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Editor's
Note
Recently, I was part of a large group of concerned hospital leaders who discussed potential solutions to the nursing shortage and what we all need to be doing right now. In the midst of the questions, a novice CEO asked for my opinion: "Do you think using registry is good or bad?" Well, a little of both, I suppose. Like chocolate, when taken in small, exquisite doses, it can be wonderful. However, if one sits and consumes an entire box, it is not good for us at all. Exploring the market forces that have changed the role that temporary nurses (registry or traveling nurses) play in our patient care delivery system is something we all can learn from. However, understanding the role that registry plays in staffing patient care today requires some careful examination. It is important to consider registry from two different perspectives: First, the hospital and its nursing staff that need registry and, second, the nurse who chooses to work registry. Each has different needs. As you can imagine, these points of view differ greatly. In the beginning, the use of registry was designed to respond to patient care needs that occurred in the peak of our season. This was generally thought to be a wise and prudent alternative to hiring for the busy season, only to lay off excess staff when census dropped. At most, perhaps one registry nurse worked a given shift, and was surrounded by nurses familiar with the hospital, patients and physicians, to serve as resources. It made sense, didn't it? For managers, there was always some nagging concern that registry nurses might not measure up or have the same clinical quality as our own staff. Or perhaps nurses with performance problems would find a haven in a registry where accountability was limited by the eight- to 12-hour shifts in different hospitals. Well, it is definitely a different story now. Many nurses have found relative freedom and autonomy working with temporary labor arrangements, either short-term "a shift at a time," or longer-term traveling contracts. While some of the comfort, stability and relationship-building that come from going to the same place every day may be missing, it seems the personal control over one's work life and career self-management may compensate for it. Perhaps there are some lessons in this for hospitals? Although it may benefit the nurse who chooses this newfound freedom, what has been the overall impact on patient care? It goes without saying that a temporary nurse is better than none, which is the most likely alternative. There is no more overtime to be had. We've stretched ourselves beyond reason. However, hospitals are seeing temporary staff making up an increasing percentage of their bedside caregiver hours. The financial impact of this shows up on every hospital's bottom line. It is a slippery slope, no doubt. My growing concerns regarding hospitals' dependence on registries are many. First is the injustice that temporary nurses make far more money than the hospital's core RN staff. These are the very nurses who end up serving as a resource, guide and troubleshooter for the temporary nurse, and supposedly represent the clinical heart and soul of a hospital. There is something wrong with this picture. People might ask why an organization would pay a premium for a nurse whose commitment to the organization does not extend beyond the shift? From a patient care perspective, how can you risk quality and safety by placing so much responsibility in the hands of a nurse who is most likely unfamiliar with the setting, policies, physicians and co-workers' abilities? Not only is this unfair to the patient, but it also is unfair to the nurse. Nonetheless, temporary nurses provide a vital source of clinically expert nurses in almost all specialties. The bottom line
is that all our energies are best spent investing in the pipeline
for nurses, so that registry/temporary nurses can return to the
role of adjunct staff. Our investment, financial and emotional,
needs to be directed at the core-committed staff who, day after
day, are the ones we all depend on. That is where we will find patient
care that functions like a well-oiled machine, with every part knowing
its role and performing it to perfection.
What
do you think?
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NEWS
AND TRENDS | CAREER
CENTER | EDUCATION
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