Congress Abstracts 2003

34

STRATEGIES FOR THE SUCCESSFUL INTEGRATION OF AGENCY NURSES: MEETING THE CHALLENGES OF A NURSING SHORTAGE. Lyle Baker, RN, BSN, Johns Hopkins Hospital, Baltimore, MD.

The impact of the nursing shortage has caused an increase in the use of agency nurses in many hospital units. On our hematological malignancies unit, up to 45% of our staff may be agency nurses on a given shift. This presents a challenge in terms of maintaining staff cohesion, teamwork, and a balance in shift coverage. Attention to chemotherapy and side effects, aplasia, infection, bleeding, and psychological support are critical components of patient care standards. To address these challenges, we developed a program to maintain quality while supporting agency nurses. We contract only with agency nurses who are oncology experienced and chemotherapy certified by the ONS. This lessens the orientation time, which allows for an easier transition for them into the unit operation. Agency nurses, who have cancer or hematologic malignancies experiences, are knowledgeable about many of the standards of care for this patient population. The clinical nurse specialist (CNS) provides structured educational supplements to them. The CNS also ensures that self-learning packets and skills checklists are completed during the orientation period. They receive e-mail, including all communications sent to the unit staff. They participate in staff meetings, which keeps them informed about changes in patient care standards. This provides them with a sense of belonging and establishes a climate of teamwork. Charge nurses on each shift are responsible for confirming that they are appropriately practicing within unit standards. We contract with them for full time hours or less desirable shifts over several months. This provides more structure, improves consistency in patient care, and decreases time required to frequently orient new agency nurses, which causes tension. More desirable schedules for the permanent staff improve retention and unit cohesion. Agency nurses have expressed a desire to join permanent staff. Our unit has effectively utilized agency nurses to provide adequate nurse-patient ratios and has maintained our standards of patient care and a climate of camaraderie and teamwork.