Temporary emergency room staff members "are associated with more severe medical errors" than their permanent-employee counterparts, a group of Johns Hopkins researchers has found.
Temporary ER staff associated with more severe errors: study
These temporary workers are twice as likely as permanent employees to be involved in medication errors that harm patients, according to a Johns Hopkins news release about the researchers' study. The researchers' findings appear in the July/August issue of the Journal for Healthcare Quality.
Temporary ER workers may be unfamiliar with hospital policies, which could hinder teamwork, and they're also less likely to speak up if they notice problems, the researchers noted. However, the blame for the errors may not be the fault of the temporary employees alone, said Dr. Julius Cuong Pham, the study's leader and an assistant professor of anesthesiology and critical-care medicine and emergency medicine at the Johns Hopkins University School of Medicine in Baltimore.
"It may not be the temporary staff that causes those errors but a function of the whole system," he said.
The study in particular calls into focus the practice of hiring temporary nurses, noting that they are a cheaper option than permanent hires. Temporary nurses—a growing part of the hospital workforce—earn more per hour but don't receive benefits, the researchers noted.
Pham said hospitals don't have many options in addressing unfilled positions. The alternative to hiring temporary staff members is leaving those positions unfilled, he wrote in an e-mail.
Last week, Parkland Memorial Hospital in Dallas announced that it would hire several temporary ER nurses as part of a corrective-action plan created after CMS officials notified the hospital that they had found safety concerns that posed an "immediate and serious threat to patient health and safety." Parkland faces removal from the Medicare program unless the safety issues are addressed to the CMS' satisfaction by Sept. 2.
Miriam Sibley, chief nursing officer for Parkland, said the hospital only hires staff on a long-term basis, not shift by shift. The hospital also has instituted a number of safety measures, including computerized physician order entry, smart pumps and having a pharmacist present in the emergency department, to help avoid safety issues.
"Additionally, medication errors are tracked through an online tool, so we would be aware of any increases," Sibley said in an e-mail.
Hospitals, to ensure safety, should allow ample time for orientation so temporary workers can grow comfortable with local personnel and hospitals' culture, procedures and information management systems, Pham suggested.
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