Temporary Nursing Staff Research Articles

Utilizing the Nursing Professional Development Model to create and sustain nursing education aimed at improving the care of patients with Parkinson's Disease in the hospital.

The Nurse Professional Development Model (NPD) has been utilized to improve quality of care for several conditions. Patients with Parkinson's Disease (PD) are susceptible to higher risks while in the hospital. Educational efforts for this patient population are challenged by the small, disbursed number of patients as well as increased turn-over and reliance on temporary nursing staff. To properly care for this patient group, any education has to be hospital wide and ongoing for maintenance of competency. We have used the NPD Model to initiate education for new incoming nurses as well as for continued education for a program that requires hospital-wide reach. Our utilization of the NPD Model for this high risk, low volume patient population has helped us improve the safety of this patient population in the hospital. With this manuscript we detail the need and the educational platform with the hope of it serving as a reference for other institutions facing similar challenges.

Investigating the impact of temporary nurses on permanent nurses' commitment via perceptions of illegitimate tasks: Across-sectional study.

To explore illegitimate tasks as a potential mechanism that links permanent nurses' perceived exposure to temporary nurses to lower levels of affective organizational commitment. A time-lagged cross-sectional survey study. Survey data from N = 239 permanent nurses in the German-speaking part of Switzerland were analysed via Structural Equation Models. The study revealed a negative relationship between permanent nurses' perceived exposure to temporary nurses and their level of organizational commitment that was mediated by perceptions of unreasonable and unnecessary tasks. Healthcare institutions increasingly depend on temporary nurses to fill staffing vacancies. Our data suggest that the deployment of temporary nurses may have adverse effects on permanent nurses' affective organizational commitment via perceptions of illegitimate tasks. Our quantitative survey study provides a novel, theory-driven understanding of how perceived exposure to temporary nurses may impact work-related attitudes of permanent nurses. Our findings suggest that the clinical community should limit permanent nurses' exposure to temporary nursing staff to protect their commitment. If this is not possible, we encourage strategies to counteract associated feelings of illegitimacy, for example, by showing appreciation for permanent nurses' willingness to take over responsibility for temporary nurses. The study adheres to the STROBE reporting guidelines for cross-sectional studies. No patient or public contribution.

Testing a model of Thai nurses' intent to stay in employment.

To test the causal model of intent to stay in employment of nurses in regional medical centers. Effectiveness and quality of nursing care are determined by an adequate number of nursing staff; however, there is an ongoing challenge of nursing shortage. Improving nurses' intention to remain in employment is an effective way to address the problem of nursing shortage. This study employed a cross-sectional design. The sample was 1224 registered nurses from nine regional medical centers across Thailand, selected using multistage random sampling. Data were collected between January and July 2019 and analyzed with structural equation modeling. The final model could explain 40.3% of the variance in intent to stay. Transformational leadership, coworker support, professional autonomy, opportunities for promotion, marital status, and job satisfaction positively affected intent to stay, while burnout negatively affected intent to stay. This indicates that seven factors that should be considered by nurse managers in developing a framework for constructing interventions to increase nurses' intention to continue working in their organization. Nurse managers should strengthen the intent to stay of nurses by providing consultations, building a positive work atmosphere, and encouraging nurse leaders to apply transformational leadership behaviors to the organizational administration. Policymakers should consider enacting policies and regulations for nurses' benefits, such as allocating civil servant positions to temporary nursing staff, expanding the framework of career advancement to a senior professional position, and considering salary and overtime pay, to increase nurses' intent to stay in an organization.

The association between care left undone and temporary Nursing staff ratios in acute settings: a cross- sectional survey of registered nurses

BackgroundThe shortage of health workers is a global phenomenon. To meet increasing patient demands on UK health services, providers are increasingly relying on temporary staff to fill permanent posts. This study examines the occurrence of ‘care left undone’, understaffing and temporary staffing across acute sector settings.Methods“Secondary data analysis from an RCN administered online survey covering nurses from hospitals and trusts across all four UK countries. Staffing and ‘care left undone’ measures were derived from the responses of 8841 registered nurses across the UK. A locally smoothed scatterplot smoothing regression analysis (Loess) was used to model the relationship between any ‘care left undone’ events and full complement, modest and severely understaffed shifts, and proportions of temporary staff.ResultsOccurrence of ‘care left undone’ was highest in Emergency Departments (48.4%) and lowest in Theatre settings (21%). The odds of ‘care left undone’ increase with increasing proportion of temporary staff. This trend is the same in all understaffing categories. On shifts with a full quota of nursing staff, an increase in the proportion of temporary staff from 0 to 10% increases the odds of care left undone by 6% (OR = 1.06, 95% CI, 1.04–1.09). Within the full quota staffing category, the difference becomes statistically significant (p < 0.05) on shifts with a proportion of temporary nursing staff of 40% or more. On shifts with a full quota of nursing staff the odds of a ‘care left undone’ event is 10% more with the proportion of temporary nursing staff at 50%, compared to shifts with modest understaffing of 25% or less with no temporary nursing staff (OR = 1.1, 95%CI, 0.96–1.25).ConclusionThe odds of a ‘care left undone’ event are similar for fully staffed shifts with a high temporary nursing staff ratio compared to severely understaffed shifts with no temporary nursing staff. Increasing the proportion of temporary nurse staff is associated with higher rates of self-reported care left undone by nursing staff. This has significant implications for nurse managers and policy makers.

Does longer roster lead-time reduce temporary staff usage? A regression analysis of e-rostering data from 77 hospital units.

Use of temporary nursing staff is contentious and expensive. Using e-rostering data from 77 hospital units, this research investigates whether longer roster lead-times reduce temporary staff usage. It is commonly assumed that longer roster approval lead-times, the time from when a roster is approved, to when it is worked, result in better, more cost-effective rosters. Consequently, many hospitals target lead-times of 6weeks, a figure recommended for the UK National Health Service in a recent governmental review. This contrasts with the minimum lead-time advocated by New South Wales Ministry of Health, which advises a shorter lead-time of 2weeks. Using data from 77 hospital units, this paper explores this assumed relationship. Using data extracted from the e-rostering system of an NHS Acute Foundation Trust, this study uses linear regression analysis to explore the relationship between roster approval lead-time and temporary staff usage. The data were captured over a period of 9months from 15 February 2016-23 October 2016, a total of 693 rosters. This research suggests that late roster approval may contribute to as much as 37% of temporary staff usage, while approval 4-6weeks prior to the roster being worked reduces this to approximately 15%. However, this is only relevant under specific conditions. Importantly, this should be considered before mandating lead-times across all units. This research implies that the optimum approval lead-time lies between 4-6weeks; however, given other challenges, achieving this in practice may prove difficult.

Development of Intention to Stay Model for Temporary Nursing Staff in RS UNAIR

Introduction: Intention to stay of nurses is important to reduce turnover rate and to improve the stability of hospital. Quality of nursing work life (QNWL) has been found to influence intention to stay. However, reliable information of this effect is limited. The purpose of this study was to develop the model of intention to stay for temporary nursing staff in RS UNAIR. Method: Anexplanative cross-sectional survey design was used in this study. Data were collected by using questionnaire among 32 nurses working at different units in this hospital through simple random sampling and analyzed by partial least square (PLS). Result: QNWL affected job satisfaction but did not affect commitment. Commitment was significantly affected by job satisfaction. There was effect of job satisfaction on intention to stay. Commitment also significantly affected intention to stay Discussion: QNWL is a predictor of intention to stay trough job satisfaction and commitment. It is recommended that more focused interventions on QNWL, job satisfaction, and commitment developments may improve intention to stay. Recruitment of non-nursing staff to carry out billing and administrative tasks is urgently needed. Suggestions for further research is to analyze the effect of empowerment, remuneration, and career ladder on nurses’ intention to stay.Keywords: intention to stay, quality of nursing work life, job satisfaction, commitment.

Development of Intention to Stay Model for Temporary Nursing Staff in RS UNAIR

Introduction: Intention to stay of nurses is important to reduce turnover rate and to improve the stability of hospital. Quality of nursing work life (QNWL) has been found to influence intention to stay. However, reliable information of this effect is limited. The purpose of this study was to develop the model of intention to stay for temporary nursing staff in RS UNAIR.Method: Anexplanative cross-sectional survey design was used in this study. Data were collected by using questionnaire among 32 nurses working at different units in this hospital through simple random sampling and analyzed by partial least square (PLS). Result: QNWL affected job satisfaction but did not affect commitment. Commitment was significantly affected by job satisfaction. There was effect of job satisfaction on intention to stay. Commitment also significantly affected intention to stayDiscussion: QNWL is a predictor of intention to stay trough job satisfaction and commitment. It is recommended that more focused interventions on QNWL, job satisfaction, and commitment developments may improve intention to stay. Recruitment of non-nursing staff to carry out billing and administrative tasks is urgently needed. Suggestions for further research is to analyze the effect of empowerment, remuneration, and career ladder on nurses’ intention to stay.

The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals

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.

Use of temporary nursing staff and nosocomial infections in intensive care units.

To examine the nature and prevalence of the use of temporary nursing staff in intensive care units and relationships between the use of temporary nursing staff and the occurrence of nosocomial infections (central line-associated blood stream infections and ventilator-associated pneumonia). Hiring temporary nurses raises controversial issues with respect to nurse staffing, care processes and patient outcomes, yet empirical findings regarding the use of temporary nurses are mixed. Whether adverse patient outcomes in intensive care units are related to the use of temporary nursing staff remains unexamined. A retrospective longitudinal design was used. Data were collected monthly from 12 intensive care units at six hospitals; 144 ICU-month data points were used for the analysis. Chi-square, anova and logit regression models were used to examine the research questions. The intensive care units used higher levels of temporary nursing staff, but the use of temporary nursing staff was not significantly associated with nosocomial infections. Nurses' perceptions regarding staffing and resource adequacy were significantly associated with nosocomial infections. No evidence was found to link the use of temporary nursing staff and nosocomial infections. Instead, nurses' perceptions of staffing adequacy were related to nosocomial infections. Given the greater use of temporary nursing staff in intensive care units, nurse managers in intensive care units need to monitor the levels of temporary nurse staffing and develop a systematic approach for hospitals to assist in these nurses' adjustment, which can reduce the burden of both temporary and permanent intensive care unit nurses. In addition to quantitative measures of nurse staffing, nurses' perceptions regarding staffing adequacy can be used to measure nurse staffing in relation to adverse patient outcomes.

PHC-007 Deployment of Bar Code Medicines Administration to Control the Administration of Medicines in Geriatric Units

BackgroundOf the errors occurring in drug treatment, about 24% take place during the step of administration (Mission nationale d’expertise et d’audit hospitaliers (MeaH) 2008). Poon et al, showed in 2010...

The Pivotal Plan

This article reviews how the nurse leaders of a 136-bed medical/surgical service developed and implemented a methodical plan to fill RN vacancies, decrease labor costs, and improve quality. This simple, straight-forward approach was designed to rapidly fill core staff positions while minimizing the impact of the vacancies and ultimately eliminate the use of temporary nursing staff. The detailed components of the plan provided a way to assess vacancy data, time temporary replacements, and structure beneficial hospital partnerships, all of which were instrumental in the success of the plan. The plan was implemented throughout the facility because of proven success in the medical/surgical service. The leaders' focus on decreasing labor costs resulted in hiring a stable core staff that was able to attain established quality initiatives. The financial and quality outcomes of the service demonstrate the ability to sustain excellent results over time.

Temporary nursing staff - cost and quality issues

This paper is a report of a comparative study of temporary and permanent staff work activity, cost and quality of care. Temporary nurse staffing can consume significant proportions of the health service wages bill, and this is unlikely to fall owing to recruitment and retention problems, high sickness absence and the tendency for staff to work 'casually'. If temporary workers are here to stay, then what impact do they have on inpatient care? For example, do ward nursing quality and costs change when temporary staff are employed? Ward patient dependency, nursing activity, workload, staffing and data on quality were collected using non-participant observation, document analysis, staff and patient interviews in 605 United Kingdom general and specialist wards between 2004 and 2009. These wards were divided into two groups: 368 employing only permanent staff during data collection and 237 with permanent, and temporary staff in the ward team at the time when the observations were made. Workloads and time out (sickness absence, etc.) in wards employing temporary staff were greater than in units with permanent staff only, thereby justifying hiring short-term staff. Wards with temporary and permanent staff were more expensive to run and working styles were different. Overall quality scores, however, were no different in the two types of ward. Ward managers need to monitor temporary staffing and the effect they have on nursing activity and quality. Similar studies in mental health, learning disability and community nursing would generate additional insights.

An outline of appropriate risk management in the use of temporary dental nursing staff in practice

It'll never happen, it might not happen, it shouldn't happen, it happened!The risk of human error represents the greater threat to complex systems such as the delivery of healthcare rather than technical failure. Much of the legislation recently introduced in UK healthcare services, Building a Safer NHS; An Organisation with a Memory and A First Class Service evolved from a growing awareness of adverse incidents occurring in the healthcare setting. In general dental practice the absence of a trained skilled dental nurse with local knowledge of the working environment constitutes a risk to patient safety. Be this through the lack of appropriate selection, training, induction or clinical supervision of an appropriate stand in. Be it due to poor governance, audit or quality control the cost to the practitioner, practice, profession and patient can be high. To mitigate this risk a comprehensive risk management system will be needed in practice. Planning to prevent such risks requires understanding, analysing, managing and costing the risk. Success depends on robust systems for screening, contracting and training of staff within an educated team of safety orientated personnel supported by suitable frameworks for standards, resources, policies, protocols, processes and checks within a clearly identifiable chain of command.

Caring for Cognitively Impaired Nursing Home Residents with Pain

In this ethnographic study, nurses clearly described their beliefs, values, and experiences related to assessing pain in nursing home residents. These were affected by (a) the nurse’s perception of the role, (b) the resident’s ability to verbalize his or her pain, and (c) the nurse’s skill in identifying behavioral cues including nonverbal pain communications such as agitation or change in functional status. Knowledge of the individual resident was crucial; knowledge of the field of geriatric nursing was also important. Characteristics of the setting including formal and informal job expectations and the use of temporary nursing staff influenced practice.

Reversing the flow

The London Agency Project limits the commission fees that NHS trusts in the capital have to pay to employ temporary nursing staff

Workload and Environmental Factors in Hospital Medication Errors

Nine hospital workload factors and seasonal changes in daylight and darkness were examined over a 5-year period in relation to nurse medication errors at a medical center in Anchorage, Alaska. Three workload factors, along with darkness, were found to be significant predictors of the risk of medication error. Errors increased with the number of patient days per month (OR/250 patient days = 1.61) and the number of shifts worked by temporary nursing staff (OR/10 shifts = 1.15); errors decreased with more overtime worked by permanent nursing staff members (OR/10 shifts = .85). Medication errors were 95% more likely in midwinter than in the fall, but the effect of increasing darkness was strongest; a 2-month delay was found between the level of darkness and the rate of errors. More than half of all medication errors occurred during the first 3 months of the year.

Profiling “flexible” nursing staff: bank nurses in Scotland

Nurse banks are locally organised “in house” sources of temporary nursing staff. This paper reports on a survey of nurses working on three nurse banks in the National Health Service in Scotland. A total of 203 nurses responded to the survey, which revealed marked differences in the profile of the nurses working on each of the banks, in terms of age, biographical details, career plans and work commitments. Main issues for management revealed by the survey were the need for good communication with temporary staff and high levels of reported dissatisfaction with access to training opportunities. The paper concludes that there is no “standard” model of a nurse bank in the NHS in Scotland and no standard profile of bank nurses.

Managing temporary nursing staff: nurse banks in Scotland.

Nurse banks are locally organized in-house sources of temporary nursing staff. Reports on a study of policy and practice in the management of nurse banks in the National Health Service in Scotland. The study was based on a census survey of all 55 NHS units in Scotland (100 per cent response rate). Examines management rationales in establishing a nurse bank, explores costs and benefits of managing a bank, and provides recommendations on good practice in maintaining continuity of care.

The effect environmental change has on the frequency of violent incidents

Violence is an important consideration in the management of psychiatric patients. Probably one in ten psychiatric patients assault staff (DHSS, 1988), although this may be an underestimate (Lion et al, 1981). Fellow patients are assaulted less frequently (Nobel &amp; Rodger, 1989). Several factors have been associated with violent behaviour in patients: suffering from schizophrenia, delusions, hallucinations (Noble &amp; Rodger, 1989); being young, compulsorily detained and an increased use of temporary nursing staff (James et al, 1990).

An Increase in Violence on an Acute Psychiatric Ward

The increase in violent incidents on an acute psychiatric ward over a 15-month period was found to be strongly associated with the increase in use of temporary nursing staff (r = 0.63; P = 0.0005). The change in staffing patterns accounted for 39% of the variance in violence. An examination of the characteristics of all patients admitted to the ward revealed that the violent patients were significantly younger, more likely to have been admitted compulsorily and less likely to be depressed than non-violent ones.