Temporary Nurses Research Articles

Human Capital and Productivity in a Team Environment: Evidence from the Healthcare Sector

Using panel data from a large hospital system, this paper presents estimates of the productivity effects of human capital in a team production environment. Proxying nurses' general human capital by education and their unit-specific human capital by experience on the nursing unit, we find that greater amounts of both types of human capital significantly improve patient outcomes. Disruptions to team functioning attributable to the departure of experienced nurses, the absorption of new hires, and the inclusion of temporary contract nurses are associated with significant decreases in productivity beyond those attributable to changes in nurses' skill and experience. (JEL I11, J22, J24, M12, M54)

NURSE STAFFING UNDER DEMAND UNCERTAINTY TO REDUCE COSTS AND ENHANCE PATIENT SAFETY

Hospitals must maintain safe nurse-to-patient ratios in patient care units to offer adequate and safe patient care. Since the patient demand is highly variable, during high patient demand periods temporary or overtime nurses are hired to ensure safe nurse-to-patient ratios. These overtime nurses incur higher expense, and are often less effective. We study the problem of permanent nurse staffing level estimation under demand uncertainty as a newsvendor model. Our models are based on limited moment information of the demand distribution. Additionally, we introduce the use of asymmetric cost functions representing overstaffing and understaffing nursing costs. Findings using data from the general surgery and intensive care units at hospitals in Chicago, IL and Augusta, GA are presented. Computational results based on publically available cost data show that 3.1% and 7.3% annual cost savings result by introducing salvage value and newsvendor optimization in intensive care and general care units respectively. This new staffing scheme also improves patient safety as shifts are staffed with more permanent nurses.

Predicting the unpredictable: comparing readmitted versus non-readmitted colorectal surgery patients

BackgroundTo evaluate readmissions to determine predictors and patterns of readmission. MethodsProspective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined. ResultsA total of 212 readmissions and 3,292 nonreadmissions were analyzed. The majority was elective. Readmitted patients were older (P = .003), had more comorbidities (P < .0001), longer operative times (P < .0001), length of stay (P < .0001), and higher costs (P = .002). At the time of discharge, more readmitted patients required temporary nursing (P < .0001). Independent readmission predictors were higher American Society of Anesthesiologists score, previous abdominal operation, intensive care unit stay, and dysmotility/constipation surgery. At the time of readmission, 29.2% required reoperation. More than half had an open procedure initially (55.2%). After initial open procedures, reoperative time (P = .05) and LOS were longer (P = .028), and more patients required temporary nursing care at the time of discharge (P = .046). Readmissions caused an additional mean hospital cost of $12,670.89. ConclusionsReadmitted patients have distinct demographic and outcomes variables. As most were elective cases, stratifying patients preoperatively may enable perioperative planning for this higher risk group.

Temporary migrant nurses in Australia: Sites and sources of precariousness

Temporary migrant workers are widely regarded as a precarious group of workers. This precariousness is often traced back to the sphere of employment, though recent research also points to the implications of the limited rights entailed by temporary migrant status. This article draws on empirical work among registered nurses who have participated in the Australian 457 visa scheme – the major programme for temporary migrant workers in Australia. Using a range of empirical sources, including in-depth interviews with 26 temporary migrant nurses, we examine whether these nurses experience precariousness and locate the sites and sources of precariousness. The article draws attention to the importance of the regulatory context that defines different pathways from the country of departure to employment in the Australian healthcare system. We suggest that, although temporary migrant nurses are well integrated within the healthcare workforce in terms of formal wages and conditions, other stages in their migration pathways can be associated with precariousness. This in turn has significant impact on experiences at work and outside the workplace.

Demand for temporary agency nurses and nursing shortages.

There is an ongoing debate about the reasons for the growth of temporary employment of registered nurses (RNs). Some argue that efficiency incentives to increase flexibility and reduce labor costs are the principal cause, while others point to shortages of RNs as the stronger determinant. Using hospital-level data from California's Office of Statewide Health Planning and Development, we find a significant trend of increasing demand for agency nurses during the years of RN shortage. Demand rose with inpatient days, patient demand fluctuation, and the level of fringe benefits. Competition between hospitals and unionization, however, did not affect hospitals' demand for temporary RNs.

Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery

Elderly patients often are regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The goal of this study was to compare the cost of care and short-term outcomes of elderly and nonelderly patients undergoing laparoscopic colectomy. Our hypothesis was that elderly patients managed with laparoscopic colorectal surgery and an enhanced recovery protocol (ERP) can realize the same benefits of lower hospital length of stay (LOS) without increasing hospital costs or readmission rates. Review of a prospective database identified all patients that underwent an elective laparoscopic colectomy from 2009 to 2012. Patients were stratified into elderly (≥70 years old) and nonelderly (<70 years old) cohorts. The main outcome measures were discharge disposition, hospital costs, hospital LOS, and 30-day readmission rates between the laparoscopic and open groups. A total of 302 nonelderly (66%) and 153 elderly (34%) patients were included in the analysis. The elderly cohort had significantly higher comorbidities than the nonelderly group. There were no mortalities. Operative variables (procedure time, blood loss, and intraoperative complications) were similar. At discharge, significantly more elderly patients required temporary nursing or home care. There were no significant differences in short-term outcomes of LOS, 30-day readmission rates, or costs for the episode of care between the two groups. Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients. Despite higher comorbidities, elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates.

James Buchan explains why some trusts are upping expenditure on temporary staff.

Reports that some NHS trusts' spending on temporary nurses may be on the rise flies in the face of fiscal logic, especially given that other organisations are reported to be reducing agency use as a cost-cutting measure.

Use of Outsourced Nurses in Long-term Acute Care Hospitals

When staffing effectiveness is not maintained over time, the likelihood of negative outcomes increases. This challenge is particularly problematic in long-term acute care hospitals (LTACHs) where use of outsourced temporary nurses is common when providing safe, sufficient care to medically complex patients who require longer hospital stays than normally would occur. To assess this issue, the authors discuss the outcomes of their survey of LTACH chief nursing officers that demonstrated LTACH quality indicators and overall patient satisfaction were within nationally accepted benchmarks even with higher levels of outsourced nurses used in this post-acute care setting.

Exploring Risk Groups Workplace Bullying with Categorical Data

In this study, we first explore whether different exposure groups of workplace bullying exist, employing a large, heterogeneous sample. The results show six different exposure groups: almost 30.5% is not bullied since they report hardly any negative act at work at all, 27.2% face some limited work criticism, 20.8% face limited negative encounters, 8.3% is occasionally bullied, 9.5% are predominately work related bullied, and a total of 3.6% can be seen victims of severe workplace bullying. In a second step, the relationship between the identified target groups and social demographics were investigated using multinomial logistic regression to identify risk groups of workplace bullying. Employees between the age of 35 and 54, public servants, blue-collar workers, as well as employees working in the food and manufacturing industries have a significantly elevated risk to be victims of workplace bullying. In contrast, employees younger than 25, employees with a temporary contract, teachers, nurses and assistant nurses are those least likely at risk. These findings are important for policymakers at the national and organisational level as they assist in focussing towards possible avenues to prevent workplace bullying.

Use of temporary nurses and nurse and patient safety outcomes in acute care hospital units

To deal with nursing shortages and inadequate hospital nurse staffing, many solutions have been tried, including utilizing temporary nurses. Relatively little attention has been given to use of temporary nurses and its association with both nurse and patients outcomes. : The purpose of this study is to investigate the association between use of temporary nurses and nurse (needlesticks and back injuries) and patient (patient falls and medication errors) safety outcomes at the nursing unit level. Data came from a large organizational study which investigated the relationship between registered nurse (RN) staffing adequacy, work environments, organizational, and patient outcomes. The sample for this study was 4,954 RNs on 277 nursing units in 142 hospitals. Nurses working on nursing units with high levels (more than 15%) of external temporary RN hours were more likely to report back injuries than nurses working on nursing units that did not use external temporary RNs. Nurses working on these nursing units also reported greater levels of patient falls compared with those who did not use temporary RNs. This study found that nurses working on nursing units with moderate levels (5-15%) of external temporary RN hours reported fewer medication errors than those without using any external temporary RNs. Hospitals need to monitor the levels of temporary nurse use and maintain a level of approximately 15% to ensure both nurse and patient safety outcomes. The temporary nurse use to manage nursing shortfall may provide both benefit and harm to nurse and patient safety depending on the level of the use.

Modelling the size and skill-mix of hospital nursing teams

Previously published work has described the development of a hospital capacity simulation tool, PROMPT. PROMPT has now been adopted by a number of hospitals in the UK and is used for both strategic and operational planning and management of key hospital resources. The work, as presented here, extends the PROMPT functionality to consider in more detail workforce issues. In particular, working with some of the current hospital users, the research has focussed on detailed planning for calculating the size and skill-mix of inpatient nursing teams. The chosen methodology utilizes both simulation and optimization. Outputs from the PROMPT three-phase discrete event simulation are fed into a stochastic programme which suggests the optimal number of nurses to employ (whole time equivalents) by skill-mix and the corresponding numbers by shift. A novel feature of the tool is the ability to predict and compare nursing needs based on different methods of capturing patient-to-nurse ratios as currently adopted across the UK National Health Service. Illustrative results from one hospital demonstrate that although the overall sizes of nursing teams on different wards are of an acceptable level and comparable to the outputs from the simulation phase of the work, often the number of nurses employed at different grades is not well matched to patient needs and the skill-mix should be reconsidered. Results from the optimization phase of the work suggest that it is cost beneficial to increase the number of permanently employed nurses to account for fluctuations in demand and corresponding high costs of temporary (agency) nurses. The scenario functionality of the tool permits for the study of changing size and skill-mix as a consequence of changes in patient volumes, patient case-mix, numbers of beds and length of stay.

Call for Better Screening of Temporary Nurses

Call for Better Screening of Temporary Nurses

Employment and Wage Issues : The Case of Temporary Nurses in the U. S. A.

Employment and Wage Issues : The Case of Temporary Nurses in the U. S. A.

Empowerment, job satisfaction, and organizational commitment: comparison of permanent and temporary nurses in Korea

Aim This study was conducted to describe and compare empowerment, job satisfaction, and organizational commitment between permanent and temporary nurses in Korea. Background Since Korea's economic crisis of 1997, Korea's labor market has been undergoing dramatic modification, and the rate of temporary nurses employed in health care organizations has gradually increased. However, studies focusing on nurses' employment status, which potentially affect the individual and hospital organization, have been rarely conducted. Methods This was a descriptive comparative study. The convenient sample of 416 nurses from 19 hospitals in Korea completed a structured questionnaire. Results Overall, permanent nurses presented higher levels of job satisfaction, organizational commitment, and empowerment than did temporary nurses. Conclusions The results of this study indicated that health care administrators should develop strategies to close the gap of perceptions between permanent and temporary nurses in Korea. The results of this study also imply that such opportunities and compensation plans related with administrative recognition should be made available to the temporary nurses to manage their workforces more efficiently.

Stochastic dynamic nursing service budgeting

We address the nursing service budgeting problem from the department manager’s point of view. The model allocates the budget dynamically to three types of nursing care capacities: 1) permanent nurses, 2) temporary nurses, and 3) overtime. The quarterly tactical decisions are the aggregate weekly shift pattern of permanent nurses and the policy for hiring temporary nurses and using overtime. The decisions are optimized with respect to nursing care shortage and a soft-constraint on the annual budget. For the aggregate weekly shift pattern, permanent nurses require a notification lead-time of one quarter to prepare the personal rosters. Our model offers a solution to the nursing service budgeting problem that extends the existing literature by using a Markovian demand model, resolving the anticipation of the operational decisions, and applying general budget as well as shortage penalty functions.

Nursing Time Devoted to Medication Administration in Long‐Term Care: Clinical, Safety, and Resource Implications

To quantify the time required for nurses to complete the medication administration process in long-term care (LTC). Time-motion methods were used to time all steps in the medication administration process. LTC units that differed according to case mix (physical support, behavioral care, dementia care, and continuing care) in a single facility in Ontario, Canada. Regular and temporary nurses who agreed to be observed. Seven predefined steps, interruptions, and total time required for the medication administration process were timed using a personal digital assistant. One hundred forty-one medication rounds were observed. Total time estimates were standardized to 20 beds to facilitate comparisons. For a single medication administration process, the average total time was 62.0+/-4.9 minutes per 20 residents on physical support units, 84.0+/-4.5 minutes per 20 residents on behavioral care units, and 70.0+/-4.9 minutes per 20 residents on dementia care units. Regular nurses took an average of 68.0+/-4.9 minutes per 20 residents to complete the medication administration process, and temporary nurses took an average of 90.0+/-5.4 minutes per 20 residents. On continuing care units, which are organized differently because of the greater severity of residents' needs, the medication administration process took 9.6+/-3.2 minutes per resident. Interruptions occurred in 79% of observations and accounted for 11.5% of the medication administration process. Time requirements for the medication administration process are substantial in LTC and are compounded when nurses are unfamiliar with residents. Interruptions are a major problem, potentially affecting the efficiency, quality, and safety of this process.

Explanations for Persistent Nursing Shortages

This paper contributes to the economics literature on nursing market shortages by putting forward two new models that suggest three new explanations for perceived nursing shortages. The first model focuses on hospitals hiring both permanent staff nurses and temporary contract nurses. It shows that hiring both classes of nurses can represent optimizing behavior, and that an interesting kind of perceived nursing shortage results from this dual hiring. The second model posits two classes of hospitals, ``premier" and ``funds-constrained," and generates two distinct kinds of nursing shortages: economic shortages, involving unfilled, budgeted positions, and ``noneconomic" professional standards shortages. We believe that the perceived existence of professional standards shortages may be a significant explanation for the widespread impression of persistent shortages.

Overcoming Legal Obstacles Involving the Voluntary Care of Children Who Are Separated From Their Legal Guardians During a Disaster

A large-scale disaster may separate children from their parents or guardians and may strand many children in the care of temporary caregivers, including physicians and nurses. In general, unless a physician or nurse is a member of a public sector emergency response program (a "VHP"), parental consent is required for the treatment of minors outside of an emergency department unless the minor is suffering from an imminently life-threatening condition. Physicians or nurses who are not VHP's may be held liable (civilly, criminally and administratively) if they provide care without parental consent outside of an emergency room to a child who is not suffering from an imminently life-threatening condition. The existing rules regarding parental consent would, in many cases, limit (or at least discourage) the provision of optimal health care to children in a large-scale disaster by restricting care aimed to alleviate pain, the treatment of chronic conditions as well as the treatment of conditions, or potential conditions, that could worsen or develop in the absence of treatment.Additionally, "Good Samaritan" laws that generally limit the liability of health care providers who voluntarily provide care in an emergency may not apply when care is provided in a crude or makeshift clinic or when care is not provided at the scene of the emergency. Thus, benevolent physicians and nurses who voluntarily provide care during a large-scale disaster unjustly risk liability. The prospect of such liability may substantially deter the provision of optimal medical care to children in a disaster. This article discusses the shortcomings of current laws and proposes revisions to existing state laws. These revisions would create reasonable and appropriate liability rules for physicians and nurses providing gratuitous care in emergencies and thus would create reasonable incentives for health care providers to deliver such care. ("Gratuitous care" is the legal term for care provided voluntarily and without expectation of payment.).

Does one surgery do the trick?

In Brief Temporary nurses measure up just fine…new guidelines for unstable angina and NSTEMI…privacy violations under scrutiny…and more.

A new slant on unstable angina

In Brief Temporary nurses measure up just fine…new guidelines for unstable angina and NSTEMI…privacy violations under scrutiny…and more.