N.B. auditor general's report sparks committee meeting on travel nurse contracts

New Brunswick’s Department of Health is the first to be in the hot seat at a legislative committee meeting focused on the $173 million spent on travel nursing contracts.

Earlier this month, the auditor general released a scathing report looking into the contracts, calling them shocking and risky.

Paul Martin said some contracts had an auto-renewal clause, weren’t signed by both parties, or signed by the wrong person altogether.

His audit showed it was costing Vitalité Health Network more than $300 an hour for each in-person staff person provided by a private travel nurse agency.

Deputy Minister Eric Beaulieu spent Tuesday morning answering questions from public account committee members on the role the department played in the signing or approval of these contracts.

Beaulieu said early 2022 was the first time the Department was made aware of the province’s use of travel nurses. He said the service has existed for many years throughout the country, but prior to 2022, they had not been used in New Brunswick “very much.”

Vitalité Health remains under contract with one agency until at least 2026.

Former Health Minister Dorothy Shephard asked if the department has looked into whether the network could save money within that existing contract.

“We know that there’s a lot more money to be spent yet, so has the department of health been involved in reviewing those contracts now…?” she asked.

Beaulieu replied the department isn’t party to the contract, but said he does feel confident that cost-savings can be found in the overall system, by helping the health networks recruit sustainable staff.

Shephard also asked if the Department has seen three internal audits Vitalité had completed on some of its contracts. Those internal audits were not released to the auditor general – Vitalité said it’s currently in negotiations with one company and revealing the details of those internal audits could jeopardize that.

Beaulieu said the Department has not seen those internal audits.

He said the Department was aware of the need for travel nurses during the pandemic “and supported it.”

But he said the department does not approve any contracts the health networks sign.

Shephard called it a failure of processes. 

Green Party MLA Megan Mitton asked if the department would have had to approve a health network if it were about to go over budget.

Beaulieu confirmed it is common practice for the health networks to turn to the department and discuss contracts that might push them over budget.

He said they were informed by Vitalité the health network expected to be about $22 million over budget due to the network’s first contract for travel nurses, which was with the company Canadian Health Labs in 2022.

But he said they weren’t approached by Horizon, which spent $3 million on travel nurses in 2022/23.

Beaulieu clarified several times that the department does not give a “green light” for a health authority to sign a contract, but he said the Department did confirm to Vitalité that it understood “the need to secure additional staff.”

Specifically, he said the health networks were struggling to secure staff for dialysis and emergency department services.

Beaulieu said he did have a “30-second” call with the CEO of Canadian Health Labs.

“I just asked, ‘Is this the best price you can give for this one contract?’” he said.

He said that was for the first contract with CHL, and said the more important part was to try and shorten the time of the contract.

Retention bonus versus travel nurse contracts

Beaulieu said right now, the system is short 735 registered nurses, of 5,812 total budgeted positions. That’s a vacancy rate of about 12.6 per cent.

But over the last three years, Vitalité has seen a net loss of 41 registered nurses.

He was asked if there had ever been a discussion on if retention bonuses would have been a better option than spending so much on travel nurses.

The deputy minister said they had calculated how much it would cost the province to match the retention bonus program that Nova Scotia had in place. The estimate was about $100 million.

Otherwise, Beaulieu said any kind of retention conversations are to be held at the bargaining table.

He wouldn’t speak to reporters.

Megan Mitton said she doesn’t believe the department didn’t know what was going on.

“It is hard to believe that government wasn't really involved in the workings of the RHAs. We've seen how they intervened and fired CEOs, fired the boards, gotten rid of elected members, created this supreme committee where everyone's at the same table,” she said. “So it's really hard to believe they don't know what's going on.”

Horizon says travel nurses were ‘essential’

Horizon Health Network’s CEO Margaret Melanson said the health network is committed to a more sustainable staffing model that does not depend on travel nurses.

But she said retaining travel nurses was “essential” to ensure patient safety. In 2022, she said they had reached a “very critical situation, where we had vacancies in many areas that reached 50 per cent in many units.”

The staffing turnover rate was about 6.4 per cent prior to 2020, but moved to 11 per cent in 2021-22.

Melanson said during COVID-19 pandemic, some nursing staff had not been able to take their vacation in two years.

“We had all of our contracts reviewed by the office of the attorney general,” she said.

Although she said one contract was signed quickly, because of the urgent situation the system was facing in the fall of 2022, with an unprecedented number of people seeking medical assistance for respiratory illnesses.

But Melanson said that contract was still sent to the attorney general’s office after it was signed.

The committee will meet again Wednesday, with the Department of Social Development answering questions.

Vitalité Health Network Registered Nurses

2021-2022:

• Hires: 71
• Exits: 105

 

2022-2023:

• Hires: 45
• Exits: 51

 

2023-2023:

• Hires: 88
• Exits: 89

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