Challenges and Implications of Using Agency Nurses: A Case Study of Holliswood Care Center

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Challenges and Implications of Using Agency Nurses: A Case Studyof Holliswood Care CenterIn1,200-1,500 words, analyze the challenges and implications of usingagency nurses at Holliswood Care Center(HCC). Discuss the impact ofinadequate orientation, historical basis for current procedures, and evaluatetheir effectiveness. Provide recommendations for improvement, citing atleast4 academic sourcesinAPA format.

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A1) ProcedureNationwide there are currently 16,000 certified nursing homes caring for 1.4million residents (Zhao & Haley, 2011). Due to high nurse turnover rates andpersistent staffing shortages, many nursing homes utilize nurse staffingagencies to meet staffing needs. Holliswood Care Center (HCC), a 300 bednursing home, with five residential floors, located in Hollis, New York is notexempt from such staffing challenges. In fact, according to Yves Pascal,Director of Nursing (DNS) at HCC, “Usually, 2-3 LPN’s per shift are requireddaily” (Y. Pascal, personal communication, December 15, 2013). Agencynurses are approved to work at HCC once they submit a current physicaland complete an in-house facility orientation. During this orientation, agencynurses receive NewYork State mandated in-services, such as patient abuseandHIPPA.Thenursesalsoreceivespecificinstructionregardingemergencyprocedures,medicationpolicy,employeeconductandprocedures. However, specific unit policies and procedures, location ofspecific supplies are not included in the general orientation. Upon completionof the orientation, the agency nurse receives no further orientation orprecepting. Thus when an agency nurse enters HCC for their first shift theyare functioning independentlyand with limited knowledge. This is clearly aproblem, which varies in degree of potential danger to patients based on thespecific unit assignment. For instance, on the 7-3 shift there are 2 nurses perfloor, a charge nurse and a secondary nurse. In thissituation, new agencynurses have an opportunity to work in close cooperation, ask questions andseek guidance from a more seasoned and knowledgeable nurse. In contrast,the 3-11 and 11-7 shifts consist of a single nurse on each unit. The agencynurse’smainsourceofsupportisasingleRNSupervisorwhoseresponsibilityistoprovidenursingsupervisionfortheentirefacility.Therefore, agency nurses may find it stressful and challenging as they beginto work at HCC and for an inexperienced agency nurse, employment at HCCcan be downright disastrous for the nurse and patient. While the agencynurse orientation procedure has been in place for over 25 years, onlyrecently with the sale of HCC to new owners has this procedure become aproblem. The previousowner and administrator, Mr. and Mrs. Ahuja, usedone staffing agency, Match One Staffing, for many years which providedcompetent and regular agency nurses. The new owners have sought to

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increase profits by using staffing agencies based on competitive bidding,which has resulted in a supply of inexperienced nurses.Theproblemswithinadequateorientationandlack ofexperiencearereflected in unit administrative task failures and poor clinical outcomes. Whileno systematic in-house study has been conducted to determine the specificratesandoutcomesassociatedwithnewagencynurses,anecdotalinformation from nursing management provides an overview of the problem.RN supervisor, Nathalie Francios, who supervises the 3-11 and 11-7 shifts,reportslatemedications,medicationerrors,missedorincompletetreatments,poor time management leading to delays in assessment andcare, poor performance in emergency situations and inadequate assessmentskills (N. Francois, personal communication, December 15, 2013). Ms.Francois shared an experience with an agency nurse who worked thepsychiatric unit on the 11-7 shift (N. Francois, personal communication,December 15, 2013). The nurse called Ms. Francois and reported a patientwas complaining of feeling restless and anxious. Ms. Francois who wascaring for another resident who had just fallen, provided clear directions tothe agency nurse. Ms. Francois instructed the nurse to “Assess the patient’svital signs, obtain an oxygen saturation level and determine if the patientreceived their 6am Ativan”. According to Ms. Francois,the nurse reportedshe would check and call right back. Five minutes later Ms. Francois went tothe unit to assess the patient, the patient was not breathing and a full codewas initiated. Ms. Francois determined upon questioning the nurse that shenever checked vital signs due to looking for the pulse oximeter. The patientwas subsequently revived and transferred to the hospital via ambulance.This situation, illuminates the issues with using agency nurses who lackadequate and specific unit orientation, the experience and the requiredcompetency required to utilize critical judgment and function autonomouslyon a unit. In summary, the use of agency nurses is often unavoidable,however to facilitate the highest and most effective level of care for residents,HCC must change their agency nurse orientation procedure. The revisedagencynurseorientationproceduremustincludespecificunitbasedinformation and ensure competency level appropriate to the skill required atHCC.A2a) Basis for Practice

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The current orientation procedure for agency staff nurses was establishedbytheformerOwner/AdministratorandcurrentDNS,YvesPascal.According to Smith (2012), “One role of the nursing home administrator is torun the facility based on state standardsand to develop policies andprocedures that are in line with federal and state requirements.” At theinception of the agency nurse orientation policy, the administrator and theDNSdesignedaprocedurethatwouldmeetminimalstandardsincompliance withstate and federal laws. It is the DNS’s responsibility toensure nurses possess the clinical competency, support and resources toprovided effective nursing care. The DNS’s role regarding the orientationprocedure is to tailor an orientation in cooperationwith the in-servicecoordinator that meets the needs of the specific facility, unit and patients.However,aspreviouslydiscussedthegeneralorientationwasneverexpanded due to the competency and regularity of the agency nursesassigned from Match OneStaffing.A2b) RationaleFederal and state laws mandate minimum staffing levels in nursing homes.According to Harrington, Jacobsen and Stamatopoulos (2012), The FederalNursing Home Reform Act of 1987 requires nursing homes to providesufficient staff and services to attain or maintain the highest level of physicalmental and psychosocial well-being of each residents. In addition, poorquality in nursing homes has been demonstrated to be directly related to lowstaffing levels (Harrington, Jacobsen & Stamatopoulos, 2012). In compliancewith federal and state laws and to ensure safe and effective care forresidents, the use of agency nurses was instituted and a procedure foragency nurse orientation established at HCC. The agency nurse orientationwas designed to provide the nurse with the required mandated informationfor clinical assignment at HCC. According to Jooste and Prinsloo (2013), “Itisessentialthattheagencynurseisawareoftherelevantpolicies,procedures, resource material and documentation procedures”. The designof the orientation was also based on contractual agreement with Match OneStaffing. In particular, that nurses would be competent and capable ofacclimating tonew nurse unit environmentswith minimum assistance.According to Kirchner (2012), an agency’sscreening policy should becomprehensive and effective and be comparable to that of the recruitingorganization.

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