Temporary nursing staff - cost and quality issues.
OBJECTIVE
This paper is a report of a comparative study of temporary and permanent staff work activity, cost and quality of care.


BACKGROUND
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?


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Quantitative Methods Leeds Health Sciences Institute Health and Social Care Centre, Leeds University, UK. k.hurst1@ntlworld.com
Keith
K
Hurst
Adam
A
Smith
D001509:Bed Occupancy; D002983:Clinical Competence / Q000592:standards; D006801:Humans; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000191:economics* / Q000458:organization & administration / Q000600:supply & distribution; D016524:Parental Leave; D010561:Personnel Staffing and Scheduling / Q000191:economics* / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D018582:Sick Leave / Q000706:statistics & numerical data; D013647:Task Performance and Analysis; D006113:United Kingdom; D014940:Work Schedule Tolerance; D016526:Workload