Temporary emergency room nurses who are unfamiliar with their surroundings may inadvertently be a threat to the patients they serve, according to new research from Johns Hopkins University School of Medicine.
The study found that the temporary help was twice as likely as permanent staff to be involved in medication errors in the hectic and fast-paced environs of the ER. However, the study's authors stressed that temporary nurses should not necessarily be blamed for those shortcomings, which the researchers said are complex and diffuse.
"A place that uses a lot of temporary staff may have more quality of care issues in general," study leader Julius Cuong Pham, MD, an assistant professor of anesthesiology and critical care medicine and emergency medicine at the Johns Hopkins University School of Medicine, said in a media release. "It may not be the temporary staff that causes those errors but a function of the whole system."
The nation's hospitals have become more reliant on temporary nurses and other temporary clinical staff because of widespread shortages of healthcare professionals. Temporary nurses generally earn higher wages than their permanent coworkers, but they don't receive benefits, and could be cheaper in the long run.
"It's one of those necessary evil sorts of things," Ann Marie Papa, RN, president of the Emergency Nurses Association, tells HealthLeaders Media. "Temporary help can be tremendous when you are struggling with nursing shortages but the key is that these temporary nurses are properly trained and they have proper orientation, mentoring, and supervision."
The Johns Hopkins study examined a national Internet-based voluntary medication error reporting system and data from 2000 and 2005, encompassing nearly 24,000 emergency department medication errors among 592 hospitals.
Medication errors made by temporary workers were more likely to reach the patient, result in at least temporary harm and also be life-threatening, they found. The findings appear in the July/August issue of the Journal for Healthcare Quality.
Pham said temporary personnel are often not familiar with local staff, care management systems, protocols, or procedures. This may hamper communication and teamwork that causes them difficulty in retrieving important medical information and leave them unsure of which procedures to follow.
Temporary help may be less likely to speak up if they see problems and also lag behind the latest knowledge because, unlike permanent employees, temps typically manage their own continuing education.
Papa agreed with that assessment, and said it underscores the need for hospitals to embrace their temporary staff for the time they're there, and give them the same consideration and training they would offer permanent staff.
"It is up to the organization to ensure that the new nurses, the temporary nurses, the new graduates, are properly trained about procedures, protocols, and the culture of the hospital and the department in which they are working," Papa says.
It starts with frontline charge nurses making assessments of the people they supervise to ensure their competency. "Watch them put the IV line in. Watch them interview a patient. Someone has to verify their competency," Papa says.
That alone is not enough, she says. Temporary staff needs to know they have the support of management. "Sometimes temporary nurses tell me 'I go into an organization and nobody talks to me.' There is the reason why the nurses are going to have an error, because they are afraid to ask a question," Papa says. "We have to embrace temporary nurses and help them and be their life line. There should be a charge nurse or a supervisor ready so that if the temporary nurse could say 'I am not familiar with this' or 'I don't know your policy on this,' they are ready to help."
"You can take a nurse from the same hospital and move [him or her] from the ICU to the post-anesthesia unit and they still need to have a different type of orientation because the equipment and the style of patient is different. It's important that the organizations recognize this. Proper mentoring and supervisions are critical," she said.
John Commins is the news editor for HealthLeaders.