Perceived Advantages and Disadvantages of Using Agency Staff Related to Care in Nursing Homes: A Conceptual Model

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ABSTRACT

Data from 3,946 nursing homes (66% response rate) were used to examine the advantages and disadvantages of using agency staff. A conceptual model showing potential reasons for the relationship between agency use and care quality was also developed. Fifty-nine percent of nursing homes used some agency staff (i.e., RNs, licensed practical nurses, nurse aides) in 2006. The conceptual model and empirical analyses show that agency staff likely influence other staff, facility operations, and residents. Administrators listed more disadvantages than advantages of using agency staff.

Despite federal regulation and extensive state oversight, many of the nation's 17,000 nursing homes still provide poor quality of care (Institute of Medicine, 2001). No panacea likely exists for improving this, but most experts in this area would cite nursing home staff as essential change agents. However, our understanding of what staff are needed to help provide high-quality care is still underdeveloped; for example, the impact of agency staff is unknown. Our understanding in this area consists almost entirely of the effects of staffing levels (Harrington & Swan, 2003) and turnover (Castle & Engberg, 2007). That is, high staffing levels and low turnover are associated with high quality of care. Our understanding of what staff are needed to help provide high-quality care may be further improved by examining agency staff. Agency staff are used by many nursing homes, yet few studies have examined the impact of agency staff use.

Agency staff are workers who belong to a firm that subcontracts their services to another firm, including nursing homes, assisted living, and home care. These firms are often called staffing agencies, or more simply, agencies (Ward, Grimshaw, Rubery, & Beynon, 2001). Agency staff are hired by nursing homes to work on a temporary basis. Agency staff can be useful for nursing homes. For example, a nursing home experiencing an unexpected shortage of staff, due to turnover or absenteeism, can use agency staff to quickly fill these available positions. In addition, agency staff could influence quality of care. However, to date, little research has examined why nursing homes use agency staff and their relationship with quality of care.

Following a general perception in the literature, some recent research has shown that higher numbers of agency staff are associated with low quality...