Employers are relying on temporary workers more and more throughout the workforce. From seasonal help at retail stores, to workers in landscaping, no one wants to commit to hiring full-time employees.

Temps, however, are showing up in places where you might not expect them. Many white collar jobs are now “screened,” even law firms use temps, although they call them “contract” employees.

But you may not suspect that the staff in the emergency room treating you after some trauma would be temporary employees. Well, guess again, the nurse handing the doctor your meds might be a temp.

They may present an increased risk of errors from insufficient training and orientation, and less familiarity with local culture and practice.

However, their impact, particularly in the emergency department where the risk of preventable medication errors is high, has not been established.

Why Use Temporary Staff?

The use of temporary staff in hospitals and other aspects of the health care industry is increasing due in part to work-force shortages and perceived cost savings.

Some hospitals are understaffed and unable to secure sufficient permanent staff. To cover all positions, they are forced to resort to temporary staff. The choice for the hospital may be to have an area, like the emergency department, work understaffed and either leave positions vacant, or require available staff to work longer hours.

Neither of these choices is optimal, and studies suggest both produce adverse patient outcomes. Vacant positions clearly produce the possibility of patients not receiving care when then need it, while overworked fatigued staff also increase the likelihood that a patient could receive negligent care.

Some hospitals look to temporary workers as a means of cost savings. Fewer permanent workers mean lower training, benefits and potentially salaries.

However, while they may save something on lower heath care benefits and vacations, failing to properly train temporary staff appears to have some correlation to the higher incidence of medication errors.

Adverse Outcomes

The study, Are Temporary Staff Associated with More Severe Emergency Department Medication Errors?published in the Journal for Healthcare Quality, found that the more harmful an outcome, the more likely the error was committed by temporary staff. The odds of temporary nursing staff being involved in the error increased monotonically as the severity of harm increased.

Temporary staff errors were more likely than permanent staff errors to affect a patient, require patient monitoring, result in temporary harm, and be life threatening.

The study noted that they might present an increased risk of errors from insufficient training and orientation, and less familiarity with local culture and practice.

Emergency Department

The study points out that emergency department may by particularly ill suited for the use of temporary staff. As the study frames it, “The ED is a unique environment with a high risk for medication errors. This is likely due to increased severity of disease, the rapidity with which life-saving decisions must be made, the medical complexity of patients, and overcrowding.”

Because most ERs have to operate as a well-organized system, the use of temps is problematic, as they often lack the training and may not be fully familiar with the procedures and operational behavior of a particular emergency room.

The study notes, “errors are generally the result of multiple ”system” factors within an organization and temporary staff may be especially vulnerable to these system errors.

Temporary staff is often not familiar with local staff, care management systems, protocols or procedures. Thus, they may be at risk for ineffective communication and teamwork, difficulty retrieving medical information, and not knowing what procedures to follow.”

Possible Solutions

The authors of the study note that some hospitals are left in a somewhat untenable situation, “Given the evidence supporting enhanced nurse staffing and fatigue on performance, it is unclear whether temporary staff pose a greater or lower safety risk than insufficient staffing or overworked/fatigued staff.”

The study suggest that healthcare organizations should work towards having sufficient of permanent staff to avoid the need for temporary staff and that if they must resort to temporary staff, they need to be “thoroughly familiarized with local personnel, procedures, and operating systems.”

This, of course, undercuts the savings some organizations may be trying to achieve by the use of temporary staff in the first place. But it also highlights the illusory “savings” that they may obtain with temps.

A single, severely adverse patient outcome, in other words, a patient injured or killed by negligence, could easily wipe out several years of these savings. And even less severe mistakes, those that only require additional in-patient care, or prolonged treatment, could add up to significant expenditures over time.

The study indicates the need for additional research and especially a greatly improved nationwide reporting system for error reporting. It is difficult to improve a system when it is difficult to even isolate what the problems are.

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