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Are Agency Nurses the Answer? End the Culture of Agency Use

The issue of agency use has been a thorn in the side of chief nursing, executive, and financial officers as well as human resource leaders for more than 3 decades. The concerns have remained the same: high cost, lack of commitment to mission, physician and patient satisfaction, and the extra burden placed on existing staff, which accelerate turnover. As the economy and trends have changed over the decades, so too have the level and nature of supplemental staff. Gone are the days of scheduling agency staff on a shift-by-shift, day-by-day basis. In most hospitals, that has been replaced with 13-week travel nurse or local agency nurses on contract for 2 weeks to 6 months.


There is a general acknowledgment that contracting with agency staff has raised the level of care and professionalism and has provided some short-term peace of mind. However, the shift to longer contracts for supplemental agency nurses has created a new set of problems: the evolvement of a culture of agency dependency with its associated costs.


So are you one of those hospitals that are agency-dependent? I have identified 10 questions to determine if there is a culture of agency use developing in your facility.


1. Do you allow agency staff to extend or renew contracts?


2. Do you have any agency nurses who have been at your facility for more than a year?


3. Do you adhere to request policies for additional agency staff?


4. Is a vacant position ever "held" so that an agency nurse can remain?


5. Are agency nurses permitted to compete for time off with your own permanent staff?


6. Does each stakeholder know the exact cost of an agency nurse?


7. Does each unit manager know what is spent each month on agency staff, both collectively and in their unit?


8. Is there a system in place to monitor or curb agency nurse overtime?


9. Is there an alarm system in place when agency use reaches a certain point?


10. Are there routinely scheduled meetings between administration, nursing, finance, and human resource to discuss staffing and recruitment?



Any strategy to lower or eliminate agency nurse use requires the involvement and commitment from all stakeholders: administration, nursing, human resources, finance, education, and marketing. Agency nurse utilization is not simply a nursing department issue, and the frequently mandated "cut the nursing budget" will not lead to the desired results.


After working with hospitals nationally we have determined that a culture of agency usage can be eradicated only if there is:


* acknowledgement that a culture of agency use exists


* clarification of accountability for agency nurse use


* improvement or overhaul of the process for scheduling staff


* systematic approach to convert agency nurses to staff


* support and options provided to unit managers


* immediate reduction among the units that are the highest users


* elimination of all agency use by low end users


* optimization of the prn/float pool


* transformation of the recruitment process


* implementation of an agency use "alarm system"



By developing, implementing, and monitoring a systematic approach to culture change, the chain can be permanently broken, and the bottom line can be enhanced. Working together, the administration can stop the bleeding and blaming while improving not only staffing but also, ultimately, patient care.


Source:AdviseMentor Newsletter, a publication of AchieveMentors Inc. Article was written by Peter Callan, RN, and reprinted with permission from Leslie Furlow, MSN, PhD, president of AchieveMentors Inc. For more information, visit the Web site at


New Web Site Illuminates the Health Policy Maze

Caught in the health policy labyrinth? A new Web site,, aids policy makers, analysts, healthcare professionals, the media, and concerned laypeople as they explore the intricacies of the US healthcare system, strive to understand what works and what does not, and design approaches for improving it.


The easy-to-navigate site, created by the Urban Institute's Health Policy Center, provides a rich array of research, commentaries, congressional testimonies, statistics, and need-to-know facts. Special sections provide tables and charts highlighting timely statistics, and the Fact of the Day spotlights a policy nugget each weekday.


The site presents the Institute's latest work on topics such as the following:


* state and federal healthcare reform;


* public coverage, including Medicaid, SCHIP, and Medicare;


* private health insurance;


* the uninsured;


* people with disabilities;


* long-term care;


* vulnerable populations, including racial and ethnic minorities, immigrants, and those with high medical needs;


* quality of care; and


* access to care.



Source: June 2, 2008, press release from the Urban Institute's Health Policy Center (


How Do Nurses Spend Their Time?

The summer 2008 issue of The Permanente Journal provides an article by Hendrich et al that details how a sample of 767 nurses in 36 hospitals spend their time. The authors identified 3 main targets for improving the efficiency of nursing care: documentation, medication administration, and care coordination. To access the article, go to