Abstract
BackgroundGlobally, flexible work arrangements – through the use of temporary nursing staff – are an important strategy for dealing with nursing shortages in hospitals.ObjectiveThe objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa.MethodsFollowing ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices).ResultsIn the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care.ConclusionHospital managers and policy-makers need to address the effective utilisation of agency nurses and quality of patient care in tandem.
Highlights
Flexible work arrangements Á through the use of temporary nursing staff Á are an important strategy for dealing with nursing shortages in hospitals
In light of the considerable amount of money spent on nursing agencies in the South African public health sector [21], the objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa
In the UK, the National Audit Office (NAO) estimated that the average amount of time spent by senior staff in arranging temporary cover ranged from 9Á30 minutes per day [15], which is more time than that spent at the two case study hospitals
Summary
Flexible work arrangements Á through the use of temporary nursing staff Á are an important strategy for dealing with nursing shortages in hospitals. Objective: The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. Conclusion: Hospital managers and policy-makers need to address the effective utilisation of agency nurses and quality of patient care in tandem
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