff were more likely to make mistakes like medication errors. Agency nurses were also more costly, the report said.
It recommended the province undergo a review of the use of agency staff and “implement strategies to reduce usage and prevent price gouging.”
The Ministry of Long-Term Care’s response in the report said it would work with the Ministry of Health to plan for future staffing needs, it was reviewing the use of agency staff and would implement programs that support recruitment and retention.
WATCH: Private agency nurses cost much more. Hospitals need them anyway
Canadian hospitals are facing a nursing shortage partly because many nurses have left for more flexible, higher paying nursing agencies. CBC’s Christine Birak found out why the cost to the public system is more than just financial and what it would take for nurses to come back.
A separate auditor general report found the use of nurses from private staffing agencies in Ontario hospitals soared, costing millions of dollars. Exactly how much is unknown because the province doesn’t track agency staff costs. The report noted there’s nothing in place to cap what agencies charge health-care facilities.
The Ministry of Health’s response in the report said it would be able to monitor how agency staff are used in some service departments and would work on evaluating the reliance of agency staff by “engaging with frontline partners” and reviewing mechanisms that would allow staff to move more freely between hospitals.
“Agency nursing is not the way to go. It’s not the best use of our health-care dollars,” Registered Nurses’ Association of Ontario president Claudette Holloway said.
Vivian Stamatopoulos, a long-term care researcher who teaches in the faculty of social science and humanities at Ontario Tech University in Oshawa, said instead of relying on agencies, the province should support health-care facilities in efforts to hire more permanent, full-time staff.
“It makes no sense to have agencies at all,” she said.
Province doesn’t answer questions about oversight
Ariss and Martin said they haven’t heard from the province about how to fix the problems that come from using agencies.
Ariss noted wages for hospital nurses have improved, but that’s because of arbitrated decisions, rather than the province.
The various unions listed different ways the province can fix the problem, including:
- Increasing pay for nurses and health-care workers, especially for RPNs.
- Improving workplace safety and staff-to-patient ratios.
- Create a framework to oversee privately-run agencies and phase them out.
- Streamline nursing certifications and remove financial barriers to get post-secondary nursing degrees.
The Ministry of Health and Ministry of Long-Term Care declined interviews about the lack of oversight and didn’t directly answer questions about the lack of oversight and calls for change.
Ministry of Health spokesperson Anna Miller said while the province funds the operation of hospitals, hospitals are “independent corporations responsible for their own day to day operations, including staffing arrangements and salaries.”
Miller also said the ministry does not have any contracts with healthcare worker agencies.
Ministry of Long-Term Care spokesperson Daniel Strauss said the ministry isn’t involved in staffing decisions at homes and the College of Nurses of Ontario oversees nursing in the province.
CBC contacted the College but it declined to comment.
Strauss also said the ministry has spent millions of dollars to increase the number of long-term care inspectors and introduced an investigation unit to address serious non-compliance issues.
Ariss said it sounded like the Ministry of Health was passing the buck.
Martin said oversight is possible. For example, long-term care homes could have regulations in place for agencies the same way there are rules in place to ensure appropriate meals are served, among other standards.
Phasing out agencies is possible too, though it will take time since they are being relied on so much, she added.
“We absolutely believe the risks tied to agencies are too great to have them continue to function in the system when there is a better way.”
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