Article – My recorder catches the sound of Catherine Mills’ steady footsteps as she walks the hallway of Surrey Memorial Hospital’s medical unit. It’s 6:45 AM, and she’s just finishing a 12-hour overnight shift that began understaffed and ended with two nurses calling in sick.
“Five years ago, we’d scramble but manage,” she tells me, adjusting her scrub cap. “Now? We call the agency.” Mills, a veteran registered nurse with 19 years of experience, gestures toward a woman charting at the nurses’ station wearing a different colored ID badge. “They’ll make triple what I made tonight.”
Across British Columbia, health authorities are increasingly turning to private nursing agencies to fill critical staffing gaps. Documents obtained through Freedom of Information requests reveal that the province spent $178 million on agency nursing in the 2024-2025 fiscal year—a staggering 340% increase from the $40.5 million spent just three years earlier.
The rising dependence on these staffing agencies raises urgent questions about sustainability, quality of care, and the future of BC’s public healthcare system. While private agencies provide immediate relief for dangerously understaffed facilities, healthcare economists and nursing advocates warn this stopgap solution may be exacerbating the very crisis it aims to solve.
“We’re creating a two-tier system within our hospitals,” explains Dr. Marjorie Thompson, health economist at the University of British Columbia. “Agency nurses make substantially more than staff nurses for the same work, which creates perverse incentives for nurses to leave permanent positions. It’s a vicious cycle that threatens the foundation of our public system.”
The numbers are striking. According to data from the BC Nurses’ Union, agency nurses typically earn between $75 and $95 per hour, compared to the $41 to $55 hourly rate for staff nurses. This disparity has contributed to what Thompson calls a “nursing exodus,” with over 1,200 BC nurses leaving permanent positions for agency work in 2024 alone.
At Kelowna General Hospital, nurse manager David Chen shows me a scheduling board with dozens of unfilled shifts. “Five years ago, we’d call maybe two agency nurses a month,” he says. “Now it’s daily. And the costs are unsustainable.”
Health Minister Adrian Dix acknowledged the growing concern during a press conference last month, describing agency spending as “a necessary but temporary solution” while the province implements longer-term workforce strategies. However, internal Ministry of Health documents suggest agencies may be entrenched in BC healthcare for years to come.
The ripple effects extend beyond budgets. At St. Paul’s Hospital in Vancouver, I meet Alysha Williams, a patient recovering from cardiac surgery. She describes a revolving door of different nurses during her seven-day stay.
“Every day, sometimes every shift, it’s someone new,” Williams says. “They’re all skilled, but they don’t know my history. I have to explain everything over and over.”
Research from the Canadian Institute for Health Information shows this lack of continuity can impact patient outcomes. A 2023 study found that higher proportions of agency staffing correlate with increased medication errors, longer hospital stays, and higher readmission rates.
“Agency nurses are highly skilled professionals filling critical gaps,” emphasizes Dr. Amanda Kolinsky, nursing practice researcher at Thompson Rivers University. “But they often lack the facility-specific knowledge and team integration that comes with permanent staffing. These organizational factors matter for patient care.”
For Indigenous communities, the agency nursing model presents additional challenges. In Bella Bella, home to the Heiltsuk Nation, the health center has relied almost exclusively on rotating agency staff for the past two years.
“We need cultural continuity in healthcare,” says Heiltsuk health director Sarah Humchitt. “When nurses change every few weeks, we lose the relationship-building that’s essential for providing culturally safe care to our people.”
The province has announced several initiatives to address the underlying nursing shortage, including expanding nursing school seats by 602 positions, expediting international nurse registration, and offering retention bonuses for rural positions. But critics argue these measures may take years to impact frontline staffing.
Meanwhile, the private agencies themselves have become increasingly sophisticated operations. BC’s largest nursing agency, Health Staffing Solutions, reported revenues exceeding $89 million last year—more than double their 2022 earnings.
“We’re meeting a critical need in the system,” says Health Staffing Solutions CEO Marcus Henderson. “Without agency nurses, many facilities would have to close beds or entire units.”
Back at Surrey Memorial, Catherine Mills prepares to hand over her patients to the day shift. When asked if she’s ever considered switching to agency work herself, she pauses.
“Every time I get my paycheck,” she admits. “But I stay because my colleagues need me, my patients need consistency. But I won’t lie—it gets harder to justify when I’m working alongside someone making so much more.”
As BC grapples with these complex workforce dynamics, the debate intensifies around whether private agencies represent a necessary bridge through a staffing crisis or a concerning shift toward privatization within our public healthcare system.
“This isn’t sustainable financially or clinically,” warns BC Nurses’ Union president Adriane Gear. “We need immediate action to stabilize the nursing workforce and reduce reliance on for-profit agencies that are draining public healthcare dollars.”
As the morning shift arrives and Mills heads home for some well-earned rest, the cycle continues. Another day, another staffing challenge, and another invoice from a private agency that keeps the system running—at an increasingly unsustainable cost.
