Reallocating agency funding to strengthen permanent nurse retention

1. In BC pay for nurses are funded through ‘BC Ministry of Health budget’ and compensation and retention incentives in BC must be bargained at the provincial level through BCNU and HEABC, how do you see a VCH specific retention model being implemented without creating inequity across health authorities? Do you think this evolving into a province-wide strategy rather than remaining within a single health authority?
2. In Singapore, after the ANGEL scheme was introduced for nurses, parliamentary debate quickly emerged about whether similar retention incentives should be extended to other healthcare workers, which raised equity and financial considerations. If a similar incentive model were introduced in BC, how do you see the province managing potential pressure to expand the program beyond nursing, and do you think the system could realistically sustain that budget?

The presenter responded thoughtfully to both questions and demonstrated engagement with policy complexity. The response to the second question was well articulated, acknowledging that any system-level initiative will inevitably encounter financial, political, and ethical challenges. The presenter also recognized that progress may require moving forward despite anticipated resistance, demonstrating insight into the realities of large-scale policy reform.

The response to the first question was partially developed but did not fully address the feasibility concerns raised. The presenter suggested beginning with a pilot within Vancouver Coastal Health and expanding over time. While the idea demonstrated initiative, it did not account for the structural constraints of British Columbia’s provincial bargaining framework, which prevents individual health authorities from implementing independent financial incentive models. Although the presenter referenced the existing rural nursing incentive program as a potential parallel, it remains unlikely that a localized or sector-specific implementation (only in VCH) could occur without provincial alignment or collective bargaining approval.

Overall, the responses showed reflection and openness; however, deeper consideration of provincial funding mechanisms, labour relations, and collective agreement structures would strengthen the feasibility component.

The presentation demonstrated clear organization and strong alignment between the problem statement and the proposed solution. The presenter began by identifying what is currently available in the system, including reliance on agency staffing and existing recruitment strategies. This helped establish a foundation and made the need for an alternative model understandable.

The rationale for selecting a financial retention incentive was well articulated. The presenter explained that retention incentives may help stabilize the workforce by reducing turnover and dependence on agency staffing. The strengths of the solution were highlighted effectively, including its potential to offer long-term stability, reduce financial inefficiencies, and improve nurse commitment to the organization.

The PowerPoint slides were visually engaging and well structured, using a logical flow from problem to evidence to proposed solution. A notable strength was the incorporation of original international policy sources, particularly the Singapore Ministry of Health document “Long-Term Retention Scheme for Nurses in the Public Healthcare System (ANGEL).” Using an original government source, rather than a summary, strengthened the academic rigor of the presentation and demonstrated strong research effort.

What was not fully effective

1. Too broad for system-thinking approach: The proposed solution operates at a system-wide level and would require significant policy change, provincial bargaining, and financial restructuring. The assignment criteria emphasize systems thinking, which encourages starting with smaller, incremental changes that can evolve over time. The current proposal outlines a province-level financial incentive model affecting an entire health authority (and potentially all health authorities in BC), which represents a significant policy shift requiring provincial bargaining, financial restructuring, and stakeholder agreement. Because the solution operates at a macro-level and depends on major legislative and financial approval processes, it may be too expansive for the stage of inquiry required in this assignment. Narrowing the change to a smaller, testable component may better reflect systems-thinking methodology and allow evaluation of early impacts, adaptation, and scaling.
2. Evidence misaligned : Use of Québec’s Bill 10 as evidence of feasibility requires clearer contextual alignment. Bill 10 aims to regulate and restrict agency staffing rather than introduce financial incentives. Although both approaches seek to reduce reliance on agency workers and stabilize the nursing workforce, they represent different policy mechanisms. Because Bill 10 is still in early implementation and outcomes remain mixed, it may not yet provide sufficient evidence to support the financial feasibility of the proposed incentive model. Additionally, the connection between restricted agency spending and the potential reinvestment of those savings into retention incentives was not explicitly demonstrated. Aligning the rationale with evidence directly connected to retention incentives or explaining the mechanism linking Bill 10 savings to incentive investment would strengthen the justification.

How could this be improved going forward?

1. Consider a scalable recognition based pilot: A smaller-scale recognition approach may serve as a more feasible starting point than a large financial incentive model. Recognition programs already exist within BC health systems such as Island Health’s Celebration of Excellence Awards and Recognition of Action Awards and operate outside collective bargaining agreements, meaning they do not require approval from BCNU, HEABC, or the Ministry of Health (Island Health, n.d.). Expanding similar unit-level recognition initiatives (e.g., milestone awards, professional development grants, or team achievement acknowledgements) could support retention by fostering belonging, morale, and professional identity, while aligning with systems-thinking principles that emphasize small, implementable changes capable of scaling over time.
2. Incorporate data’s to strengthen justification : To strengthen the rationale for the proposed solution, incorporating recent local and provincial workforce data may help more clearly demonstrate the extent of the retention challenge. For example, current labour reports indicate that British Columbia has more than 5,300 nursing vacancies, with projections suggesting continued growth in workforce shortages over the next decade (BC Nurses’ Union, 2023). Additionally, overtime remains a significant workload indicator and retention risk factor, with recent data showing that 11.5% of hours worked in BC hospital nursing units are overtime (Canadian Institute for Health Information [CIHI], 2024). Including indicators such as vacancy trends, overtime burden, or agency-staffing reliance would build a stronger evidence base and reinforce the urgency of exploring alternative retention models.
3. Develop more detailed policy and implementation pathway: The proposal may be strengthened by developing a clearer policy and implementation roadmap. A more detailed sequence identifying key stakeholders, approval bodies, timelines, and evaluation mechanisms would enhance feasibility and demonstrate strategic planning. Outlining how collaboration with BCNU, HEABC, the Ministry of Health, and health authority leadership may unfold and identifying conditions required for successful advocacy would provide a more realistic picture of how the model could progress from concept to action. For example, implementation could be structured in four phases: Phase 1: Stakeholder Scoping and Alignment (0–6 months), Phase 2: Pilot Design and Negotiation (6–12 months), Phase 3: Pilot Implementation and Evaluation (12–24 months), and Phase 4: Scale and Policy Integration (24+ months). Presenting the solution with this level of clarity would align the proposal more closely with real-world policy processes and support a more practical and phased approach to change.