title: Factors influencing agency nursing and moonlighting among nurses in South Africa.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, Johannesburg, South Africa; laetitia.rispel@wits.ac.za.
authors.forename: Laetitia C
authors.initials: LC
authors.lastname: Rispel
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, Johannesburg, South Africa.
authors.forename: Duane
authors.initials: D
authors.lastname: Blaauw
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Tobias
authors.initials: T
authors.lastname: Chirwa
authors.affiliation: Department of Sociology, University of the Free State, Bloemfontein, South Africa.
authors.forename: Katinka
authors.initials: K
authors.lastname: de Wet
mesh_terms: D000328:Adult; D000368:Aged; D003284:Contract Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data* / Q000600:supply & distribution; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: South Africa; agency nursing; human resources; moonlighting; nurses; overtime