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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000368945.98560.20
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Call for Better Screening of Temporary Nurses

Potera, Carol

Section Editor(s): Pfeifer, Gail MA, RN

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E-mail: ajnNews@wolterskluwer.com

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Abstract

Recent report questions competence of some per diem nurses.

One solution to the chronic nursing shortage that plagues health care facilities is hiring nurses from temporary staffing agencies. Filling shift gaps with per diem temporary nurses prevents burnout among regular staff and having to pay costly overtime. An investigative report from the December 6, 2009, Los Angeles Times and the independent investigative journalism group ProPublica, however, questions the competence of some temporary nurses and the safety of patients in their care. (Read the story at http://bit.ly/6y8sU5.) Skipping from job to job makes it easy for subpar nurses to hide their misconduct and its consequences, according to the investigators.

Cases in point. Using personnel files, court documents, disciplinary records, and interviews, the reporters described poor screening practices at agencies that supply temporary nurses. Among the situations described, three California firms employed the same nurse whose license was suspended in Minnesota for stealing drugs at a series of temporary nursing jobs. Even after hospitals file complaints, agencies still shuffle incompetent nurses from hospital to hospital, including one nurse accused of ignoring patients and sleeping on the job—and who had convictions for prostitution and carrying a concealed weapon. Nurses with complaints on file at one agency readily find work through other firms, according to the investigation. Temporary nurses are in such demand that some agencies hire them without even conducting a phone interview.

In a letter to the Los Angeles Times on December 10, 2009, the American Staffing Association, an industry trade group in Alexandria, Virginia, said that the report "raises some legitimate concerns, but the focus was on exceptions rather than the rule." They point to a study in the July–August 2007 Journal of Nursing Administration that combined survey answers from Pennsylvania nurses with hospital data to determine that temporary nurses were as qualified as the permanent staff and helped to improve patient outcomes.

There's a national database that provides information on incompetent physicians to state and federal agencies and certain health plans. Similar information on nurses was supposed to be added to the database decades ago, but efforts to do so stalled; according to ProPublica's own report on this issue (http://bit.ly/4oIQL4), the administration says the information should be available this year. However, unless hospitals are given access to the database, and are willing to designate temporary staffing agencies as their own agents, it may be difficult for crucial groups to access the information.

Carol Potera

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Fast STATS

* $161: The average cost per prescription purchased in 2006, compared with $79 in 1996, according to the Agency for Healthcare Research and Quality (AHRQ; http://bit.ly/69m0BC).

* 6.3%, or $344 billion: The growth in overall hospital costs from 2004 to 2007, according to the AHRQ (http://bit.ly/7bTX6). The most rapid increases in total hospital costs for this time period were for these top [10] procedures:

* Bone marrow transplantation (up 84.9%, to $1.3 billion)

* Open prostatectomy (up 68.6%, to $1 billion)

* Aortic resection (up 38.5%, to $1.9 billion)

* Cancer chemotherapy (up 33.2%, to $2.6 billion)

* Spinal fusion (up 29.5%, to $8.9 billion)

* Lung lobectomy or pneumonectomy (up 29.2%, to $1.8 billion)

* Incision and drainage of skin (up 28.6%, to $1.1 billion)

* Knee arthroplasty (up 27.5%, to $9.2 billion)

* Nephrotomy or nephrostomy (up 25.3%, to $683 million)

* Mastectomy (up 23.8%, to $660 million)

* 24.1%: The percentage of 838 U.S. girls and women ages 14 to 19 with a sexually transmitted disease—from a Centers for Disease Control study in the December issue of Pediatrics (http://bit.ly/5j6xNA).

* 44.1 million: The estimated number of people in the United States who will have diabetes by 2034 (up from 23.7 million now)—from a study in the December 2009 issue of Diabetes Care.

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