Some small rural communities are included in BC’s Provincial Rural Retention Incentive. Others, such as Cranbrook and Kimberley, are not. It’s unclear why. Image via Google Maps.
Michelle Gamage Jan 17th 2025 The Tyee. Michelle Gamage is The Tyee’s health reporter. This reporting beat is made possible by the Local Journalism Initiative.
Giving nurses a pay bump can draw them to an area, advocates say. But they move on when the extra money dries up.
Lisa Foxworthy wants to put her community on the map.
This January, Sting’s lead guitarist will perform in Vancouver for the first time.
She wants the province to include Cranbrook and its neighbouring community Kimberley in its Provincial Rural Retention Incentive, which offers financial incentives for nurses working in remote communities.
She told The Tyee if other small towns are able to offer incentives and her town isn’t, health-care workers will overlook remote communities in the southeast of the province when deciding where to settle long-term.
Foxworthy is a licensed practical nurse but spoke to The Tyee as an individual, not on behalf of her union or employer.
This summer, Foxworthy started a petition asking the province to include Cranbrook and Kimberley in the initiative. It’s gained over 1,700 signatures, but time is running out.
While hospitals in Foxworthy’s area haven’t yet had to close due to staffing challenges, she says those challenges have been getting worse. There are no other health-care facilities nearby they could divert patients to in the event of a closure, she added.
The Provincial Rural Retention Incentive program is set to run from April 2, 2024, to March 31, 2025, and includes three incentives around retention, travel and referrals for full- and part-time health-care workers in 56 communities.
Workers in eligible communities can get an extra $8,000 per year or get higher pay if they commute more than 40 kilometres to work.
The program was funded by a $73.1-million investment by the province to support retention and recruitment efforts, the Health Ministry told The Tyee in an email.
The ministry didn’t answer emailed questions about the criteria used to determine which communities were included, and why Cranbrook and Kimberley weren’t included.
Instead, the Health Ministry told The Tyee it is “reviewing” a request to include Cranbrook and Kimberley in the Provincial Rural Retention Incentive and will also be evaluating how the program did and how it could be improved upon. This includes possibly expanding the program beyond March 31, 2025, the ministry said.
The initiative was first introduced in 2021 and initially aimed at helping reduce staff turnover in Northern Health’s Northeast Health Service Delivery Area, Prince Rupert and Hazelton. It later expanded to Grand Forks in the Interior Health Authority in 2022 and to communities across B.C. in 2024, according to a press release from the Hospital Employees’ Union praising the move.
Incentives are “key” to the province’s strategy to attract health-care workers to rural areas, but they aren’t a perfect solution, says Paul Adams, executive director of the BC Rural Health Network.
When financial incentives are time-based, for example offered for two years, it will usually attract people to a small community for two years and then they move away when the incentives dry up, he said. This creates a “revolving door of health-care providers,” which affects patient care because patients don’t have anyone keeping an eye on their long-term health.
And when incentives are doled out across the entire province, then it’s no longer an incentive but a raise, he said, adding B.C. does need more public nurses and needs to pay them more in general.
If you provide incentives in one community but not a neighbouring community, you can run the risk of essentially “transferring the problem” of understaffing, Adams said.
At the same time, health authorities aren’t making arbitrary decisions around what communities get to offer financial incentives; these decisions are based off data, he added.
What that data is, however, also hasn’t been released publicly.
BC Nurses’ Union president Adriane Gear told The Tyee she has also asked about Provincial Rural Retention Incentive criteria and similarly hasn’t been given an answer.
More holistic solutions
Gear and Adams called for more holistic approaches to improving the overall working conditions for health-care workers, which will in turn improve recruitment and retention efforts for nurses.
Gear pointed to B.C.’s promise to implement minimum nurse-to-patient ratios, for example, which will cap how many patients a single nurse looks after. This will go a long way to helping reduce the workload for nurses and also reduce the moral distress they feel when unable to properly look after patients, which leads to burnout, Gear said. It will also help with recruitment because nurses will want to work in places where they can properly do their jobs, she added.
Implementing nurse-to-patient ratios increases the number of nurses a health-care facility needs to employ, so financial incentives might be helpful in recruiting new staff to smaller communities, Gear said.
Gear also called for more investments in security guards, especially for health-care facilities in remote areas.
Depending on how remote the community is, the only police available can be a 90-minute drive away, Gear said.
“Some of these communities, the RCMP are only on call overnight, so you’re waiting for someone to be summoned who has to get out of bed and respond to a situation. That’s not good enough,” she said.
Reduction of agency nurses
Gear and Adams both said they’d like to see the province reduce its spending on agency nurses and instead increase its investment in the nurses it already has.
Agency nurses are fully trained and qualified registered nurses who can work similar positions as other nursing professionals, but they work for private agencies that contract their services to health authorities. Public nurses, by contrast, are employed directly by a health authority.
“These are for-profit, privatized nursing services and the government and health authorities have, it seems, written a blank cheque,” Gear said.
“If you can afford to pay for agency nurses in communities like Kimberley or Cranbrook, why can’t you, or won’t you, consider them for the PRRI? Invest in your own nurses,” she added.
Solutions to small-town staffing challenges could also include bolstering what services are available in a community to attract highly skilled workers, Adams said.
When the province created the regional health authorities in the early 2000s, it focused on efficiency and cost savings, not realizing that centralizing health services would strip experts out of small towns and “impact the social fabric of a rural community,” Adams said.
