Managing the complexity of nurse shortages: A case study of bank and agency staffing in an acute care Trust in Wales, UK

Background: Managing nurse shortages is a major challenge in Trusts today given the worldwide shortage of nurses. To fill the gap created by a lack of permanent staff UK government agencies have increasingly used bank and agency staff. Managing this type of staffing effectively and efficiently, in the context of shrinking healthcare funds, is a major challenge in providing safe and quality healthcare. Objective: To analyse bank and agency nursing staffing patterns and factors that impact on these patterns. Design and setting: Case study within the largest hospital in one Welsh Integrated Healthcare Trust. Data sources: De-identified bank and agency staffing electronic and manual database records and focus group interview with bank and agency office staff. Results: A predictable bank and agency staffing pattern was found, wherein bank and agency nursing staff were used with increasing frequency towards the end of the week. Demand for bank and agency nursing staff occurred because of: hospital practices that fund a fixed staff establishment for nursing units, while patient numbers and acuity are variable; poor forward planning; sickness, and absence due to professional development or staff training. Conclusion: There is a need for managers to reconsider management and recruitment policies, particularly in relation to using bank and agency staff. The complexity of staffing challenges managers to focus on predictability of workload needs and other factors that affect staffing requirements, such as: professional development, flexible working rosters to match the need and minimize sickness and turnover of staff