Union: Healthy Environments, Better Orientation Can Solve Temp Nurse Issue

The Los Angeles Times published an exposé this month about temporary nursing firms that fail to perform thorough background checks on nurses they hire to fill the temporary staffing needs of hospitals in California.

The article contains shocking tales of nurses with criminal records, suspended licenses in other states, or serious allegations of unprofessional conduct who nonetheless are hired by temporary agencies and sent to work at California hospitals. When unsuspecting hospitals have problems with nurses and instruct agencies to not send that individual again, nurses are often simply placed with another facility. Nurses fired by one agency can be easily hired by another.

The temporary nursing industry is a $4 billion behemoth. Agencies run the gamut from firms with strict background checks that provide hospitals with well-qualified and vetted staff to those that hire nurses without even conducting an interview.

Some hospitals interview and check the credentials of every temporary nurse brought onboard. Others rely on the agency to do that for them, particularly when nurses are needed on short notice, and the news that some staffing agencies may not be vetting nurses as hospitals expect has been received with horror.

The issue of agency nurses is particularly relevant in California, where nearly 6% of RNs are temporary and the use of agency nurses has been considered imperative for meeting the state's strict nurse-patient ratios.

I talked with a couple of executives from the newly-consolidated National Nurses United union about this issue. We discussed ways hospitals can avoid using temporary nurses, California's nurse staffing regulations, and whether NNU supports the creation of a national "bad" nurse registry.

Jean Ross and Deborah Burger, two of the three co-presidents of NNU, say temporary agencies can be a blessing for hospitals occasionally, but that the only way for hospitals to really solve the issue of being staffed with competent RNs is to focus on ensuring a stable, long-term workforce that is committed to the organization, their coworkers, and their patients.

They say the solution to solving nurse turnover and retention is to create healthy working environments, and they believe this is demonstrated by hospitals that address nurses' issues using fewer travel or temporary nurses. And they reject the argument that California's staffing ratios have increased the need to hire agency nurses.

"In California, as a result of the ratios, nurses have come back into the profession from other states," says Burger. "They have increased their hours. There was a shortage until we had the ratio law. At that point, nurses came back in to nursing. I think something like more than 50,000 nurses came back into California as a result of the ratio law."

While acknowledging there are occasional nurses who do not belong in the profession, Burger says most of the problems associated with temporary nurses result from the fact they often do not receive adequate orientation or time with preceptors at the facility to which they are assigned.

"Even if they were good nurses, it's difficult to expect they will know the politics, policy, and procedures of a certain facility. Even though the practice is similar, it's usually the politics and policies and layout that get people into trouble," says Burger.

This is why NNU is supporting a bill currently in the California legislature that would require organizations provide ample orientation to temporary nurses and ensure their competency before they are allowed to practice at the facility.

For those so called "bad" nurses, Burger does not support the creation of a nursing registry that would track nurses nationally. She believes this is a function of the state Boards of Nursing that should receive appropriate funding to be able to fulfill their responsibilities.

"I'm all for that making sure patients are protected," says Burger. "That's why a third-party clearing house like the state Board of Registered Nursing should be the authority body. They are the ones who give the temporary nurse the license in the respective state."