Use Of Agency Staff Research Articles

When Agency Fails: An Analysis of the Association Between Hospital Agency Staffing and Quality Outcomes.

Staffing is critical to hospital quality, but recent years have seen hospitals grappling with severe shortages, forcing them to rely on contract or agency staff for urgent patient care needs. This shift in staffing mix has raised questions about its impact on quality. Consequently, this study investigated whether the increased use of agency staff has affected healthcare quality in hospitals. Given the limited recent research on this topic, practitioners remain uncertain about the effectiveness of their staffing strategies and their potential impact on quality. Drawing from agency theory, data were obtained from Definitive Healthcare which consolidates information from numerous public access databases pertaining to hospitals such as the American Hospital Association Annual Survey (hospital profile) and the Hospital Value-Based Purchasing Program (quality data). We conducted a cross-sectional study using a multivariable linear regression model (2021-2022) with appropriate organizational and market- level control variables. Quality was measured across eight variables while the independent variable of interest was agency labor cost ratio operationalized as the percentage of net patient revenue consumed by agency labor expense. Our results suggested that the employment of agency staff was significantly and negatively associated with six of eight quality measures tested, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) star rating, Hospital Compare rating, the hospital Total Performance Score (TPS), and three of the four sub-domains that comprise the TPS: clinical domain score, person and community engagement domain score, and the efficiency and cost reduction score. Our results indicated that the increased use of agency labor may have a significant negative influence on quality outcomes at the hospital level. Our findings support the premise that interventions that promote full-time staffing may be more supportive of the quality of care delivered as well as patients' perceptions of care.

NURSING HOME WORKFORCE CHALLENGES: INCREASED NURSING STAFF LABOR COSTS AND USE OF AGENCY STAFF FROM 2017 TO 2021

Abstract Nursing homes face rapidly increasing wages and change their input mix as they face workforce shortfalls. For 15,959 freestanding NHs from 2017-2021, the proportion of hours worked by agency staff and the median wage cost per hour of agency and directly employed nursing staff were calculated from Medicare cost reports and Payroll-Based Journal data. The median hourly wage cost of directly employed staff (wage and fringe) increased 18.1% for RNs (to $41.99 in 2021), 19.8% for LPNs ($32.29), and 27.5% for CNAs ($19.62). The median hourly wage cost of agency staff (amount paid to staffing agency) increased at a faster rate and was substantially higher: 22.8% for RNs ($64.19); 28.3% for LPNs ($52.42), and 34.9% for CNAs ($33.73). The use of agency staff increased, starting from approximately 2% of all nursing staff hours for each of the nursing staff types in Q1 2017 to 5.6% hours for RNs, 9.4% hours for LPNs, and 8.8% hours for CNAs in Q4 2021. These observations have implications for quality and access to nursing home care. High use of agency staff may affect quality of nursing home care, and substantial wage differences between agency and directly-employed staff may affect worker satisfaction and attachment of directly employed workers. Hourly wage costs for all nursing staff have increased more rapidly than nursing home revenues, which only increased 16.6% over the study period; this suggests that, without payment rate increases, nursing homes may reduce labor inputs to contain costs, or may go out of business.

FOSTERING CONSISTENT AND ENGAGING CARE FOR PEOPLE WITH DEMENTIA IN LONG-TERM CARE

Abstract Maintaining a stable and qualified direct care workforce in long-term care organizations has become increasingly difficult as shortages intensify, turnover increases, and the use of agency staff remains at high levels. Efforts to improve this situation need to include high quality training that is incorporated into onboarding, ongoing continuing education, and infused into the culture of the organization. Using data from our ongoing NIA-funded study, “Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia,” we describe the competencies used by direct care workers (DCWs) with exceptional capacity, or ability and resources to engage people with dementia, and the factors that promote or limit the development and use of these competencies. Focal residents with dementia (N=66) were followed at eight diverse assisted living communities for one year and 53 DCW were interviewed across three waves of data collection. Interview transcripts and fieldnotes from more than 2000 hours of observation were analyzed using a grounded theory approach. Organized by four engagement approaches: knowing the person, connecting with and meeting people where they are, being in the moment, and viewing all encounters as opportunities, we identified competencies and the multiple intersecting factors which impact meaningful engagement and competency development including community staffing, consistent assignment, scheduling, DCW training, DCW tenure, and community resources. Implications for practice, which emphasize the elaboration of specific competencies, have the potential to inform the development of DCW training, the promotion of supportive work environments, and social policy that support person-centered dementia care.

1756. Takeaways from Investigation of a Large Invasive Group A Streptococcus Outbreak in a Skilled Nursing Facility, Virginia, 2022-2023

Abstract Background Group A Streptococcus (GAS) primarily infects the respiratory tract, skin, and soft tissue. Invasive GAS (iGAS), in which the bacteria infect a normally sterile body site, is severe and can be life threatening, especially in older adults. The Virginia Department of Health investigated a prolonged iGAS outbreak in a skilled nursing facility from March 2022 - April 2023. Cases continued despite multipronged outbreak response. Methods A case was defined as GAS isolated from a sterile or nonsterile body site. Cases were identified through active surveillance, retrospective chart review, colonization screening by skin/throat swab, and culture. Multiple onsite visits were conducted to assess infection control practices at the facility. Genotyping (emm type) analysis was performed on resident and staff isolates. Results From March 2022 to April 2023, 30 (71.4%) GAS cases were identified among facility residents, and 12 (28.6%) cases among staff. Ten residents (23.8%) died. GAS was isolated from throat (21, 50%), wounds (14, 33.3%), from more than one site (2, 4.8%), and invasive infections (5, 11.9%). Twenty (47.6%) cases were identified through colonization screening; the carriage rate among residents was 7% (16 positive out of 230) and 2.8% among staff (4 positives out of 142). Sequencing was conducted on 34 isolates, 33 (97%) were emm type 89 and were within < 10 single nucleotide polymorphisms (SNP) apart. Infection prevention assessments identified gaps in hand hygiene, wound care, and environmental cleaning and disinfection. Conclusion Genotyping results suggested common source exposure. GAS might have transmitted several times between colonized or infected residents and staff which caused the extended outbreak. Multiple challenges at the facility contributed to a prolonged outbreak despite aggressive interventions. Challenges included high staff turnover; use of agency staff since the beginning of the COVID-19 pandemic; change in facility ownership; suboptimal infection prevention practices including wound care; and lack of appropriate active surveillance for GAS infections. Review of epidemiological data, frequent onsite infection prevention assessments, numerous educational sessions, and active follow-up were all crucial strategies for outbreak mitigation. Disclosures All Authors: No reported disclosures

Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic

Staffing shortages have been widely reported in US nursing homes during the COVID-19 pandemic, but traditional quantitative research analyses have found mixed evidence of staffing shortfalls. To examine whether nursing home administrator perspectives can provide context for conflicting aggregate staffing reports in US nursing homes during the COVID-19 pandemic. In a qualitative study, convergent mixed-methods analysis integrating qualitative and quantitative data sets was used. Semistructured qualitative interviews were conducted between July 14, 2020, and December 16, 2021. Publicly available national Payroll Based Journal data were retrieved from January 1, 2020, to September 30, 2022, on 40 US nursing homes in 8 health care markets that varied by region and nursing home use patterns. Staffing and resident measures were derived from Payroll Based Journal data and compared with national trends for 15 436 US nursing homes. Nursing home administrators were recruited for interviews. Of the 40 administrators who consented to participate, 4 were lost to follow-up. Four repeated, semistructured qualitative interviews with participants were conducted. Interview questions focused on the changes noted during the COVID-19 pandemic in nursing homes. Thematic description of nursing home administrator compensatory strategies to provide context for quantitative analyses on nursing home staffing levels during the COVID-19 pandemic. A total of 156 interviews were completed with 40 nursing home administrators. Administrators reported experiencing staff shortages during the COVID-19 pandemic and using compensatory strategies, such as overtime, cross-training, staff-to-resident ratio adjustments, use of agency staff, and curtailing admissions, to maintain operations and comply with minimum staffing regulations. Payroll Based Journal data measures graphed from January 1, 2020, to September 30, 2022, supported administrator reports showing that study facilities had reductions in staff hours, increased use of agency staff, and decreased resident census. Findings were similar to national trends. In this qualitative, convergent mixed-methods study, nursing home administrators reported the major staffing strain they experienced at their facilities and the strategies they used to offset staffing shortages. Their experiences provide context to quantitative analyses on aggregate nursing home census data. The short-term compensatory measures administrators used to comply with regulations and maintain operations may be detrimental to the long-term stability of this workforce.

Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey

BackgroundOutbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have occurred in long-term care facilities (LTCFs) worldwide, but the reasons why some facilities are particularly vulnerable to outbreaks are poorly understood. We aimed to identify factors associated with SARS-CoV-2 infection and outbreaks among staff and residents in LTCFs.MethodsWe did a national cross-sectional survey of all LTCFs providing dementia care or care to adults aged 65 years or older in England between May 26 and June 19, 2020. The survey collected data from managers of eligible LTCFs on LTCF characteristics, staffing factors, the use of disease control measures, and the number of confirmed cases of infection among staff and residents in each LTCF. Survey responses were linked to individual-level SARS-CoV-2 RT-PCR test results obtained through the national testing programme in England between April 30 and June 13, 2020. The primary outcome was the weighted period prevalence of confirmed SARS-CoV-2 infections in residents and staff reported via the survey. Multivariable logistic regression models were fitted to identify factors associated with infection in staff and residents, an outbreak (defined as at least one case of SARS-CoV-2 infection in a resident or staff member), and a large outbreak (defined as LTCFs with more than a third of the total number of residents and staff combined testing positive, or with >20 residents and staff combined testing positive) using data from the survey and from the linked survey–test dataset.Findings9081 eligible wLTCFs were identified, of which 5126 (56·4%) participated in the survey, providing data on 160 033 residents and 248 594 staff members. The weighted period prevalence of infection was 10·5% (95% CI 9·9–11·1) in residents and 3·8% (3·4–4·2) in staff members. 2724 (53·1%) LTCFs reported outbreaks, and 469 (9·1%) LTCFs reported large outbreaks. The odds of SARS-CoV-2 infection in residents (adjusted odds ratio [aOR] 0·80 [95% CI 0·75–0·86], p<0·0001) and staff (0·70 [0·65–0·77], p<0·0001), and of large outbreaks (0·59 [0·38–0·93], p=0·024) were significantly lower in LTCFs that paid staff statutory sick pay compared with those that did not. Each one unit increase in the staff-to-bed ratio was associated with a reduced odds of infection in residents (0·82 [0·78–0·87], p<0·0001) and staff (0·63 [0·59–0·68], p<0·0001. The odds of infection in residents (1·30 [1·23–1·37], p<0·0001) and staff (1·20 [1·13–1·29], p<0·0001), and of outbreaks (2·56 [1·94–3·49], p<0·0001) were significantly higher in LTCFs in which staff often or always cared for both infected or uninfected residents compared with those that cohorted staff with either infected or uninfected residents. Significantly increased odds of infection in residents (1·01 [1·01–1·01], p<0·0001) and staff (1·00 [1·00–1·01], p=0·0005), and of outbreaks (1·08 [1·05–1·10], p<0·0001) were associated with each one unit increase in the number of new admissions to the LTCF relative to baseline (March 1, 2020). The odds of infection in residents (1·19 [1·12–1·26], p<0·0001) and staff (1·19 [1·10–1·29], p<0·0001), and of large outbreaks (1·65 [1·07–2·54], p=0·024) were significantly higher in LTCFs that were for profit versus those that were not for profit. Frequent employment of agency nurses or carers was associated with a significantly increased odds of infection in residents (aOR 1·65 [1·56–1·74], p<0·0001) and staff (1·85 [1·72–1·98], p<0·0001), and of outbreaks (2·33 [1·72–3·16], p<0·0001) and large outbreaks (2·42 [1·67–3·51], p<0·0001) compared with no employment of agency nurses or carers. Compared with LTCFs that did not report difficulties in isolating residents, those that did had significantly higher odds of infection in residents (1·33 [1·28–1·38], p<0·0001) and staff (1·48 [1·41–1·56], p<0·0001), and of outbreaks (1·84 [1·48–2·30], p<0·0001) and large outbreaks (1·62 [1·24–2·11], p=0·0004).InterpretationHalf of LTCFs had no cases of SARS-CoV-2 infection in the first wave of the pandemic. Reduced transmission from staff is associated with adequate sick pay, minimal use of agency staff, an increased staff-to-bed ratio, and staff cohorting with either infected or uninfected residents. Increased transmission from residents is associated with an increased number of new admissions to the facility and poor compliance with isolation procedures.FundingUK Government Department of Health and Social Care.

The social integration of healthcare agency workers in long-term care facilities: A cross-sectional study

BackgroundPatient care quality is a key concern for long-term care facilities and is directly related to effective collaboration between healthcare professionals. The use of agency staff in long-term care facilities creates important challenges in terms of coordination and communication within work units. ObjectivesThe purpose of this study is to assess the mediating effect of common in-group identity in the relationship between permanent employees’ perceptions regarding the use of agency workers -namely distributive justice, perceptions of threat, perceived similarities with agency workers, and leader inclusiveness toward agency staff- and the permanent employees’ adoption of collaborative behaviours. DesignCross-sectional study. SettingsThree long-term care facilities. Participants290 regular healthcare employees (nurses and care attendants). MethodsData were obtained through questionnaires filled out by employees. Hypotheses were tested using structural equation analyses. ResultsThe results showed the indirect effects of perceived distributive justice, perceived similarity and leader inclusiveness toward agency workers on permanent employees’ cooperation behaviours through common group identification. Perceptions of threat were not related to common group identification or collaborative behaviours. The results also showed that common in-group identification is related to cooperation behaviours only for employees without previous experience as agency workers. ConclusionsThis study suggests that permanent healthcare employees who feel they are fairly compensated relative to agency workers, who consider these workers as similar to them, and who believe their supervisor appreciates agency workers’ contributions tend to develop a common in-group identity, which fosters collaborative behaviours. Managers of long-term care facilities who wish to foster collaboration among their blended workforce should thus create an environment conducive of a more inclusive identity, particularly if their employees have no previous experience as agency workers.

Antipsychotic use for behaviours by persons with dementia in residential aged care: the relatives’ perspectives

Objective: To explore relatives’ experience, knowledge and perceptions of challenging behavioural and psychological symptoms of dementia (BPSD) and association with antipsychotic use for persons with dementia in residential aged care. Design: A qualitative Interpretive Description design using semi-structured interviews was used for understanding the construct and context of perceptions and experiences using a six-step process to analyse themes. Settings: South Australia, Victoria and Western Australia. Subjects: Six relatives of a person with dementia in residential aged care. Main Outcome Measure: Themes describing relatives’ experiences, knowledge and perceptions of antipsychotic medication use for the person with dementia in residential aged care. Results: Three themes were identified: 1) lack of education and information - relatives found it difficult to differentiate between behaviours influenced by disease or antipsychotic medication; 2) need to be included in decision-making - relatives’ believed challenging behaviours resulting from BPSD could be prevented with a more person-centred approach; and, 3) influence of aged care culture on attitudes towards use of antipsychotic medication - relatives’ identified this could be problematic depending on use of agency staff and time pressures. Conclusion: Relatives of persons with dementia require support and education about the progression of dementia, BPSD and the risks and benefits that antipsychotic medication may have on BPSD. Most importantly, relatives need to be involved in decision-making regarding the use of antipsychotic medication. Nurses have a role to educate care staff on the use of person centred care in preference to medication for better care of the person with dementia.

Seven day services could leave emergency departments understaffed, doctors warn

Consultants have warned that introducing seven day services could lead to the understaffing of emergency departments and acute services. Delegates at the BMA’s annual UK consultants’ conference in London on Wednesday 4 March voted unanimously in favour of a motion which opposed proposals by NHS Employers for doctors to provide elective services at nights and weekends. The motion said that the proposals would “exacerbate the difficulty in recruitment to acute specialties, result in worse services for patients, and incentivise emigration [of doctors].” It said that the plans would also “necessitate increased use of agency staff and …

Recruiting, retaining and making the best use of social workers in adult social care

PurposeThis paper seeks to identify the most effective ways both to recruit and retain social workers. It aims to explore the roles and skills that social workers bring to the provision of social care for adults and to invite a more detailed debate on the particular responsibilities in the field of neurodisability.Design/methodology/approachThe paper draws on successful methods of recruitment and retention of social workers, from the experience of recruiting managers and the perspectives of social workers. It explores the current, in part inconclusive, debates on how best to utilise their practice skills and knowledge. It also invites the contribution of people working in this field to inform a second paper for the journal to address this in more detail in the field of neurodisability.FindingsDespite enduring problems in the supply of capable and skilled social workers and low levels of retention, strong leadership by managers of social work services can take positive steps to ensure the provision of sustainable services and avoid the use of agency staff. These leaders can positively identify and make best use of the specific practice skills and knowledge of social workers, which in itself supports higher levels of retention.Originality/valueThe paper is based on direct experience of achieving high levels of successful recruitment and retention of social workers in times of short supply and a positive analysis of the specific and positive contribution of social workers in adult social care.

Trust ends use of agency staff as NHS in London seeks £1bn savings

Trust ends use of agency staff as NHS in London seeks £1bn savings

Trust ends use of agency staff as NHS in London seeks £1bn savings

Trust ends use of agency staff as NHS in London seeks £1bn savings

The use of professional ‘agency’ social workers: some findings and recommendations from recent research in England

This paper looks at some of the findings from empirical research exploring the impact of the increased use of agency staff within statutory social work sectors in England. Alongside the long-term expansion of contingent employees in the delivery of social work the article also acknowledges the more recent greater regulation of the agency social work role. Research clearly indicates that there remain both benefits and drawbacks to the use of contingent labour. Professional locum staff can provide a rapid and reliable response to ongoing staff shortages within core areas of social work; however, they can also pose potential risks and their use suggests an evasion of underlying structural problems relating to staff retention and recruitment. With more regulation of contingent staff and less demand for qualified social workers the period of expansion of professional agency employees appears to be at an end. Nevertheless at least sporadic demand is likely to always remain and the article concludes with some recommendations of how to best manage and utilize professional agency staff.

Axe falls on hundreds of Scottish nursing posts.

The NHS's own statistics show NHS providers in Scotland have chopped 711 whole-time equivalent nursing and midwifery posts in just six months and reduced the use of agency staff by a half in a year.

Staff Assist: A Resource to Improve Nursing Home Quality and Staffing

This study describes the creation and use of a web-based resource, designed to help nursing homes implement quality improvements through changes in staffing characteristics. Information on staffing characteristics (i.e., staffing levels, turnover, stability, and use of agency staff), facility characteristics (e.g., ownership, size), and quality (i.e., quality measures [QMs]) coming from 2,946 nursing homes were utilized in a simulation analysis. The simulation was used to predict changes in each of 11 QMs, based on changes in staffing characteristics for individual nursing homes using the web-tool. The website was visited 2,347 times in the first 6 months after it became operational. Evidence would suggest that it was useful in informing nursing home management of the importance of staffing and facilitating staffing changes; moreover, active users of the website showed improvements in quality, with an average of 5 of the 11 QMs improving by more than 1%. The web-based resource may be a feasible low-cost model that can be replicated, to provide further information for other areas of quality improvement in nursing homes.

Getting out what we put in: productivity of the English National Health Service

Many countries are incorporating direct measures of non-market outputs in the national accounts. For any particular output to be included there has to be data about it for two adjacent periods. This is problematic because the classification of non-market outputs is often subject to wholesale revision. We outline the challenges associated with classification changes and propose a solution. To illustrate we construct output and input indices and estimate productivity growth of the English National Health Service (NHS) for the period 2003-2004 to 2007-2008. Our index of output growth incorporates all care provided to NHS patients and captures improvements in survival rates, waiting times and disease management. We find that more patients are being treated and the quality of the care they receive has been improving. We implement our approach to dealing with changes as to how health services are defined and show what effect this has on estimates of output growth. Our index of input growth captures all labour, intermediate and capital inputs into health service production and we improve on how capital has been measured in the past. Inputs have increased over time but there has also been a slowdown since 2005-2006, primarily the result of a levelling off in staff recruitment and less reliance on the use of agency staff. Productivity is assessed by comparing output growth with growth in inputs, the net effect being constant productivity growth between 2003-2004 and 2007-2008.

Trust approves accelerated pay plan to fast-track band 5 nurses

An NHS trust is encouraging nurses to move from band 5 to 6 far quicker than normal to improve retention and reduce the use of agency staff.

Use of Agency Staff in Nursing Homes

This article describes the extent and degree of use of agency staff by nursing homes and examines the relationship between agency staffing levels and quality of care in a large sample of nursing homes (N = 3,876). The quality indicators came from the Nursing Home Compare Web site. It was found that many nursing homes used agency staff (approximately 60% used at least some), and a strong association between better quality and lower agency use existed for both nurse aides and RNs. The influence on quality for the highest levels of agency use, compared with no agency use, was clinically significant. On the basis of these findings, facilities considering using high levels of agency staff should do so carefully.

Considerations in the use of agency workers in care homes

Care homes must be careful to define the employment status of all of its workers to avoid penalties for not affording the proper protections for care home staff. Polly O'Malley considers the use of agency staff.

New Contractual Relationships in the Agency Worker Market: The Case of the UK's National Health Service

AbstractIn recent years, there has been a trend towards the negotiation of closer contractual relationships between employers and employment agencies. However, little is known about this change or its likely consequences. In theory, such relationships can benefit employers by lowering fees and also reducing many of the hidden costs associated with the use of agency staff by improving the effectiveness of placement matching. Against this is the suggestion that formal partnerships are unlikely to have a positive impact given the uncertainty of demand for temporary labour and broader tendencies for risk displacement in buyer–supplier networks. In this article, our aim is to explore this matter focusing on recent developments in the UK's National Health Service. We find that new contractual relationships such as framework agreements and master vendor contracts are having mixed effects. While they serve to reduce direct costs for employers in the short term, this has been at the expense of relationship building and improvements in placement matching. These developments are also found to have some potentially negative consequences for the agency workforce itself.