ALMOST £10 million has been spent on agency staff in Northern Ireland's biggest health trust in a month - with nurses from private recruitment firms making up half the bill.
The record pay relates to September and was revealed in a leaked document which disclosed spending across the different directorates of the Belfast trust.
Sources say agency costs are set to exceed £100m by the end of the financial year.
The confidential financial paper provides the most up to date spending on stand-in staff, with a total of £9.6m spent in September - an increase of 35 per cent on the previous month.
In a statement, the trust said it is under "unprecedented service pressures and resulting challenges for staff" but confirmed it has developed a Winter Workforce Plan with agreed actions to "enhance staffing".
Some agency nurses can earn up to £40 an hour during peak periods and the total monthly bill for temporary nurses and midwives was £4.8m.
A shortage of doctors - particularly among more junior and middle grade staff - resulted in a £2.2m bill for temporary trust medics.
In a statement, the trust said it is under "unprecedented service pressures and resulting challenges for staff" but confirmed it has developed a Winter Workforce Plan with agreed actions to "enhance staffing".
Rita Devlin, director of the Royal College of Nursing (RCN) in the north, said she was "unfortunately not surprised " by the figures, which she described as "unsustainable".
The trade union head also said agency nurses should not be "vilified" for turning to private firms for work, insisting that failed workforce planning over the last decade had created current market forces.
"The Department of Health will tell you that the number of nurses has increased, which it has slightly, but demand has increased greatly," she said.
"Whatever way you cut it there is only one pool of nurses in Northern Ireland and there's not enough of them to meet demand regardless of where they work.
"The agency bill is a huge spend but what for it means for our staff is very concerning. If your ward is covered by agency, what is missing is the camaraderie of working in a team - and what that does to help with resilience and your mental well being.
"If you're working in a good team, that sustains you and keeps you going. That's what a lot of our nurses are reporting is impacting on them."
The Belfast trust has confirmed it has met with trade unions, including the RCN, to "identify solutions" to safeguard services in coming weeks as well as in the long term.
Ms Devlin said the onus was on health chiefs to ensure a retention strategy was in place to keep highly skilled staff in post.
"We need to have leadership on this issue as the loss of staff, as we seen with the recent resignation of eight ICU nurses, leaves a massive hole in terms of knowledge, skill and expertise," she added.
"At the moment our members can see no light at the end of the tunnel. They need hope."
