1. Introduction
The function of NHSScotland is to provide high-quality, timely care from the right staff, in the right place, at the right time ( SEHD 2002). This requires the supply of nurse staffing to match the demands of the service. It is recognised that the increasing use of complementary nurse staffing across Scotland is one option for maintaining the necessary supply.
Ensuring that the required numbers of nursing staff are maintained in spite of staff leave or increased activity is a part of daily life for operational managers and nurse leaders around the country. Support can be secured by other means, such as redeploying staff from another area to cover on a short-term basis, employing existing part-time staff for extra hours, or arranging overtime from full-time substantive staff, all of which are used to a greater or lesser extent across NHSScotland. When sources of staffing outwith the substantive workforce are required, however, there are two main sources - nurse banks and nursing agencies. These two terms are defined below (throughout this report, 'complementary staffing' is the collective term used for staffing from nurse banks and nursing agencies).
Nurse bank |
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A nurse bank is a group of flexible employees, contracted to work on an as-and-when-required basis, often at short notice, to cover for planned and unplanned shortfalls in staffing. The employees are referred to as 'bank nurses' and are NHS employees, recruited and trained within the parent NHS organisation. Bank nurses may work within a variety of clinical areas, depending on their relevant skill set and are paid at NHS rates through NHS payroll systems. Almost every area of NHSScotland has access to a nurse bank, although organisation of the bank varies widely. |
Agency |
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Agency nurses are flexible employees employed via a third party, a commercially-driven and profit-making organisation which the NHS engages to supply staff on an ad hoc basis. The NHS pays the agency a fee that includes an element of commission and the remuneration that will subsequently be paid to the agency nurse, according to the agency's pay structure. The staff supplied are referred to as 'agency nurses'. |
Aims
The aims of the project on which this report is based were to:
- conduct a mapping exercise of management arrangements for existing nurse banks across Scotland;
- establish why nurses join nurse banks and gain an understanding of the characteristics, motivation and experiences of this staff group as part of the workforce;
- research flexible employment options utilised outwith NHSScotland that may offer alternative models for consideration; and
- explore options to meet the Partnership Agreement commitment.
The project Steering Group considered the various options and developed a series of recommendations for implementation across NHSScotland.
Methods
The breadth of information to be collected required input from a variety of sources within and outwith NHSScotland, using a variety of methods. The Nationally Co-ordinated Nurse Bank Arrangements Report can be accessed at: http://www.scotland.gov.uk/publications/2005/03/20795/54069
Results
The findings were analysed and key issues and themes identified. The results and outcomes have been grouped according to these key issues and themes, summarised below.
1.1 Trends in supply and cost
There has been growth in the use of supplementary staffing, which accounted for 4.7% of the total nursing resource in 2002/03. The cost of supplementary staffing from the nurse bank source is almost half that of agency nursing sources. The supply from nurse bank has increased over the last four years.
1.2 Models of nurse bank
The majority of nurse banks operate more locally than the 16% supplying to NHS Board or operating division level. There was a desire to retain the local/personal perspective of nurse banks while achieving the benefits of single-system working.
1.3 Characteristics of bank nurses and user perceptions
Just over 14% of bank nurses had multiple nurse bank contracts within one NHS Board area. Fewer had multiple nurse bank contracts across NHS Board boundaries. Almost one fifth of bank nurses are seeking substantive employment.
1.4 Management and operational issues
Review of recruitment procedures, induction processes and ongoing performance management highlighted aspects of current practice that could be improved through the provision of support to bank nurses via line management arrangements, to ensure retention of staff within the organisation.
1.5 Continuing professional development
Mandatory training was offered by all nurse banks to a greater or lesser extent. The provision of professional training, however, was an area of dissatisfaction for bank nurses. One quarter of the nurse banks reported not funding bank nurses' attendance at professional training.
1.6 Information technology
Half of the NHS Board or operating division nurse banks use commercially available software systems, which are rated highly by users. The functionality and interrelationships of the various data components in the nurse bank systems are complex.
1.7 Use of agency
Four-fifths of charge nurses and team leaders noted concerns about the level of induction provided to agency nurses. Contrary to anecdotal reports, however, the charge nurses and team leaders did not indicate concerns regarding the impact of agency nursing on patient care. Most NHS Boards have strategies in place to reduce reliance on agency and the Best Procurement Implementation ( BPI) project will ensure that all NHS Boards have access to agency nursing through nationally-contracted agreements.