Agency Nursing Research Articles

Ownership Matters: Not-for-Profit Chain Nursing Homes Have Higher Utilization of Agency Nursing Staff.

Nursing homes (NHs) have long struggled with nurse shortages, leading to a greater reliance on agency nurses. The purpose of this study was to examine the impact of NH ownership on agency nurse utilization. Data were derived from multiple sources, including the Payroll-Based Journal and NH Five-Star Facility Quality Reporting System (n: 38,550 years: 2020-2022). A 2-part logistic regression model with 2-way fixed effects (state and year) was used to assess the association of ownership and agency nurse utilization. Model 1 compared facilities with and without agency nurse use, while Model 2 focused on NHs using agency nurses, examining high utilization (top 10%). The dependent variables were agency nurse utilization ratios for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs). The primary independent variable was ownership/chain affiliation: for-profit chain (FPC), for-profit independent (FPI), not-for-profit chain (NFPC), and not-for-profit independent (NFPI). Model 1 showed that NFPC facilities had higher odds of using agency RNs (OR = 1.65), LPNs (OR = 1.53), and CNAs (OR = 1.38) compared to NFPI facilities (all P < .001), while FPC facilities also had increased odds for RNs (OR = 1.43), LPNs (OR = 1.30), and CNAs (OR = 1.15) (all P < .001). Model 2 indicated that NFPC, FPC, and FPI facilities were more likely to be high utilizers (top 10%) of agency nurses, with NFPC facilities having the highest odds across all categories. Pairwise comparisons showed that NFPC had the highest utilization of agency RNs and LPNs compared to other ownership groups. These results highlight the significant impact of NH ownership on staffing practices, suggesting that ownership type influences agency nurse utilization.

Agency nursing: tips for making the shift

Agency nursing: tips for making the shift

Us and them: Experiences of agency nurses in intensive care units

ObjectiveThis qualitative case study describes the work experiences of agency nurses from their perspective. It explores their interactions with intensive care unit managers to whom they report in their designated intensive care units and their relationships with fellow permanent nurses. MethodsA qualitative study was undertaken in three intensive care units at a public hospital in South Africa. Face-to-face interviews were used to collect data from eleven agency nurses. Thematic analysis of the data was undertaken. FindingsThe challenges of agency nursing work were haphazard clinical allocation, a lack of self-efficacy and competence, and feelings of exclusion. Positive aspects of the agency nurse experience included feedback and support from permanent nurses and intensive care unit managers and occurrences of belonging and acceptance. ConclusionThe findings of this study point to the importance of agency nurse relationships with managers and fellow permanent nurses. To ensure patient care is not compromised, managers and nurse managers have a responsibility to ensure a welcoming, inclusive and nurturing environment for all staff tasked with intensive care unit responsibilities.

The experiences of the agency registered nurse: An integrative literature review.

To examine experienced registered nurses' motivations for choosing agency work, their experiences and perceptions of agency nursing and how they meet their regulatory professional development obligations. Agency registered nurses are employed by healthcare organizations to meet staffing shortfalls and contain costs. Using an integrative review framework, four databases (CINAHL, Medline, Embase and Scopus) were systematically searched between 2000 and 2017: study selection followed the Preferred Reporting Items for Systematic reviews and Meta-analyses. Our search identified 491 sources. From these, two primary qualitative sources were included in this review. Four themes were identified: orientation, allocation of the agency nurse, isolation in clinical practice and lack of education opportunities. Given the limited literature on agency nurses and how to support them, further research is required on this subject. Support for agency nurses is necessary, so they can seamlessly integrate with the healthcare team to provide safe patient care. This review may assist managers to identify strategies to effectively engage and support agency registered nurses in the acute care nursing team. The gaps identified highlight the need for further research to explore agency nurses' motivations, and support needs to inform future strategic workforce planning.

What do we know about our agency nurse population? A scoping review.

Nurse staffing shortages are often managed by using temporary staff. This review discovers what is known about nurses who choose to work in this way. A literature search found eight international studies investigating the lived experience of agency nurses. Nurses actively choose agency nursing to work flexibly and avoid office politics or as a career stop-gap. However, respondents describe feeling isolated, working difficulties with permanent staff and fewer opportunities for training. Though participants described positive reasons for choosing agency nursing, there were significant downsides. The findings must be viewed in the context of the continued feminized nature of the nursing profession as care responsibilities were cited as a reason for choosing this study pattern. However, the lack of security and provision of adequate pensions and career advancement are considerable issues. The costs of using agency staff are high and consideration must be given to encouraging these nurses into substantive contracts. These individuals show considerable resilience, flexibility, and varied expertise. Such qualities are vital for health care in the 21st century and understanding why they opt out of permanent nursing will enable employers to adapt practices to harness this. Suggestions for practice and further research are presented.

Putting a price on care.

As a relatively expensive staffing solution, agency nursing is often in the spotlight in the cost-conscious NHS.

The health system consequences of agency nursing and moonlighting in South Africa

BackgroundWorldwide, there is an increased reliance on casual staff in the health sector. Recent policy attention in South Africa has focused on the interrelated challenges of agency nursing and moonlighting in the health sector.ObjectiveThis paper examines the potential health system consequences of agency nursing and moonlighting among South African nurses.MethodsDuring 2010, a cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses providing clinical care completed a self-administered questionnaire after giving informed consent. The questionnaire obtained information on socio-demographics, involvement in agency nursing and moonlighting, and self-reported indicators of potential health system consequences of agency nursing and moonlighting. A weighted analysis was done using STATA® 13.ResultsIn the survey, 40.7% of nurses reported moonlighting or working for an agency in the preceding year. Of all participants, 51.5% reported feeling too tired to work, 11.5% paid less attention to nursing work on duty, and 10.9% took sick leave when not actually sick in the preceding year. Among the moonlighters, 11.9% had taken vacation leave to do agency work or moonlighting, and 9.8% reported conflicting schedules between their primary and secondary jobs. In the bivariate analysis, moonlighting nurses were significantly more likely than non-moonlighters to take sick leave when not sick (p=0.011) and to pay less attention to nursing work on duty (p=0.035). However, in a multiple logistic regression analysis, the differences between moonlighters and non-moonlighters did not remain statistically significant after adjusting for other socio-demographic variables.ConclusionAlthough moonlighting did not emerge as a statistically significant predictor, the reported health system consequences are serious. A combination of strong nursing leadership, effective management, and consultation with and buy-in from front-line nurses is needed to counteract the potential negative health system consequences of agency nursing and moonlighting.

Factors influencing agency nursing and moonlighting among nurses in South Africa

Background In South Africa, nurses are the largest category of the health care providers. Their optimal performance is critical for the successful implementation of impending health sector reforms. Objective This paper examines the occurrence of agency nursing, moonlighting, and overtime among nurses in South Africa, and the factors influencing moonlighting. Design This cross-sectional survey was a one-stage cluster random sample of 80 hospitals in four South African provinces, selected with stratification from the public and private health sectors. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information, the questionnaire elicited information on the frequency of agency nursing, moonlighting, and overtime, and the nurses’ reasons for doing moonlighting. Survey data were weighted and analysed using STATA version 12. Results The majority of survey participants (n=3,784) were South African (98.0%), female (92.7%), and employed in government (52.8%). Their mean age was 41.5 years (SD 10.4). The occurrence of moonlighting among nurses in the 12 months preceding the survey was 28.0% [95% CI: 24.2–32.1], the frequency of agency nursing was 37.8% [95% CI: 32.4–43.6], while 56.0% of nurses did overtime [95% CI: 51.4–60.4]. In the multiple logistic regression analysis, predictors of moonlighting were province, sector of primary employment, unit of work, category of nurse, and having children. The odds of moonlighting was 1.51 [95% CI: 1.03–2.21] times higher for private sector nurses than for public nurses, while the odds ratio for auxiliary nurses was 0.61 [95% CI: 0.47–0.79] compared to professional nurses. The odds of moonlighting was 1.49 [95% CI: 1.18–1.89] for nurses with children, compared to those without. Conclusions Agency nursing, moonlighting, and overtime are common among South African nurses, but have received insufficient policy attention. These issues need to be addressed as part of the implementation of comprehensive health workforce strategies.

Trusts launch recruitment drives in bid to tackle death rate anomalies

Recruitment drives have been launched by at least three hospitals identified as having higher than expected death rates after a government-ordered review criticised them for inadequate staffing. The review by NHS England medical director Sir Bruce Keogh into the care and treatment provided at 14 trusts in England found insufficient numbers of staff at eight of them. Commenting on the review RCN general secretary Peter Carter said: ‘There is an undeniable link between nurse staffing levels and patient mortality and we cannot keep failing to address this issue.’ Shadow health secretary Andy Burnham claimed that 1,117 nursing jobs had been lost at seven of the investigated trusts since May 2010. The review found evidence of an over-reliance on agency staff, and Nursing Standard research has revealed soaring levels of spend on agency nursing staff at two of the trusts. The amount spent on agency staff at Buckinghamshire Healthcare NHS Trust for example increased from £2 million in 2010/11 to £3.8 million in 2012/13, while United Lincolnshire Hospitals NHS Trust spent £977,094 in 2010/11 on agency nurses, which rocketed to £2.3 million in 2012/13. The trust’s board recently approved the recruitment of 80 more nurses. East Lancashire NHS Trust and Burton Hospitals NHS Foundation Trust are among the 14 organisations reviewed that are now boosting their nursing workforce. The former has appointed 40 more nurses and intends to hire a further 30 as well as 30 healthcare assistants. At Burton, another 49 nurses have been employed.

Agency Nursing in Australia

Working as an agency nurse has not been easy, but it has been a great way to explore Australia and the different hospital systems – private and public.

Reducing the deployment of agency nurses

The article evaluates a strategy to reduce the deployment of agency nursing staff at Royal Liverpool and Broadgreen University Hospitals NHS Trust in England. The specific aim of the strategy was to ensure that a pool of nurses who were employed already, had received basic orientation training or had attended an induction program at the trust was in place. A summary of the approaches deployed in the strategy is given

The experience of agency nurses working in a London teaching hospital

This Husserlian phenomenological study explored the lived experience of eight full-time agency nurses working in the environment of intensive care in London, United Kingdom. In-depth interviews were used to ascertain the participants' experiences of full-time agency nursing in intensive care. Colaizzi's [Colaizzi P. Psychological research as the phenomenologist views it. In: Vale R, King M, editors. Existential-phenomenological alternatives for psychology. London: Oxford University Press; 1978, p. 48-71] method of data analysis was utilised. Thematic analysis identified three cluster themes: the shared experience of lacking confidence; the shared experience of deskilling; and the shared experience of feelings of isolation. The theme of the shared experience of lacking confidence identified the importance of support and understanding of agency nurses' needs in the ICU. The theme of the shared experience of deskilling illuminated participants concern at not having the opportunity to care for patients of higher acuity. The theme of the shared experience of feelings of isolation highlighted that often participants did not feel they "belonged to a team". Study findings suggest the need to include: the implementation of protocols within the clinical setting; the provision of performance feedback to agency nurses; and the consideration of ongoing structured professional development and education for ICU agency nurses.

Agency and bank nursing in the UK National Health Service

The article draws on published research, mainly survey-based, and original case study interview data to explore the forms of temporary employment in nursing, the reasons nurses give for taking temporary or agency work, as a main job or a second job, and their experiences in such employment.

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers.

There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers. This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work. Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate. Three major themes emerged from interview data: planning for ward allocation, communication and professionalism. In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff. Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses. For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration. A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles. The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled--with the aim of providing quality patient care.

This issue of JAN

This issue of JAN

Agency nursing in Melbourne, Australia: a telephone survey of hospital and agency managers.

Agency nursing is a poorly understood and under-researched phenomenon. Despite the considerable costs and possible benefits of using agency nurses, little is known about the nature of agency nursing from different perspectives, including hospital and agency managers. To describe the professional relationship between hospitals and nursing agencies, utilization trends of agency nurses, and institutional policies relating to the employment of agency nurses. A telephone survey was conveyed to managers of 70 acute hospitals (service purchasers) and 26 agencies (service providers) to provide baseline information on the utilization of agency nurses in acute hospitals in Melbourne, Australia. Introductory telephone calls were made to the chief nursing officers of the hospitals and the chief executive officers of nursing agencies in order to explain and seek approval for the proposed project. Approval to conduct telephone interviews was obtained from 30 acute hospitals and six agencies, representing a response rate of 43% and 23%, respectively. Separate questionnaires were used for the two categories of respondent. In some cases the questionnaire could not be completed using the telephone and a copy was then sent by post for completion. Findings revealed the high utilization of agency nurses in hospitals, the limited nature of continuing education for agency nurses, tensions between matching agency nurse qualifications with acute specialty needs and the notion that agencies preferred nurses to be flexible in their work assignments. The study was limited by the fact that the final sample was small (30 hospitals and six agencies), and therefore may not be representative of the wider population of Melbourne hospitals or agencies. However, it provided evidence on the utilization of agency nurses in public and private hospitals that will help shape policy on the regulation of the agency nursing workforce.

The expectation and reality of bank and agency nursing.

We should all accept that temporary workers are here to stay and we should: Ensure that banks and agencies have thorough selection and pre-employment checking strategies, including professional registration and induction provision. Check what it costs to employ a particular nurse. A staffing agency will be highly profitable on a 10 per cent commission but may be charging much more. It may be cheaper to employ in-house staff on overtime. Accept that supply may not match demand and that this is not the fault of the nurses. Ensure nurses who take work outside their usual areas of expertise remember to tell other staff that they may need extra support when they arrive on duty. Ensure temporary staff are orientated to the clinical areas and are offered support by their colleagues. If and when things go wrong discuss them with clinical areas, as well as banks and agencies. It is vital that temporary staff are managed and patterns of unacceptable performance are monitored and acted upon. The growth in temporary working makes matching an increasingly difficult task and puts new challenges on monitoring performance. The effective bank or agency will offer education and appraisal and will have specific policies to ensure clinical governance. Not long ago that there were too few shifts to offer bank nurses. How things change--and how important it is for a service manager to ensure that temporary staff represent value for money and have professional integrity, and that staff realise that they are well supported. After all, they will be a value component of the workforce.

Primary Health Care and partnerships: collaboration of a community agency, health department, and university nursing program.

Health care reform proposals emphasize health care that is essential, practical, scientifically sound, coordinated, accessible, appropriately delivered, and affordable. One route to achievement of improved health outcomes within these parameters is the formation of partnerships. Partnerships adopting the philosophy and five principles of Primary Health Care (PHC) focus on health promotion and prevention of illness and disability, maximum community participation, accessibility to health and health services, interdisciplinary and intersectoral collaboration, and use of appropriate technologies such as resources and strategies. A community service agency serving a multicultural population initiated a partnership with a health department and a university undergraduate nursing program. The result was a preschool health fair and there were benefits for each partner-benefits which could not have been realized without the collaboration. The health fair partnership planning, implementation, and evaluation process was guided by a framework shaped by the philosophy and five principles of PHC. The educational process described can be applied to other learning experiences where the goal is to help students understand and apply the concepts of PHC, develop myriad nursing competencies, and form collaborative relationships with the community and health agencies. Community health care dilemmas and nursing education challenges can be successfully addressed when various disciplines and sectors form effective partnerships.

Can Nursing Survive? a View Through the Keyhole

Nursing in the United Kingdom is undergoing massive retrenchment. An increasing number of nurses are unable to obtain employment following qualification and agency nursing and short-term contracts are becoming the norm. Amalgamations of colleges of nursing have resulted in redundancies of nurse teachers and a significant reduction in student nursing places. The profession of nursing in the UK is in a state of crisis from which it may never recover. Nurses have generated and facilitated this situation in their self-interested quest for professional status. Essentially, nurses have turned their backs on many nursing skills and allowed others to take on the role. British nursing may find its survival through its health care assistants. Nurses in other countries should take note and take steps to safeguard the profession on an international level.

Agency nursing and continuing education

Agency nursing and continuing education