Between April 2021 and April 2024 Alberta Health Services increased spending on private for-profit staffing agencies from just over $5 million a year to more than $156 million a year, an increase of roughly 3,000 per cent, according to documents obtained through a freedom of information request. 

If current spending trends hold, AHS will have spent more than $330 million on agency nursing in the past three fiscal years. 

Photo from Rally for Respect on Oct. 24, 2024 at the Alberta Legislature in Edmonton. Photo by Lindsey Tran, United Nurses of Alberta.  

Between April 2022 and September 2024, AHS hired 628 Registered Nurses through various staffing agencies. In the same time frame they also hired 121 Licensed Practical Nurses and 119 Health Care Aides through the agencies. This was all done through 1,929 placements or contracts via 21 different agencies. 

Health Minister Adriana LaGrange acknowledged that agency nursing has “been a problem for everyone across Canada” and that “we really need to make sure that we wean ourselves off the reliance on agency nursing” in front of the Legislature’s Standing Committee on Families and Communities on March 2024. 

Health Minister Adriana LaGrange did not reply to questions on this story, her office forwarded our questions to AHS who gave a response. 

From April 1 to September 30 of this year AHS has spent $47,359,453.43 on private staffing agencies. If spending trends hold, AHS is projected to spend nearly $95 million on agency nursing in 2024/25, with the health authority having budgeted just $35 million for the expense. 

Screenshot from Freedom of Information request to AHS. 

AHS spent $81,021,671.25 on private nursing contracts in the 2022/23 fiscal year and $154,623,084.12 in the 2023/24 fiscal year. 

While the projected $95-million expense this year is a 39 per cent decrease from the peak in 2023/24, it’s still the second highest yearly amount ever spent by AHS on for-profit staffing agencies ever. 

“AHS is working to reduce our reliance on agency nursing and ensure work is done by employees where appropriate,” the agency noted in its final response to The Progress Report’s request. “Contracted staff are being used only when we have exhausted other options with existing staff.” 

Courtesy of Alberta Health Services’ sole-source contract database, which was last updated Oct. 4, 2024 we know that AHS spent at least $5.1 million on nursing agency contracts in 2021/22, $5 million in 2020/21, $2.7 million in 2019/2020 and $400,000 in 2018/19. 

We also requested the number of hours worked by agency nurses for each year, but an AHS freedom of information coordinator told the Report that AHS doesn’t track those figures, and that they would have to go through each agency’s invoice by hand to find that information. According to that AHS coordinator, a system will be put in place next year to monitor hours for agency nurses.

One reason that might explain the dip in agency costs in 2024/25 from the peak in 2023/24 is found in a Sept. 19, 2024 briefing note from a meeting of the AHS finance, audit and risk committee. 

Citing “ongoing recruitment challenges and staffing shortages,” and the “higher hourly rates of agency staff,” the note said that nursing agency expenses “are beginning to stabilize during 2024-25 as staff overtime is being used as an alternative and vacancies are being filled.”

“As the organization seeks to reduce the dependency on agency nursing, there has been a need to cover short term challenges with overtime as an alternative. Scheduling relief coverage has proven to be challenging resulting in last minute coverage at overtime," says the report from the committee meeting. 

The AHS edict that heavily restricted nurses’ ability to work overtime appears to have been repealed. Back in March the Progress Report reported on an AHS manager advising their staff to become Tik Tok influencers to supplement their income because the ability of health care workers to work overtime was being restricted by AHS. 

How Relying On Agency Nursing Is Hollowing Out Public Health Care

Higher hourly wages aren’t the only force driving agency nursing expenses upwards. 

AHS pays for agency nurses’ accommodations, up to $200 per night, and return airfare, up to $600 within Alberta and upwards of $1,300 elsewhere within Canada. 

Those who use their personal vehicle to get to their placement are eligible for up to $500 in mileage for one way of the trip. Subject to approval from an AHS manager, AHS can also pay for rental vehicles—up to $50 a day plus taxes for those working in Calgary or Edmonton, and $100 a day plus taxes for those deployed elsewhere. 

AHS also provides a $75 allowance on each workday for agency staff to pay for food, parking and whatever other expenses they might have. 

The Progress Report provided Joan Almost, a nursing scholar at Queen’s University in Kingston, Ont., who authored a Canadian Federation of Nurses Unions-funded study into the use of private nursing agencies across Canada, with the annual figures spent on agency nursing in the freedom of information request

Cautioning that “obtaining a fulsome picture of the use of agencies” is difficult, since each province has its own data collection policies, Almost noted that the trend of increasing agency costs from 2019/2020 to 2023/24 “is comparable to similar jurisdictions.”

She said it’s important to emphasize that the funds directed towards agency nurses could have been spent elsewhere in the health-care system to ensure improved patient outcomes.

“Think of how a quarter of a billion dollars could have been spent more effectively within the public healthcare system,” said Almost. 

“Those dollars did not go into ensuring timely care in the local ER or booking someone off a surgery wait list. Instead, those dollars went into the pockets of corporate stakeholders.”

She said the root cause of health-care staffing shortages is an inability to retain employees due to poor working conditions, which isn’t going to be addressed by bringing in contract nurses from outside the province. 

“We cannot afford to keep slapping billion-dollar bandages on gaping wounds and relying on for-profit agencies to be the solution to the crisis,” said Almost. 

United Nurses of Alberta (UNA), the union representing registered nurses in Alberta, are back in bargaining with AHS and the government of Alberta. The return to bargaining comes after nurses rejected a mediator recommended agreement that would have seen a 12 per cent increase in wages over four years. 

UNA has notified AHS that they plan to apply for formal mediation and UNA locals have authorized the negotiating committee to sign off on all essential services agreements. If formal mediation fails and emergency services agreements are in place then UNA can proceed to a strike authorization vote.