'You're more your own boss': nurses' experiences of agency work

What do we know about our agency nurse population? A scoping review

BACKGROUND

Nurse staffing shortages are often managed by using temporary staff. This review discovers what is known about nurses who choose to work in this way.

PROCEDURE

A literature search found eight international studies investigating the lived experience of agency nurses.

RESULTS

Nurses actively choose agency nursing to work flexibly and avoid office politics or as a career stop-gap. However, respondents describe feeling isolated, working difficulties with permanent staff and fewer opportunities for training.

CONCLUSIONS

Though participants described positive reasons for choosing agency nursing, there were significant downsides. The findings must be viewed in the context of the continued feminized nature of the nursing profession as care responsibilities were cited as a reason for choosing this study pattern. However, the lack of security and provision of adequate pensions and career advancement are considerable issues. The costs of using agency staff are high and consideration must be given to encouraging these nurses into substantive contracts. These individuals show considerable resilience, flexibility, and varied expertise. Such qualities are vital for health care in the 21st century and understanding why they opt out of permanent nursing will enable employers to adapt practices to harness this. Suggestions for practice and further research are presented.

Nursing from the casual pool: Focus group study to explore the experiences of casual nurses

The use of flexible non-contract nursing staff is increasing in Australia and in other countries where there is currently a nursing shortage. There is sparse empirical evidence relating to the experience of these nurses. This focus group study with six groups of enrolled and registered nurses in one regional health authority in New South Wales reports on the challenges and rewards of working through the casual pool. The textual data were coded and reported in themes and subthemes; the overarching theme is balance of social and professional life, while subthemes are social politics, nursing work and professional performance. The results reveal that nurses who work from the casual pool have insight into the work environment and culture of clinical teams that is untapped formally. They have little or no chance to provide clinical teams with feedback or receive feedback on their own performance. The consequence of this study has been the development of a two-way performance intervention to promote high standards of care from nurses who work from the casual pool and the promotion of safe clinical environments and cultures.

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers. This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work. Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate. Three major themes emerged from interview data: planning for ward allocation, communication and professionalism. In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff. Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses. For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration. A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles. The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled--with the aim of providing quality patient care.

Agency-nursing work: perceptions and experiences of agency nurses

This paper explores agency-nursing work from the perspective of agency nurses to gain in-depth understanding of their clinical practice, their relationships with the employing agency, hospitals and permanent nurses, and their professional status. For this study, individual interviews were conducted with ten agency nurses who were registered with one of three nursing agencies in Melbourne, Australia. Five major themes emerged from interview data: orientation, allocation of agency nurses, reasons for doing agency-nursing work, experiences with hospital staff, and professionalism. The findings reveal that the primary reason for nurses engaging in agency-nursing work is for the flexibility it offers. While agency nurses described a commitment to professionalism, the findings emphasise the need to establish effective communication networks between agency nurses, nursing agencies and hospital institutions. Such communication between stakeholders is important to facilitate discussion of issues such as appropriate notification of shift availability, appropriate assignment of work and recognition of the agency nurse as a valuable member of the health care team. In particular, the findings highlight the importance of comprehensive orientation and education for agency nurses to shift the focus of their daily work from task completion to more comprehensive patient care.

Agency nursing in Melbourne, Australia: a telephone survey of hospital and agency managers

BACKGROUND

Agency nursing is a poorly understood and under-researched phenomenon. Despite the considerable costs and possible benefits of using agency nurses, little is known about the nature of agency nursing from different perspectives, including hospital and agency managers.

AIM

To describe the professional relationship between hospitals and nursing agencies, utilization trends of agency nurses, and institutional policies relating to the employment of agency nurses.

METHODS

A telephone survey was conveyed to managers of 70 acute hospitals (service purchasers) and 26 agencies (service providers) to provide baseline information on the utilization of agency nurses in acute hospitals in Melbourne, Australia. Introductory telephone calls were made to the chief nursing officers of the hospitals and the chief executive officers of nursing agencies in order to explain and seek approval for the proposed project. Approval to conduct telephone interviews was obtained from 30 acute hospitals and six agencies, representing a response rate of 43% and 23%, respectively. Separate questionnaires were used for the two categories of respondent. In some cases the questionnaire could not be completed using the telephone and a copy was then sent by post for completion.

RESULTS

Findings revealed the high utilization of agency nurses in hospitals, the limited nature of continuing education for agency nurses, tensions between matching agency nurse qualifications with acute specialty needs and the notion that agencies preferred nurses to be flexible in their work assignments.

CONCLUSIONS

The study was limited by the fact that the final sample was small (30 hospitals and six agencies), and therefore may not be representative of the wider population of Melbourne hospitals or agencies. However, it provided evidence on the utilization of agency nurses in public and private hospitals that will help shape policy on the regulation of the agency nursing workforce.

Working together but apart: barriers and routes to nurse--physician collaboration

The authors argue that the aircraft safety model may be of limited relevance for health care and suggest strategies for greater collaboration between nurses and physicians in the care of patients.