HD13 - Temporary Nursing Services
Executive Summary: A. Study Overview This study was initiated by the passage of House Joint Resolution No. 322 to determine the utilization of temporary nursing services by health care facilities and the impact of such utilization practices on the cost and quality of services provided in such facilities in the Commonwealth of Virginia. The Department of Commerce, the Department of Health, and the Department of Health Professions, through the means of research, a public hearing, and written comments, reviewed the nature of temporary nursing services and their unregulated effect on the public. The Departments' recommendation is based on an extensive analysis of this information. B. Key Findings 1. Temporary Nursing Services (TNSs) are used extensively throughout the Commonwealth and can be a cost-saving mechanism for well-administered health care facilities that experience brief personnel shortages. 2. Nursing homes with a high level of Medicaid reimbursable patients report a greater impact from the use of TNSs as a result of Medicaid Reimbursement Schedule. 3. Temporary Nursing Services, due to their very nature, may provide less than desired services in long-term care facilities where not only physical care but also trust, security, and social interaction are important to residents. Temporary nursing service may be used more appropriately for short-term supplemental assignments while health care facilities monitor and actively recruit to meet their full-time staff needs. 4. There was evidence that some facilities fail to maintain adequate regular staffing, and thus rely too heavily, and at great cost, upon the temporary services. The hourly rate for a temporary nurse can run from 1-1/2 to more than twice that paid to regular staff nurses. 5. Well-organized and administered nursing services have a higher percentage of well-trained, well-oriented nurses. Health care facilities may more effectively regulate quality and cost by refusing to use nursing services whose standards are not high enough and whose rates are too high. 6. Every health care provider has the duty and the responsibility to establish and review qualifications of potential nurses and then accept or reject any health care professional offered them by a temporary nursing service. 7. When problems do occur, mechanisms are available for resolving the conflict. Complaints against nurses can and should be reported to the Board of Nursing when unprofessional behavior occurs, and a contract between the vendor and the provider should allow legal avenues for grievances to be processed. C. Conclusion Temporary Nursing Services are widely utilized in the Commonwealth and such utilization may affect cost and quality of health care in facilities which use such services, if the facilities are lax in maintaining good business and health care practices. However, evidence also demonstrates that good business practices on the part of health care provider facilities will limit or remove risk to the public interest from TNSs. Testimony from some health care providers recommending an outright ban on TNSs or a cap on charges would be an improper and unnecessary intrusion into otherwise legal business enterprises. The Department of Commerce, the Department of Health, and the Department of Health Professions conclude that government intervention would not address the problems which are primarily marketplace in nature. D. Recommendation The Departments therefore recommend that temporary nursing services and health care providers continue to work together to follow guidelines presented by the American Nurses Association on the use of supplemental nursing services, in order to ensure that quality of care is not jeopardized and that temporary nursing services are effectively utilized. |
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