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Nursing Agencies – Factors to Consider

Facilities’ utilization of nursing agencies continues to remain a fact of life in a great number of healthcare facilities. Yet, their use is controversial.

The decision of a healthcare facility to use or not use an external staffing service, or agency, is one which generates a great deal of discussion. A variety of views are often expressed, including:

  • “Nursing agencies are expensive.”
  • “The quality of staff from an agency cannot match the quality of our own staff.”
  • “The agencies are stealing the nurses out of the hospitals.”
  • “We couldn’t survive without our partner agency.”
  • “As our patient census changes, we rely on our agency to provide Just in Time staff”
  • “Having a relationship with an agency is part of our facility’s Risk Management and Contingency Planning Process.”
  • “We are trying to hire more full time staff and will have less need for agency staff in the future.”
  • “Agency staff are as much a part of our facility as our own casual staff – there is no difference.”
  • “Agency staff cannot contribute as much as our own staff, since they do not know our facility, its policies and processes.”
  • “Having an open, honest relationship with our agency allows me to focus on patient care issues – not the headaches of scheduling.”

Even within a healthcare facility, there are varying opinions. How does one decide? Here are some points for consideration.

  • The decision to use the services of an agency should be made in the context of a facility’s overall Human Resources Plan.
  • The decision should be made on the basis of fact, not feeling.
  • Knowing that agency use will likely be only a very small percentage of the total number of paid hours within the facility, establish the circumstances under which an agency will be used.
  • If an agency is to be used, even minimally, a formal contract should be in place to define responsibilities, limit institutional risks, and lock in prices.
  • Define Quality Indicators to evaluate agency service.
  • Learn from businesses and other sectors of the economy that use “temp agencies” as to their pros and cons.
  • An Invoice from an Agency easily identifies the Cost of the service, which can be compared against the Value of the service that was provided. Consider doing the same for a hospital’s own staff and ask – “Nurse Jane from my hospital’s Casual Pool cost me $xxx per shift; did I get value from her services?”
  • Quantify all of the hidden costs associated with hiring, paying and managing a Facility’s own part time staff. Add in all benefits costs, sick time cost and replacement, orientation and training costs, liability insurance costs, statutory costs like CPP, EI and WSIB, in addition to the base wage rate. Compare that to the invoiced cost from an agency nurse.
  • Consider establishing a formal contract with an agency now as part of the facility’s Risk Management planning for Pandemics, Regional Emergencies, Flu Outbreaks, Transit Job Actions, etc. to know that the agency will be committed to the healthcare facility before other non-contracted clients.
  • Healthcare labour supply has rarely equaled demand. Having an agency relationship is rather like buying insurance. Some people believe in insurance and others do not.
  • How do you value having flexibility in staffing? Just in Time concepts have merit elsewhere and likely do in healthcare facility staffing as well.
  • Quality Assurance initiatives should be established to ensure an agency’s level of patient care services is consistent with the facility’s standard. Managers shouldn’t settle for a “warm body” from the agency when you could map out expectations before hand. Open, honest, documented relationships will yield true partnerships instead of just being able to say, “We got through that shift OK.”

A healthcare facility’s staffing needs change over time. Working with an agency that understands this and has a deep respect for the challenges facing the facility day in and day out, will yield a relationship built on trust and true partnership. It will yield a relationship tailored to the specific facility’s belief in the role of agency staff.