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The Changing Face of Agency Nursing

January 13, 2020

Agency nurses have long been under-represented and under-valued for the contribution they make to Australian healthcare, despite the fact agency nurses are estimated to represent 8% (30,000) of the nursing workforce.

Working casually through an agency is a genuine career option for those who enjoy a challenge and flexibility. Some nurses opt for agency while pursuing portfolio careers, or while they juggle parenthood, travel, study or because they require more flexibility to suit their personal circumstances.

Nurses who choose to work as career casuals are typically armed with unique skills, experience and qualifications, and often carry equally heavy workloads and responsibilities as permanent hospital staff. Despite this, agency nurses are generally omitted from workplace feedback forums (presumably because of the ad hoc nature of their work) yet they experience the same issues as permanent staff, from inadequate staffing to intense workloads that cause enormous strain for all – and that’s not factoring in the pressure from the agencies themselves.

An independent survey of over 500 agency nurses in 2018 revealed multiple pain points for agency nurses and the hospitals that employ them.

In simple terms, nursing agencies are financially incentivised to place nurses into casual roles, and it is agency nurses, permanent hospital staff, hospital budgets and ultimately patients, who suffer because of this incentivisation.

Agency nurses surveyed complained of issues from being treated as ‘anonymous ring-ins’ and being virtually ignored by permanent staff, to being given poor patient allocations because their skills and experience weren’t known, to the extremes of being left out of pocket due to last-minute shift cancellations and then unable to secure a shift elsewhere to replace the cancelled shift.

Hospitals complained of being sent agency staff with skills and experience that didn’t match their needs, on top of exorbitant agency fees.

“The Australian healthcare system spent at least $1.2 billion dollars on contingency workforce fees in 2018 alone. That money was just agency fees – not agency nurses’ wages.

uPaged founder Zara Lord has worked on both sides of the fence – as an AIN with an agency while a student nurse, and when she was full-time and in charge of the ward, Zara worked agency shifts when my employer had no overtime. Over the past three years, Zara has been working on a technology solution for casual nurses and the hospitals that employ them – to give them the transparency they need to make the best choices.

This is where one such innovation, uPaged, comes in. An online nursing workforce marketplace and a first for casual nursing in Australia, uPaged connects nurses to hospitals, and hospitals to nurses, cutting out the traditional nursing agency middleman. As a technology solution, uPaged isn’t the employer, so any financial biases linked to the recruitment and placement of casual nurses is removed.

Removing the agency middleman also puts control back where it belongs – in the hands of the nurses and the hospitals that employ them. Nurses are fully vetted and on-boarded to the platform, with all certifications, additional skills and qualifications, mandatory training and vaccination evidence presented to showcase their unique skills, along with automated reminders for renewals. Hospitals are matched to a nurse based on these skills and experience and can invite that nurse to a shift. Nurses can also apply for shift at a hospital, based on features from the rates offered, to hospital rating, location, ward, hours and more. The platform allows the Charge Nurse for that shift to be fully briefed, which means recognition for that casual nurse, and much better patient allocations. Nurses who use the technology find it ‘empowering and liberating’ to be recognised and appreciated for the skills and experience they are proud of, and hospitals report feeling more in control – of staff and budget.

To add to the transparency that hospitals and nurses seek, the technology provides a two-way rating system for nurses and hospitals which allows nurses to choose higher-rated hospitals to work at and enables the hospitals to invite high-rating nurses to a shift. The rating system creates a previously non-existent feedback loop, served in real-time to nurse and hospital, enabling immediately actionable insights while giving voice to casual nurses.

Technological innovation is focused on user experience so needs to support the transition of casual nurses to full-time work should they choose it. To date, many hospitals have been restricted in supporting the recruitment of casual nurses due to nursing agency contracts that require considerable placement fees, and the contracts that agency nurses sign with their agency may prevent permanent employment with a hospital until after a certain period of time. The very nature of this new model for casual nurses means that both nurse and hospital can ‘try before you buy’, without hefty recruitment or placement fees.

With Government plans for a well-distributed health workforce across Australia; for improving the quality of the health workforce, for supporting workforce mobility and protecting against inappropriate health care practice, technology and innovation in the form of solutions such as uPaged are set to meet all these objectives, including that for nationally cohesive health technology. With interoperability high on the agenda as well, platforms such as uPaged can be integrated into hospitals existing systems, providing a seamless experience for all users.

On-demand nurses provide a critical service to Australian hospitals and it is through technology that they are now getting the voice they need, the recognition they deserve, access to the training they want, and the work they want on a level playing field. At the same time, hospitals can save millions of dollars of year, and patients receive more specialised care by more appropriately skilled nurses.

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