Only way to end reliance on expensive private-agency nurses is to improve public-sector working conditions

Opinion

Hey there, time traveller!
This article was published 21/05/2024 (474 days ago), so information in it may no longer be current.

It was only a matter of time before the provincial government took action against private nursing agencies.

Premier Wab Kinew announced last week at a Brandon Chamber of Commerce luncheon that the NDP government plans to provide greater oversight of private nursing agencies. It will do so by issuing a request for proposals to “validate” agencies that contract with public-sector facilities, such as hospitals and personal-care homes, said Kinew.

“We’ll be able to ensure that there are standards in place, that there are health and safety regulations being put into place,” he said.

On the surface, it sounds like a reasonable proposition. Who doesn’t want standards in health care?

But why now? Provinces, including Manitoba, have been relying on private nursing agencies for decades to fill scheduling gaps in emergency rooms, medical wards and nursing homes. Until now, there has been little, if any, talk about regulating them.

What is relatively new is the reliance on private nursing agencies has exploded, not only in Manitoba but elsewhere, such as Ontario and Quebec. They’re charging publicly funded facilities an arm and a leg for their services — often three times or more what salaried nurses earn in the public sector.

Last year, the Quebec government passed legislation to limit the use of private employment agencies and eliminate them in the public sector by 2026. It’s a heavy-handed response to a problem that has no easy answers.

Nurses are leaving the public sector in droves largely because of poor working conditions, including mandated overtime, inflexible scheduling and dangerously low nurse-to-patient ratios.

Many have moved to private agencies because the pay is better, the scheduling is more flexible and there is no forced overtime.

Trouble is, the cost of private nursing is exorbitant. Manitoba spent $56 million on private nursing in the first three quarters of 2023-24. That amount has doubled and tripled over the years, with no end in sight to the province’s growing reliance on it.

It’s not surprising the government is looking for ways to better control that sector, if for no other reason than to get a handle on the rising costs of using it.

So what will this new oversight in Manitoba look like? It’s anybody’s guess. Like anything else the government does, the devil will be in the details.

It doesn’t appear Manitoba plans to take Quebec’s more draconian route. There are probably good reasons for that. While a ban on private nursing agencies in public facilities may be a tempting option for the government, it’s also unrealistic.

Public hospitals and nursing homes will always require private services to fill scheduling gaps, even in a properly staffed health-care system. Health care is volatile and prone to spikes in demand for services. Public hospitals and other facilities need the option of tapping into private agencies, when necessary.

What they don’t want is for private agency nurses to make up a large part of their staffing needs. The cost is prohibitive.

However, that is the reality today. It comes after years of substandard working conditions, which were made worse by the previous Progressive Conservative government. When the Tories amalgamated hospital services in Winnipeg between 2017 and 2019, they did so without consulting front-line staff. Instead, they forced hundreds of nurses and allied workers to reapply for jobs in the system, often at different hospitals and in areas many either didn’t want to be in or did not feel qualified for. Some quit, retired early or went to private agencies.

That flow of nurses from the public sector to private agencies continues today, which is why the government is now trying to stem the tide.

No one really knows what this new provincial oversight of private agencies will look like. However, it will probably be more than just legislating standards. It may even cover things such as pricing to control the monstrous costs public facilities face when they hire private nurses.

In the end, the problem won’t be solved until working conditions improve in the public sector, including the elimination of forced overtime. If the last round of collective bargaining with nurses is any indication, the province still has a way to go.

The latest nursing contract offer, which includes modest wage gains, was accepted by most bargaining units last week. But it was rejected by probably the most important one: nurses at Health Sciences Centre. The offer wasn’t good enough for them and it may have been barely satisfactory to those who accepted the deal. That could result in more nurses abandoning the public system in favour of the private option.

It is precisely why the province is looking for ways to tighten the screws on private agencies.

tom.brodbeck@freepress.mb.ca