The province’s Auditor General has “serious concerns” about the way agency nursing contracts are let and managed by the Newfoundland and Labrador Health Authority.
And Denise Hanrahan put an exclamation point on that today, noting the average agency nurse is costing the province more than $400,000 a year.
Hanrahan released the first phase of her audit into health contracts regarding agency nursing, covering the period from January 2022 up to March 2025.
Health Sector Contracts Phase 1 Report (VOCM News)
She concluded the health authority did not follow proper procedures and, as a result, “failed to ensure value” for taxpayers’ money.
She said NLHS lacked controls to verify that contract terms were followed to ensure money was not paid out “inappropriately.”
On a larger scale, the AG said government failed to properly plan for staff shortages and the use of agency nurses in the first place, adding that in the absence of effective planning, “spending continues at near record levels.”
She singled out the early half a million dollars it cost for one agency nurse, saying that’s largely due to the overtime hours they work, “resulting in less service for the money spent when compared to regular staff.”
Hanrahan has made no less than 15 recommendations for wholesale changes to the way government secures such contracts.
They include:
1. Fully engage its supply chain department, ensuring that legislation, public procurement policy, and best
practice are followed.
2. Ensure emergency exemptions for procurement are pursued in accordance with provincial legislation and
policy, including appropriate disclosures and pre-contract approvals.
3. Complete formal evaluations against predefined evaluation criteria before awarding contracts.
4. Ensure that any future agency nurse contracts use standardized contract language, terms, and conditions
that clearly state Newfoundland and Labrador Health Services’ expectations and standards.
5. Ensure that a comprehensive invoice approval process is documented, communicated and used consistently
across the organization.
6. Ensure that the invoice verification and invoice approval duties are segregated and that verifiers and
approvers sign and date all invoices when their tasks are completed.
7. Complete an immediate comprehensive audit of all amounts paid to Agency A from April 2022 to present, to
recover public funds paid in error.
8. Develop comprehensive nurse staffing plans, with regular reporting that enables management to perform
effective evaluation.
9. Develop policies and processes to ensure that casual nurses are utilized as a possible alternative to
contracted nursing services.
10. Ensure that all employees are aware of their roles and responsibilities under conflict of interest legislation,
with processes to ensure compliance occurring on an annual basis.
11. Ensure that conflict of interest screening occurs when assessing potential contractual relationships, such as
with property lessors.
12. Rectify any current accommodations that were not acquired through an open, public, and transparent
procurement process, in compliance with the Public Procurement Act and the Conflict of Interest Act.
13. Ensure management and the Board of Trustees are provided with complete and adequate information to
facilitate assessing and monitoring of all aspects of contracted nursing services usage and spending.
14. Develop and execute a corrective action plan when agency nurse spending exceeds planned expenditure.
15. Formally assess contracted nursing service provider performance during contract execution and consider
these assessments before renewing contracts.
