Temporary Nurses and Patient Safety

1966 Nurses Strike - San Fransisco Where It Al...
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California is the only state that mandates minimum nurse to patient hospital staffing ratios. So when hospital nurses go on strike in California, the hospitals postpone elective surgeries in order to reduce patient numbers, and hire temporary nurses to maintain the mandated nurse staffing levels. The recent patient death from a medication error by a temporary nurse at Alta Bates Summit Medical Center in Oakland during a nurses’ strike, has drawn attention to temporary nurses and patient safety.

Late last month more than 23,000 nurses at Sutter, Kaiser, and Children’s Hospital Oakland had a one-day planned strike protesting proposed cuts in employee benefits and patient services. Sutter hospitals locked out the nurses for four days after the strike, saying they had to sign five to eight day contracts with the firms who brought in the temporary nurses. During the lockout a temporary nurse reportedly administered a nutritional supplement through a central line (into the bloodstream) instead of through an abdominal feeding tube. Hospital spokespersons have called it a highly unusual medication error, but quickly added it didn’t have anything to do with the lockout or the use of temporary nurses. Nurses’ union officials have said the patient death wouldn’t have happened if they hadn’t been locked out after the strike. They have filed a complaint with the National Labor Relations Board over the lock out. And they have stated that it reveals that the use of temporary nurses endangers patient safety.

So what is the evidence in terms of temporary nurse staffing and patient safety and quality of care? An oft-cited study by Linda Aiken published in 2007 in the Journal of Nursing Administration, did not find that hospital patient safety was negatively affected by use of temporary nurses. However, her study used survey/self-reported data, and only included Pennsylvania hospitals. A recent large national study found that emergency department medication errors associated with temporary staff were more frequent and more likely to be life-threatening than those by permanent staff (Pham, et al, Journal of Healthcare Quality, July/August 2011). The authors point out that the use of temporary nurses (and other hospital staff) is on the rise due to work-force shortages and perceived cost savings to hospitals.

3 thoughts on “Temporary Nurses and Patient Safety

  1. RN is RN is RN. Full time, part time, PRN, float, temporary, travel, strike… They are all STILL a RN. Enteral feeding in a central line? It’s just sketchy. If one is unable to have minimal orientation to a unit with minimal experience in that kind of unit… Don’t do strike/travel nursing. My empathy runs low for that poor nurse, but I don’t think travel/strike/temporary nurses as a whole should be faulted, even if passively so. It should be the hospital and agencies responsibility to put the right people in the right places, and the nurses responsibility to recognize if they are not able to do the job in less-than perfect conditions.

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  2. I work for MGA Healthcare, and I’m put in this position on most assignments. Why can’t agencies just assign you to one floor or unit, so you can gain experience and knowledge of one floor. I have to work on floors where I’m the only one from an agency, and I feel that the permanent CNA’s take advantage of me. it’s too much to handle sometimes. They get to select and exchange patients, so I get the full assist patient’s, while they get the sitter jobs, and they don’t offer breaks. Why can’t patient’s families have a say in who cares for their love one’s, I’ve been requested several times, but never see that patient again. It’s wrong. 98% of my patient’s improve and connect with me, and it’s sad to see them struggle with nurses who have no sympathy. I also have to handle the fact that Hospital staff make almost double what you get from agencies. But twice the work is required of me. All hiring managers are aliens. So you can’t get a permanent job with benefits. And nobody cares about all the Discrimination. I can’t and the patient’s can’t understand the words that are coming out of their mouths.

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