Nunavut MLAs worry agency nurse compensation may discourage full-time employment

As Southern employment agencies continue to provide temporary nurses for the Nunavut health care system, several Nunavut MLAs are worried that the higher compensation received by agency nurses compared to that of full-time nurses will lead the latter to quit and instead work for an agency. 

“I know they are necessary, and it seems the Department of Health has to get the agency nurses in order to provide the services to Nunavummiut, but it is a growing problem in terms of an indeterminate nurse, who, in practice, makes less and has less benefits than the agency nurse,” Joe Savikataaq,  MLA for Arviat South, said.

“Agency nurses are brought up and the government pays the agency company, not the agency nurse.

“They get free travel, they get free accommodations, and my understanding is that they get a food allowance, too. I’m not sure if it’s the full per diem or not, but the indeterminate nurses don’t get any of that.

“So therefore, I’ve even heard of instances where indeterminate nurses have quit and gone to agency nursing, because financially it’s better off. They’re better off doing that, and I don’t know what the solution is, but I’d like to see less reliance on agency nurses,” he said.

Like the rest of Canada, Nunavut health care continues to experience a prolonged nursing shortage.

Savikataaq said it is a difficult situation to be in with no easy answers and despite recruitment and retention policies, as well as nursing education programs, the shortage still exists due to supply and demand.

“I don’t know what the solution is, but there has to be a way for the Department of Health to rely less on agency nurses, because the indeterminate nurses see the discrepancy in terms of the benefits that are given to agency nurses as opposed to the indeterminate, permanent nurses.”

Stretching the budget

Adam Lightstone, MLA for Iqaluit-Manirajak, said he does not deny the fact that Nunavut needs short-term temporary staff to provide crucial health care services to Nunavummiut.

“My concern is the rate at which these extensive costs for transient health care staff have ballooned in recent years, and seems like it will continue to grow,” he said.

“And there has been perceived preferential treatment towards transient employees – transient nurses – above indeterminate full-time Nunavummiut that are nurses. This was an issue I raised back in 2021,” Lightstone said, adding that using the Government of Nunavut (GN) staff housing for agency nurses was contributing to the overall housing crisis within the territory.

Further to the issue of agency nurses, Lightstone said the Department of Health has “evolved their strategy” to include transient, casual nursing staff, and indeterminate job share positions.

Paramedic Services were also included several years ago, he said, noting that the GN does not have paramedic positions within its organization.

Those services are used primarily in the summer months, when smaller communities would generally have to close or deal with emergency situations due to the annual leave of regular staff, he said.

Lightstone said while the government does maintain healthy contingency funds to address such much-needed supplementary budget requests, during the last sitting of the Legislative Assembly he asked the Department of Health how they will address the extra costs on a long-term basis.

Long-term solutions

He said one solution he offered was to create a central paramedic staffing unit that could be deployed to address staff shortages throughout the year. That same type of scenario could be created for nurses, he added.

Lightstone said more should be done to invest in and expand education for youth.

“I strongly believe that, again, the Government of Nunavut should be doing more to try and get youth into their workplaces, whether it’s in an office or working outside and getting exposed to what type of job opportunities there are, and give them an opportunity to gain experience before they graduate and are deciding what they’re going to do with their lives,” he said.

“And lastly, when it comes to the much-needed paramedics and nursing, and other healthcare professional staff, such as lab techs, X-ray techs and so on, the Arctic College does what it can, and does its best to try and provide the nursing program, and I hear it is quite a good program in comparison to the other nursing programs across Canada.

“However, I believe that there’s only, on average, seven nursing students that graduate a year, and I’m not sure how many actually stay in and work in Nunavut as nurses,” he said.

Addressing shortage

In a written response, Chelsea Halvorson, acting manager of Communications at the Nunavut Department of Health, said Nunavut has always relied on agency nurses to address staffing shortages and in 2024, there were 413 agency nurse assignments, including 71 nurse practitioners, with an average assignment length of three to four weeks.

Halvorson said agency nurses cost approximately 25 per cent more than indeterminate nurses, excluding bonuses, allowances, and pension benefits available to indeterminate staff.

“Despite higher costs, agency nurses remain critical for ensuring healthcare access in remote communities, where temporary health centre closures could leave residents without care.

“The cost of agency nurses fluctuates annually based on demand. Health has adjusted its budget accordingly to ensure adequate staffing.”

Indeterminate hiring progress

Halvorson indicated the Department has made progress in hiring indeterminate, job-share, and casual nurses despite ongoing shortages.

“Between April 1 and December 31, 2024, the Department hired 14 indeterminate, 13 job-share, and 89 casual nurses.”

She said initiatives like Memorandum of Understandings (MOUs) 15 and 16, and the “Bring a Family or Friend” program, have improved recruitment trends.

MOU 15 includes incentives like compensation for experience, retention bonuses, and a return-of-service program, while MOU 16 supports shorter job-share rotations.

Halvorson cited several challenges in hiring indeterminate staff, including the requirement for specialized skills above and beyond the initial nursing training; the remoteness of the work, resulting in the absence of social or family connections; licencing requirements, and housing, where limited housing availability in many communities restricts the ability to hire indeterminate staff. Transient housing enables job-share and casual hiring, she said.

Currently, the demand for agency nurses is decreasing, she added, noting agency contracts dropped from 506 in 2023 to 413 in 2024.

Investment needed

Lightstone said investment must be made into training to reduce the need for agency placements.

“As long as the government does build that contingency fund into the budget, then it will likely continue to be funded until such time as we have sufficient workforce to address the matter, and that length of time will depend on how much investment the government puts into training current and future generations,” he said.

Halvorson indicated that recruitment efforts are underway and include virtual and in-person job fairs, social media outreach, and having nurses share their Nunavut experiences and that “a multi-year health human resources campaign is underway to sustain recruitment momentum.”

She indicated from April 1 to December 31, 2024, the Department of Health hired 14 indeterminate, 13 job-share, and 89 casual nurses.

Savikataaq said he expects the issue to again be discussed in the next sitting of the Legislative Assembly later this month.

“It’s something that is needed. Right now, within Nunavut, the Department of Health would not be able to provide adequate care without the use of agency nurses, but there has to be, at some point, less reliance on them.”

Related stories from around the North: 

Canada: N.W.T. spent $5.2M last year on agency nurses, who are paid more than local nurses, CBC News

Greenland: Greenland to reduce services amidst staffing shortages in health care system, Eye on the Arctic

Sweden: 100,000 new residents needed to fill jobs in northern Sweden, Radio Sweden