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REPORT
NURSE BANK GOOD PRACTICE GUIDE
Prepared for Nurse Policy Branch Department of Health
By Elizabeth Bethune
FACULTY OF HEALTH, MEDICINE, NURSING AND
BEHAVIOURAL SCIENCES SCHOOL OF NURSING
November 2009
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Table of Contents
Glossary 4 Executive summary 5 Introduction 6 Background and context 6 Development of Good Practice Guide 7 Good Practice for the conduct of Nurse Banks 7 Good Practice Principles 8 Opportunities and benefits of establishing a Nurse Bank 10 Nurse Policy Branch Department of Health 12 Health care organisation – Nurse Bank business case 13 Human resource Management - policies and processes for recruitment 22 Human Resource Management:- conditions of employment and benefits 26
Human Resource Management - selection 29
Human Resource Management - induction processes 30 Human Resource Management - Mentoring, appraisal and ongoing performance management 32 Performance assessment, mandatory training and maintenance of Nurse Bank staff competency 33 Managing employment, deployment and frequency of rostering 35 Clinical governance standards 37 Performance and maintenance of a Nurse Bank 39 Evaluation and benchmarking of a Nurse Bank 41 References 42
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Glossary Alfred Health is the main provider of health services to people living in the inner southeast suburbs of Melbourne
and a major provider of specialist statewide services to the people of Victoria. These services are provided across the continuum of care from ambulatory, to inpatient and home and community based services. Alfred Health comprises The Alfred, Caulfield Hospital and Sandringham Hospital. (http://www.alfred.org.au/ accessed 18 September 2009)
Austin Health is the major provider of tertiary health services, health professional education and research in the northeast of Melbourne. Austin Health comprises Austin Hospital, Heidelberg Repatriation Hospital and the Royal Talbot Rehabilitation Centre. (http://www.austin.org.au/ accessed 18 September 2009)
CasConnect is a centralised Casual Bank coordination service, specialising in relief staffing requirements for rural and regional health services. CasConnect is not an agency, bank members are employees of the health services that they work for. Currently CasConnect provides relief staffing for: Registered Nurses, Midwives and Personal Care Attendants. CasConnect operates out of Stawell Regional Health and provides a service for ten health care organisations including Beaufort and Skipton Health Service; Dunmunkle Health Service; East Grampians Health Service (Ararat); East Wimmera Health Service; Edenhope and District Memorial Hospital; Hepburn Health Service; Rural Northwest Health, Stawell Regional Health; and Wimmera Health Care Group (Horsham) and West Wimmera Health ( http://www.Casconnect.com.au/ accessed 25 September 2009)
DH Department of Health Victoria and its antecedent organisation the Department of Human Services NBV Nurse Board of Victoria Nurse Banks
Nurse Banks are administered by hospitals. Nurses belonging to nurse banks are paid at casual rates and elect how often and when they wish to work. Nurse bank staff differ from agency nurses in that they only work within a designated hospital or hospitals and are employed by the health service (http://www.health.vic.gov.au/nursing/workforce/nurse-banks accessed 28 July 2009).
Nurse Policy Branch The Nurse Policy Branch seeks to ensure that the Victorian health care system and required services are supported by an educated, experienced and skilled nurse workforce of an adequate size and distribution to meet the needs of the public. The Nurse Policy Branch provides high-level policy advice to Government and develops and implements policy relating to nursing. Key areas of activity include: recruitment and retention; promoting safe, supportive and flexible working environments; optimising and promoting effective utilisation of nursing skills, including nurse practitioner and expansion of division 2 nurses practice; and supporting training and education to promote role development. (http://www.dhs.vic.gov.au/pdpd/html/nurse.htm accessed 28 July 2009)
Nursing Agency Privately operated organisations that supply casual nursing/midwifery staff to hospitals and other health services. (http://www.health.vic.gov.au/nursing/workforce/nurse-banks accessed 28 July 2009).
Royalbank Health Recruitment is the specialist casual bank not a private agency, supporting the staffing and
workforce requirements of The Royal Women’s Hospital, The Royal Children’s Hospital and Peter MacCallum Cancer Centre in Melbourne Victoria. Royalbank member database is continually expanding and now supports over 20 different employment categories, including nursing, midwifery, allied health,
domestic, technician and administration. (http://www.royalbank.com.au/ accessed 18 September 2009)
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Executive Summary
‘There is a truism that health workforce policy is about “getting the right staff with the right skills in the right place at the right time”’1
Both nationally and internationally the demand for nurses and midwives exceeds the supply. In Australia the nursing and midwifery workforce is becoming increasing casualised as nurses and midwives choose to work reduced hours per week as permanent part time employees (AIHW 2008)2. Strategies such as better inducements and incentives for nurses and midwives to seek permanent employment have not reversed current trends. It is clear that a major challenge for health care organisations is to fulfil their crucial responsibilities to deliver safe and effective health care to their patients and wider community. There can be significant cost and quality issues associated with the use of casual staff however there also can be benefits and opportunities to both health care organisations and to those individuals who choose casual employment. For the health care organisation one source of securing a skilled casual nursing and midwifery workforce is through the establishment of a Nurse Bank. Nurse Banks have been supported by the Department of Health Victoria since 2002. The sound conduct and maintenance of a Nurse Bank can be achieved through robust Human Resource Management structures and processes supporting the health care organisation, the Nurse Bank and the individual nurse/midwife who chooses casual employment. This report on Good Practice – Nurse Banks is an outcome of an initial preliminary review of the key themes developed out of the Nurse Bank Summit 2002, national and international Nurse Bank literature followed by consultation with existing Nurse Banks in several health care organisations in Victoria and representatives from Department of Health. This guide highlights the vital importance of developing a systematic and sustained approach to managing the conduct of Nurse Banks and we trust it will be a valuable resource for those health care organisations and networks contemplating the establishment and maintenance of a Nurse Bank, as well as for those health care organisations which currently operate a Nurse Bank.
1 Buchan, J. (2009) The nursing workforce and global economic recession. Collegian 16, 1-2. 2Australia Institute of Health and Welfare. (2008) Australia’s Health 2008 (http://www.aihw.gov.au/publications/index.cfm/title/10585 accessed 10 September 2009)
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1. Introduction In 2009, the Nurse Policy Branch Department of Health developed a Good Practice Nurse Bank Guide. The Nurse Policy Branch in 2002 undertook work to support health services to develop Nurse Banks as a complementary workforce source to reduce agency usage (Agency Directive). A number of Nurse Banks have been established since then in several health care organisations in Victoria. This guide draws on industry experience illuminating current practice and knowledge about the establishment of Nurse Banks located in these Victorian public health care organisations. For the purposes of this report, consultations were held with representatives from three metropolitan health care networks, two departments within the Department of Health and one rural health care Nurse Bank. Information from these interviews and the key messages and themes from the Nurse Bank Summit February 2002 form the basis of the guide. Case studies from the field are used as exemplars to illustrate good practice for the maintenance of effective and efficient Nurse Banks.
2. Background and context
Increasingly across Australia the trend towards casualisation of the workforce is being experienced across all areas of employment including health care services. In some professions, particularly those with a high proportion of women such as nursing, many work part time working an average 32.0 hours per week, compared with 34.7 for workers across all other professions (AIHW 20083). There is also an increase in the range of options for employment for women. Ensuring adequate nursing/midwifery staff is an ongoing challenge in an industry where service demand is difficult to control and nurses/midwives are choosing to work reduced hours a week through various workplace arrangements. As a consequence of changes in terms of how nurse/midwives are choosing to work, and the current industrial agreements that mandate minimum staffing levels, health care services increasingly rely on casual staff. The sources of casual staff can be from Nurse Agency or Nurse Bank staff. There can be significant cost and quality issues associated with the utilisation of casual staff. The Victorian Government supports the establishment of Nurse Banks in health care agencies to service and support nurse staffing requirements. To manage the use casual staff a Department of Health Agency Directive defines the limited circumstances when Agency staff instead of Nurse Bank staff can used and the conditions under which they may be engaged. Ensuring the required numbers for the daily nursing and midwifery workload and managing the employment mix of substantive and supplementary staff from sources such as a Nurse Bank, and limiting the use of Agency staff, requires careful workforce planning strategies by operational managers. There are a number of Nurse Bank models in existence in health care organisations. These models range from an independent provision by way of fee-for-service across three health care organisations or region to Nurse Banks which service one health care network. While there are similarities in these models each Nurse Bank however has specifically developed structures and governance to suit their particular remit and organisational circumstances. The Rural Health Bank Pilot (CasConnect) www.Casconnect.com.au for example aims to develop a regional approach to manage employment and distribution of casual nursing and midwifery staff across a number of rural health care agencies. For the purpose of this report the definition of a Nurse Banks is as follows:
Nurse Banks are administered by hospitals. Nurses belonging to nurse banks are paid at casual rates and elect how often and when they wish to work. Nurse bank staff differ from agency nurses in that they only work within a designated hospital or hospitals and are employed by the health service (http://www.health.vic.gov.au/nursing/workforce/nurse-banks accessed 28 July 2009).
3 Australia Institute of Health and Welfare. (2008) Australia’s Health 2008 (http://www.aihw.gov.au/publications/index.cfm/title/10585.
accessed 10 September 2009)
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The concept of a Nurse Bank is the accepted appellation, in reality however, some Banks have extended services to operate as supplementary staffing banks to support employment and service a wide range of areas and functions of the health care organisation. To this end, several of the Nurse Banks visited include Registered Division 1 and Division 2 nurses; Personal Care Attendants (PCA’s); Constant Patient Observers (CPO’s); social workers and allied health care personnel. In some instances there has been further investigation for a Nurse Bank to adopt a broader role such as determining the feasibility and attractiveness for extending the existing service to manage employment of nursing specialities across a region or employment of other health care service employees. For example, specialist Nurse Banks are being considered as a mechanism to allocate scarce nursing or midwifery resources to support and provide a service for specific complex nursing specialties required by a number of health care networks. This report on Good Practice – Nurse Banks is an outcome of an initial preliminary review of national and international Nurse Bank literature which was then followed by consultation with existing Nurse Banks in several health care organisations in Victoria. This process was to elicit and explicate good practice which could be used as a resource by those health care organisations and networks contemplating the establishment and maintenance of a Nurse Bank, as well as those health services which may be currently operating a Nurse Bank. Opportunities and benefits arising from the establishment of Nurse Banks both to the health care organisation and to individual Nurse Bank staff have been identified as part of this process.
3. Development of Good Practice Nurse Bank Guide The purpose of this project was to develop a guide that will be relevant and applicable to all Nurse Banks to provide a more systematic and standardised approach to their conduct. This guide is the result of consultation in July 2009 with four Nurse Banks in Victorian public health care organisations namely Alfred Health, Austin Health, Royalbank and CasConnect and representatives from the Department of Health. Preliminary work undertaken in 2002 at the Nurse Bank Summit has also informed the development of this guide. From the information provided a framework has been developed and principles of good practice extracted. The outcome is a guide which explicates current knowledge and practice for establishing and maintaining effective and efficient Nurse Banks by public health care services. The guide includes commentary and case studies from the field which are used as examples to illuminate Good Practice. The project personnel relied entirely on the cooperation of existing Nurse Bank staff from health care agencies and the Department of Health to provide data and information regarding the management of their Nurse Banks and are indebted to them for generously giving their time and their support for this important project.
4. Good Practice for the conduct of Nurse Banks Establishing and maintaining effective Nurse Banks requires ongoing resources, innovation as well as responsive policies and procedures to engage and retain staff interest and participation.A generic framework which has been developed outlines good practice based on openness and transparency, accessibility, integrity, equity, fairness, accountability, efficiency and self regulation to inform the conduct of a Nurse Bank. This supportive framework provides a practical guide for the establishment, development of organisational policies and processes, maintenance, clinical governance and evaluation of Nurse Banks. There were robust examples of good practice in evidence in health care organisations and while not all could be included in the final report many of these have been used as exemplars in the guide. The size, complexity and conduct of Nurse Banks will differ so flexibility is necessary in structures adopted to optimize individual Nurse Bank performance. It is expressly noted however that health care organisations are independent entities and as such have diverse structures, serve distinct communities with different aspirations, concerns and policies. These principles cannot aim to be universal to accommodate the approach to be taken by every health care organisation in the establishment and maintenance of their Nurse Bank nor will the guidelines be fully applicable in every situation. It is anticipated that health care organisations however acknowledge the dynamic relationship between principles, recommendations and identified processes and will respect the spirit in which the Good Practice Nurse Bank
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guidelines were developed to the extent that individual circumstances, governance, policies and operating procedures permit in a constantly changing health care environment. While the focus of this report is on the establishment, maintenance and utilisation of Nurse Bank staff in many instances the commentary may be applicable to employment and deployment of Agency staff and hence
reference to Agency staff may be included in parentheses.
5. Good Practice Principles
1. Nurse Banks are one part of an organisation’s integrated, comprehensive workforce plan that assists a health service to deliver safe, cost effective care with appropriately skilled staff “24*7”.
2. Evidence of a health care organisation wide strategy outlining policies, procedures and resourcing for
the conduct of Nurse Banks including governance, leadership and organisational ethos.
3. A highly competitive market exists for the employment of health care professionals and Nurse Banks exist and conduct their business in this environment. A Nurse Bank must be seen to be effective and an attractive option to the health care organisation as well as employees seeking casual employment.
4. Mechanisms are in place to support all statutory obligations and restrictions; legislation requirements including Australia and state Anti Discrimination legislation such as the Commonwealth Racial Discrimination Act 1975 and the Commonwealth Sex Discrimination Act 1984. Additionally, other legislation, regulations, policy and guidelines relevant to the nursing and midwifery workforce are supported and these include but are not limited to:
• Health Professions Registration Act 2005 • Professional Practice Boundaries: Guidelines for Registered Nurses in Victoria (NBV) • Drugs, Poisons and Controlled Substances Act 1981 and amendments • Drugs, Poisons and Controlled Substances Regulations 2006 • Guidelines: Scope of Nursing and Midwifery Practice (January 2007) • Guidelines: Delegation and Supervision (NBV January 2007) • Australian Nursing and Midwifery Council National Competency Standards for the RN, Midwife,
Enrolled Nurse and NP • National Police Record Check • Working with Children Act 2005 and version incorporating amendments as at 3 June 2008 • Immunization status.
4. Clear and timely communication is evident detailing health care organisation expectations and policies for Nurse Bank staff recruitment, employment and deployment processes The human resource policies
As you read through these principles consider whether from your perspective these principles
reflect and encapsulate good practice?
What are the views of your organisation regarding the establishment of a well constructed
Nurse Bank? Is it considered to be a sound strategic investment to meet long term workforce
planning goals. Is there a view that the establishment of a Nurse Bank is only necessary to
achieve short term workforce solutions?
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and processes for recruitment including advertising, position description, developing selection criteria, application forms, short listing, interviewing, referee reports, making the decision to employ Nurse Bank staff are consistent with health care organisation wide processes reflecting good practice in Human Resource Management. For one example of Human Resource Management good practice, good business: eliminating discrimination and harassment in the workplace see Information for Employers on http:///www.hreoc.gov.au/info_for_employers/best_practice/recruitment Organisation expectations and policies will include but not be limited to:
• description of the organisation including available employee benefits
• introduction to work area and staff with whom they will be working
• organisation policies including Equal Opportunity polices
• dignity at work including eliminating bullying and harassment policies
• confidentiality
• management of employee capability, professional expectations and compliance
• how to access support/lines of communication and dealing with employee concerns
• health and safety issues
• personal presentation and conduct including personal performance appraisal, development and review
• priority policies and procedures for the assigned work area and where to access written documents
• No lift policy
• Child Protection requirements if applicable
• waste disposal
• control of infection practice
• Incident reporting
• handling complaints and grievances
• acceptance of gifts
• location of facilities.
5. Nurse Bank governance is assisted by formal structures for line management reporting and delegation practices within the organisation.
6. Health care organisations are responsible for ensuring their Nurse Bank staff have the capability to participate effectively in delivery safe nursing/midwifery care and hence can demonstrate a level of nursing and midwifery competence for safe practice commensurate with their level of employment and necessary for practice areas in which they are employed.
7. The optimal staff profile of Nurse Banks will reflect the range of services within the organisation as well
as ensuring there is a balance of experienced and less experienced staff (thus ensuring a cost effective service can be provided).
8. All resourcing including human, technical, accommodation and financial resources allocated to the
Nurse Bank are adequate to meet its operational needs for all aspects of its conduct including robust evaluation and quality assurance processes.
9. All employees on Nurse Bank registers are informed of their personal responsibility to maintain
expected high level of competence for their level of employment and expected of the profession and are provided with professional development assistance such as mentoring, performance appraisal, peer review, skills assessment and continuing education opportunities to maintain and increase their level of competence ensuring safe and effective delivery of health care.
10. Nurse Banks systematically uses evidence from a variety of sources to monitor and improve their quality
assurance processes and functions and makes changes when appropriate.
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11. Communication between all participants in Nurse Bank functioning is timely, seamless and readily accessible.
Opportunities and benefits of establishing and maintaining a Nurse Bank For the Organisation:
• an overall health care workforce management strategy including strategies to manage short
term/peak demand staffing requirements by creating flexibility in workforce options and deployment as well as a mechanism to ensure health care organisation employment workforce strategy and spend targets are managed within budget resources;
• increased use of casual labour workforce represents a significant development in the labour market and this trend is forecasted to increase. Inherent in the human resource management of casual employees is the absolute necessity to ensure that health care organisations employing casual staff embrace opportunities to ensure that casual staff are not subjected to substandard rights, benefits and protection as well as increased substantial levels of precariousness in employment;
• an opportunity to attract, recruit and retain the best supplementary staff possible to the Nurse Bank;
• a single portal of contact and entry with the Nurse Bank being the interface between supplementary staff recruitment and health care organisation or region;
• a mechanism to provide clear, accurate and current information about role, responsibilities, knowledge, skills and experience required to adequately perform nursing/midwifery practice required. This will include not only those relating to the role but the expectation of such important qualities as flexibility and reliability and a willingness to participate in optimal rostering arrangements across all available shifts;
• a mechanism to review total staffing picture at both organisational wide and unit level and hence an option for substantive staff to manage unit level workforce demand ensuring required number of staff to provide optimum cover for all shifts and to meet patient load while assisting substantive staff to control and manage the demand for supplementary staffing;
• an opportunity to devise and maintain a robust risk management, quality and safety strategy approach when employing supplementary staffing;
• making visible the financial and human resource costs and benefits of managing a casual workforce in health care organisations;
• the remit that Nurse Banks ensure supplementary staff possess requisite knowledge, skills and competencies to practice in clinical areas and implement measures to enhance quality and mitigate risks associated with employment of supplementary staff.;
• robust data generated across a wide number of indices can be used to manage daily organisation-wide nursing/midwifery workforce and workload demand while being useful in planning and forecasting future workforce requirements as part of the process to manage an effective overall health care organisation workforce strategy;
• Nurse Bank systems provide a audit process for monitoring consistency with employment and payments made to all supplementary staff employed including Nurse Bank (and Agency) staff;
Are there other important principles that you consider ought to be included in this
document?
What do you promote as the benefits for your organisation of establishing and
maintaining a Nurse Bank?
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• an opportunity to create a inclusive workplace culture to address any negative stereotypes regarding Nurse Bank employees emanating from a different employment status within health service organisations;
• corporate accountability for a Nurse Bank to establish and use standardised and systematic staff governance systems that embodies fair and effective management of Nurse Bank staff. This includes such responsibilities as the establishment of equitable employment processes including the range of pre-employment checks necessary and used in the recruitment of the substantive workforce; When and where necessary change management strategies may be considered to change enhance the acceptance of casual employees;
• If Agency staff employed on a regular basis then health care organisation ought to consider the establishment of a Nurse Bank;
• wider professional health workforce and health care organisation appreciation of the importance of adopting good practice standards for the conduct of a Nurse Bank;
• the existence of a minimum data set which can be used for data mining and generating de-identified reports on health organisation performance against a number of organisational indices;
• an ability to be responsive to broader community needs for nursing staff mobilisation such as the implementation of a Code Brown system in the Grampians area in the event of bushfires;
• A maturation and success of a Nurse Bank is the extent to which an established Nurse Bank is seen as the obvious place to go for matters pertaining to employment of casual staff.
For the individual:
• can facilitate continuity of employment within a health service by assisting staff to manage life transitions (changing from full time to casual and vice versa over time to meet their changing lifestyle/needs);
• Nurse Bank employment is a viable option for permanent staff seeking an alternative to a substantive position because of changed circumstances;
• creates an opportunity for substantive staff to work additional shifts or to undertake shifts in another area of the organisation maintaining their allegiance to the organisation;
• increased awareness of professional accountability of the registering authority’s mandate to ensure that casual staff maintain their level of competence and scope of practice;
• continuing professional development which will be audited in accordance with the Health Professions Registration Act 2005 by the Nurses Board of Victoria (NBV) from 2009. Employment with a Nurse Bank can provide opportunities for supplementary staff to participate in professional development opportunities and annual personal performance appraisal and review contributing to their continuing competence to practice;
• allows opportunities for Nurse Bank staff to “try-out” or “test-the-waters’ in different clinical practice areas, clinical specialties or settings/campuses while building allegiance to the health care organisation;
• allows staff greater choice, autonomy and control over their personal employment arrangements;
• casual employment but with a single employer reduces requirements for providing personal information necessary when seeking employment. The type of information that is routinely requested includes but is not limited to documentation to satisfy requirements for the 100 Point Identification Checklist to confirm identity; information related to Taxation and Personal Banking details; copy of qualifications and evidence of registration status with Nurses Board of Victoria or an equivalent registering body; details of previous employment and professional referees;
• can facilitate application and appointment to a substantive employment position should one become available and should the Nurse Bank employee choose to apply at some stage in the future.
What do promote as the benefits for individuals of joining the Nurse Bank at your
organisation?
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Nurse Policy Branch Department of Health
Areas of consideration Recommended practice Process Measure of success
Nursing and midwifery workforce
strategy including a whole of
industry approach to the use of
Nurse Bank and Agency staff with
availability of written
protocols/procedures
To ensure systematic and standardised approach for
the utilisation of supplementary health care
workforce information is made accessible.
Information regarding the establishment of Nurse
Banks and use of Agency staff is available on the
Department of Health website. http://www.health.vic.gov.au/nursing/workforce/nurse-banks
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Agency Directive http://www.health.vic.gov.au/nursing/workforce/agency_directive
5
In response to concerns about high
use of agency nurses by public
hospitals, the associated costs and
implications for patient care, an
Agency Directive was issued to
health service CEOs. The directive
came into force 1st March 2002 and
remains in force.
Reduction in spend on Agency staff
and investment in the establishment of
a Nurse Bank and investment in
substantive staff.
Process for disseminating Good
Practice Guide for use in the
establishment of or use in existing
DHS Nurse Banks
Development of Good Practice Guide for Nurse Banks
which is accessible from DHS website.
All health care organisations across
Victoria are notified of the
availability of the Good Practice
Guide for Nurse Banks 2009.
All health care organisations have
access to, use and provide feedback on
the utility the Good Practice Guide
Nurse Banks.
Review and evaluation of Good
Practice – Nurse Bank Guide within an
agreed timeframe to assess utility.
Examples of good practice
Department of Health Agency directive outlines the conditions of engagement of Agency Nursing Services. In addition to the conditions under which Agency staff can be used including
replacement grade, maximum price and the process how health care organisations can apply for an exemption. This directive is readily available on the Department of Health website.
Nurse Policy Branch Good Practice Guide – Nurse Banks Department of Health Victoria 2009
4 http://www.health.vic.gov.au/nursing/workforce/nurse-banks
4accessed 13 May 2009
5 http://www.health.vic.gov.au/nursing/workforce/agency_directive
5accessed 13 May 2009
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Health Care Organisation – Nurse Bank Business Case
Areas of consideration Recommended practice Process Measure of success
Business case and executive
summary with a description and
objectives; identification of
stakeholders; encapsulation of the
overall employment ethos of the
organisation which is reflected in
policies regarding flexibility of
employment for nursing/midwifery
workforce; current and proposed
nursing/midwifery workforce
demand and supply forecast;
expected benefits; key performance
indicates, budget analysis, resources,
funding sources for the
establishment and maintenance of a
consolidated Nurse Bank in the
health care organisation;
implementation and timing to
establish Nurse Bank and evaluation
strategies.
A consolidated Nurse Bank is in place under as single
management structure.
Appropriate executive support including Director of
Nursing/Chief Executive of Nursing for line
management, on going professional advice and
support Nurse Bank Staff.
Strategic alignment with government, organisation,
department, unit and program strategic directions.
Costs and maintenance Nurse Bank
accurately determined.
Targets established informed by a
strategy that reflects local
aspirations for the substantive and
supplementary mix of nursing
workforce across all areas of the
health care organisation.
A range of employment policies
designed to promote flexible
working and attendance options
across all clinical areas in place in
accordance with Department of
Health policy and Enterprise
Bargaining Agreements.
Nurse Bank established for the
provision of a supplementary
nursing/midwifery workforce across all
areas of the organisation/network.
Benefits derived from the Nurse Bank
are commensurate with the budget
expended.
The performance of the Nurse Bank
and compliance with targets are
reviewed regularly against previously
agreed measurable quality indicators
outlined in the Business Case including
the process for evaluating the
performance of the Nurse Bank and the
services provided.
Monthly comparative costs between
Nurse Bank (and Agency) staff usage
Examples of good practice
CasConnect( http://www.CasConnect.com.au/bankmembers.php) accessed 25 September 2009) is a centralised Rural Health Bank established in the Grampians Region and funded by the
Department of Health utilising a web based system and text messaging. It is a pilot project and the involvement of health care agencies is voluntary. To date the majority of the health care
organisations in the region participate in CasConnect. The aim of this pilot is the effective management of casual nursing and midwifery staff across a geographically defined area to
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maximise fill rate of all available shifts in participating health care agencies. CasConnect is creating a cultural shift about the role and function of a Nurse Bank organisation. CasConnect has
a ‘No Cancellation’ policy which is informed by a process of encouraging understanding and respect from both the individual Nurse Bank employee and the health care organisation.
CasConnect has service level agreements in place between health care services within region. It provides a ‘fee for service’ system and has twelve month agreements in place between
CasConnect and the participating health care organisations. These agreements can be changed and will be reviewed at the end of the project. The service only charges for shifts that are
filled. The introduction of a web based system has reduced and made transparent expenditure in terms of time and costs for the procurement of casual staff where previously these costs
in have largely remained invisible.
CasConnect staff encourages an assessment of the whole employment situation providing an opportunity for health care organisations to negotiate a range of options. Health care
organisations provide available shift data as soon as possible to create the potential for shifts to be filled. CasConnect has developed strong relationships with Nurse Unit Managers
exploring optimal staffing strategies. CasConnect has the capacity to generate individual health care services reports in PDF format with detailed data illustrating trends in available shifts
across a one month cycle, the fill rate and time of filling for each shift and are forwarded to relevant hospital staff including Nurse Unit Managers. Reports can be generated across a wide
number of indices and KPI’s resulting in the identification of trends and isolating priorities for action in each individual hospital in the region. Operating hours currently are 9am to 5pm
Monday to Friday with mobile telephone contact with CasConnect staff between 6am and 10pm however these hours are currently being reviewed.
Royalbank (http://www.royalbank.com.au/ accessed 18 September 2009) is one of the longest established of the existing formal Nurse Banks. It is a mature consolidated bank that
currently services three health care organisations. This organisation has a single management structure with line management with the three health services for whom they provide a
service. The Royalbank introduced an electronic rostering for effective management of Nurse Bank nursing and midwifery staff and filling of available shifts across three health care
agencies namely Royal Women’s Hospital, Royal Children’s Hospital and Peter McCallum Cancer Centre in Melbourne. The Royalbank has established a high degree of trust with users of the
service demonstrating it could provide a responsive employment service. Establishment of the Royalbank has reduced time spent of paper rostering, increased the productive use of
available Nurse Bank nursing and midwifery staff; removed the complexity of rostering in terms of Nurse Bank nursing and midwifery staff availability for all shifts to be filled including
those shifts that may be considered more difficult to fill. The aim is meet key performance deliverables and to balance the needs of clinical areas and the needs of casual staff while
ensuring that clinical areas are staffed appropriately to minimise clinical risk. Additionally, electronic shift allocation has facilitated rostering in terms of the complexity of managing
irregular shift patterns and Royalbank has in place processes to improve service delivery. Royalbank ‘drip filters’ the available shifts to maximise the fill rate of all shifts 24/7. Electronic
management of rostering has created the ability to generate a wide range of reports based on the performance indicators of the bank and the requirements of the health care agencies. In
addition to rostering patterns database profile is available incorporating skill mix of available Nurse Bank nursing and midwifery staff; preferences including team preferences. For example,
costs associated with securing bank staff are known. Royalbank has established service level agreements for health care organsiations for which it provides a service..
Austin Health (http://www.austin.org.au/ accessed 10 September 2009) has been established since 2002. Austin Nurse Bank is to shortly begin a pilot using an electronic rostering system
and following evaluation this system may be adopted more widely by other health care organisations.
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Health Care Organisation – Nurse Bank Business Case continued
Areas of consideration Recommended practice Process Measures of success
Financial plan including budget and
funding implications
There must be sufficient allocation of financial,
human, and other resources to carry out of the
effective operations of the Nurse Bank.
Assessment of costs related to establishing and
maintaining Nurse Bank and process of review of
growth and review of expenditure.
Cost related to establishment of and
maintaining a Nurse Bank
determined with an identified
budget with establishment positions.
Annual financial target or percentage
of overall staffing costs for Nurse
Bank employment. Accountability
based on financial analysis -
projected profit and loss over the
budget cycle of the health care
organisation.
Annual Budget identified and ratified.
Evidence to ascertain whether the agreed
budget covers what is necessary and
sufficient to attain the purposes of the Nurse
Bank.
Financial costs should not be excessive,
should be proportionate to the benefits and
allocated fairly and transparently.
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Health Care Organisation – Nurse Bank Business Case continued
Areas of consideration Recommended practice Process Measures of success
Operation and action plan for role
Nurse Bank as part of overall
workforce strategy
Health care organisation workforce strategy
including policies and processes informed by
Department of Health Nurse Policy Branch Nurse
Bank and Agency Directives.
Strategic long term workforce
planning goals established.
Targets establishing overall nurse
employment goals including EFT
substantive staff, Nurse Bank (and
Agency) staff spend in the
organisation and strategies identified
to address gaps and to meet targets.
Majority of nursing workload provided by
substantive or Nurse Bank staff.
Workforce planning and performance is
monitored against targets over time
identifying particular areas where action is
required.
Nurse Bank (and Agency) staff hours per
day/per week/per month by shift determined
by each clinical area and actual spend
calculated.
Examples of good practice
CasConnect (http://www.CasConnect.com.au) participation by health care organisations in the region is voluntary with most of the health care organisations in the region now
committing to CasConnect. CasConnect provide fee for service with each health care service and undertaking the role of recruitment of casual geographically defined area aiming to
meet health care organisation targets. Casconnect also manages Agency and Agency sends all invoices for different health services in terms of hours/rates and verified against
information provided to CasConnect. CasConnect provides a point of entry for health care professionals potentially to apply to a number of health care organisations in the Grampians
area thereby gaining exposure and experience which can lead to substantive employment.
Royalbank (http://www.royalbank.com.au/) acts as a ‘broker’ for nursing and midwifery workforce responding to requests for staff from the agencies for which it provides a service.
Policies and indicators are individualised to each health care organisation. Similarly targets for nursing and midwifery workforce balance between substantive staff and Nurse Bank
(and Agency) staff determined by participating health care organisations. Policy and practice regarding the utilisation of Nurse Bank (and Agency) nursing and midwifery staff
individually determined by participating health care organisations. Participating health care services establish site specific Key Performance Indicators (KPI’s) and reports against these
are generated in a timely manner. Examples of reports include the nursing and midwifery workforce profile and percentages of substantive, Nurse Bank (and Agency) staff, allocation
and recruitment. Line reporting on Royalbank functioning is to the Royalbank Manager, Human Resources and Executive Directors of Nursing.
16
Health Care Organisation – Nurse Bank Business Case continued
Areas of consideration Recommended practice Process Measures of success
Operation and action plan for role
Nurse Bank as part of overall
workforce strategy
Substantive staff target is adequate and ensures
delivery of safe, effective and efficient patient care.
Organisational targets are met with substantive staff
establishment
Strategies identified to reduce or eliminate use of
Agency staff and reduce use of Nurse Bank staff.
Process for reviewing vacancies to
accommodate changes in service
delivery and workload
considerations.
Nurse Bank (Agency) nursing/midwifery staff
used to manage short-term staffing shortfalls
or unexpected increase in patient workload
demand.
Other strategies are in place such as short
term contracts for more long-term vacancies
eliminating reliance on Nurse Bank (and
Agency) staff.
Reduction in the use of agency staff spend enables
the re-investment in substantive staff establishment
Health care organisation targets for patient care
delivery are met.
Nurse Unit Managers are exploiting opportunities for
flexibility the policies provide in promoting
attendance at work.
The Nurse Bank Coordinator has a proactive and
flexible approach to meet the needs of the health
care organisation and employee with an emphasis
on employment security.
Unit Managers are monitoring
performance against targets to
identify proportion of care is
delivered by substantive staff and
what proportion of care provided by
supplementary staff and ensuring
strategies and actions in place to
address gaps/anomalies if and where
appropriate.
Reasons for booking Nurse Bank (and Agency)
staff documented by each clinical area.
Reduction in both demand for and utilisation
of Nurse Bank (Agency) nursing/midwifery
staff.
Examples of good practice
Austin Health (http://www.austin.org.au/) goal is to offset agency staff usage and any savings are well spent on Nurse Bank. The health care organisation has a flexible approach to work
and enactment of the policy is the remit of the Nurse Unit Manager.
Royalbank (http://www.royalbank.com.au/) is cognisant of targets established by the health care organisations for which it provides a service. Performance of Royalbank is monitored
against targets with reports generated and regular user meetings are held monthly.
17
Health Care Organisation – Nurse Bank Business Case continued
Areas of consideration Recommended practice Process Measures of success
Operation and action plan for role
Nurse Bank as part of overall
workforce strategy
Consideration be given to establishing a policy
ensuring Nurse Bank solely manages the use of all
Nurse Bank (Agency) staff across all areas of the
health care organisation to ensure that there is no
manipulation of staff; consistency in the application
of Human Resource Management processes and
policies in relation to employment, deployment and
accountability for staffing.
All requests for supplementary
staffing secured through Nurse Bank.
This may include nursing/midwifery
staff from an Agency.
% of available shifts over a period of
time filled by Nurse Bank staff as
opposed to Agency staff
Clear accountability with reporting
on alignment with targets either in
terms of % of Nurse Bank staff
employed or spend.
Use of substantive, Nurse Bank (and
Agency) staff to be monitored
against health care organisation
established targets. Timesheet
verification process for authorisation
supplementary nursing/midwifery
staff including Nurse Bank (and
Agency) staff utilisation
Nurse Bank performance against targets. Line
management reporting such as to Directors of
Nursing/Chief Nurse Executive on Nurse Bank
performance against targets.
Agreed indices determine extent and actual
costs of using Nurse Bank (and Agency)
employees.
Length of stay/retention rate and up take of
substantive employment determined for each
Nurse Bank staff in the health care
organisation
Robust systems are in place to record
approval and authorisation of hours to be
employed and payment of Nurse Bank (and
Agency) nursing/midwifery staff to be
managed through Nurse Bank and within
agreed targets.
Examples of good practice
Royalbank (http://www.royalbank.com.au/) all casual staffing (including Agency) staff secured through Bank. Royalbank has in place a time sheet authorisation process checking and
verifying every time sheet submitted for casual nursing and midwifery employees which includes bank (and Agency) staff. This bank also solely manages securing casual staff in the three
participating hospitals.
18
Health Care Organisation – Nurse Bank Business Case continued
Areas of consideration Recommended practice Process Measures of success
Complex management and
information systems in Nurse Banks
require adequate IT provision. There
is consistency in capability of
accredited software systems with
appropriate central IT support and
links with organisational IT systems
Computer technology systems in place with relevant
sophisticated software and is web enhanced.
Well supported by web enhanced
communication systems, direct line
telephone, fax, voicemail, computer
with appropriate software and email
access.
Information systems with appropriate
software in place in place with relevant staff
training to optimise Nurse Bank functions and
functioning.
Costs determined for purchase/installation
and servicing of IT systems both in terms of
initial acquisition and replacement/up dating
of hardware/software.
There are recognisable centrally located and
dedicated premises for the Nurse Bank
commensurate with its importance as the portal to
the organisation.
Resources including Information
Technology, human and dedicated
space to establish a Nurse Bank.
Equipment and IT requirements to
function effectively as Nurse Bank
requires accommodation and
resources.
Centrally located Nurse Bank premises with
clear directions and are readily accessible
within the organisation.
Attractive welcoming environment with a
customer focussed dedicated space.
Examples of good practice
Austin Health (http://www.austin.org.au/) Nurse Bank is centrally located on Level 1, Austin Hospital Tower Austin Hospital 145 Studley Road Heidelberg Victoria Australia, 3084 Tower
Building, The offices are well sign posted with easy access.
Royalbank (http://www.royalbank.com.au/) is centrally located in the new Royal Women’s Hospital precinct Unit 7G, Ground Floor 55 Flemington Road North Melbourne VIC 3051 and is
well sign posted with easy access.
19
Health Care Organisation – Nurse Bank Business Case continued
Areas of consideration Recommended practice Process Measures of success
Administrative and clerical staff
allocated to Nurse Bank and
employed having designated areas
of allocated responsibility thus
enabling effective use of clerical staff
releasing clinical staff from
administrative functions/roles.
Clerical and administration staff undertake all
administration functions associated with clinical
allocation.
Processes in place to determine vacancy rates and
within an agreed timeframe.
Nurse Banks fully operational for extended week day
hours and some service capability over weekends.
Administrative/clerical duties
including communication with Nurse
Bank staff, allocations are completed
by clerical staff.
Clerical/administrative staff adopt a
sound customer relations focus.
Nurse Bank employed and available
for an agreed extended period.
Survey of Nurse Bank administrative
processes determine required administrative
and clerical functions are being undertaken
by appropriate level of staffing and each
clerical/administrative staff position has a
current job description outlining
responsibilities and reporting requirements.
Effective workforce plans and
established health care organisation
targets for supplementary staff
spend as a percentage of overall
nurse staffing establishment
Health care organisation has a plan for a strategic
workforce target with Nurse Bank staff a percentage
of nursing staff establishment ie managing demand
and supply.
Establish agreed supplementary staffing targets
allows for monitoring of performance against target
over time and identification of areas requiring
specific or targetted action.
Clear identification of primary drivers for securing
Nurse Bank staff/staffing strategies/organisational
efficiency/benchmarking of information in each
nursing area to determine nursing staff needs.
Nurse Bank Manager monitors and
reports performance against targets
relevant action strategies formulated
against identified anomalies.
Targets have been established within
a workforce strategy that reflects
health care organisation planning
It is recognises that there will always
be a requirement for short-term
temporary employment to make up
shortfalls in permanent staffing.
Nurse Bank is notified of all shifts
available within agreed timeframe.
All employment/deployment of
casual/supplementary staffing
monitored by Nurse Bank.
Monitoring against targets so that the use of
Nurse Bank (and Agency staff) is not a
substitute for effective workforce planning.
Cost of recruitment/procurement per person
on Nurse Bank staffing list.
Cost of professional development/in-service
per person.
Composition of Nurse Bank staff assessed to
determine if this actual composition is
adequate and reflects the health care
organisation requirements for Nurse Bank
staff.
Timeframe targets met.
Reasons are known and reviewed for booking
Nurse Bank staff from all clinical areas.
20
Examples of good practice
Alfred Health (http://www.alfred.org.au/) Nurse Bank team is available seven (7) days per week and the office is staffed from 8am until 8pm each day. On weekends the office is staffed from
8.15am until 1.15pm to support Nurse Bank staff.
Austin Health (http://www.austin.org.au/) have a No Cancellation Policy for Nurse Bank staff.
Casconnect ( http://www.CasConnect.com.au) encourages health services to advise shift vacancy rates as soon as possible to create the potential for all shifts to be filled.
Royalbank (http://www.royalbank.com.au/) policy is to never cancel a shift as every nurse and midwife is valuable to the health care organisations for which they provide a service.
Royalbank provides a service from 0600 hours until 2230 hours Monday to Friday.
21
Human Resources Management - Policies and Processes for Recruitment
Areas of consideration Recommended practice Process Measures of success
Clear concise information about the
employment opportunities with a Nurse
Bank including recruitment processes and
benefits.
Nurse Bank employees are provided with
the same access to information regarding
vacancies for permanent positions as that
provided to existing permanent
employees.
Nurse Bank staff are encouraged to apply
for substantive when become available.
Duplication of processes are avoided
and common use of information
regarding all positions available in the
health care organisation including
substantive and Nurse Bank positions.
Use of application packs which include
general information for applicants; Terms
and Conditions of Service/employment
status including disclosure of police record
etc; confirmation of registration same as
for substantive staff.
Maintenance of up to date pre-
employment information including Police
Check, Nurses Board of Victoria
registration/endorsement, Child Protection
(if applicable) Immunisation.
Induction Procedures and Guidelines on
HRM Policies and Procedures same as for
substantive staff.
Monitoring of all employment
information against each Nurse Bank
employee.
An administrative mechanism in place
to ensure information is in a format that
information collected is recorded,
current and readily available for any
reporting requirements..
Nurse Bank part of the employment
strategy of health care organisation and
there are clear expectations of future
employment with health care organisation.
Up to date position description which
includes main duties/responsibilities;
knowledge and work experience required
for positions.
Contractual arrangements including
agreement about the areas of nursing in
which Nurse Bank employee will be
allocated including recognition of previous
experience in contracted grade and
incremental point.
All contracts are current and
appropriate for level of appointment.
A streamlined optimal employment
process is in place including health care
organisation response within 24 hours
with an aim of conducting interviews
within 48 hours with a fast track
induction.
Examples of good practice
CasConnect (http://www.Casconnect.com.au/) website is easily navigable. On the site there is an “Application for Casual Employment” form can be downloaded and completed clearly
specifying the required documentation to be attached and the health care organisations locations and departments.
22
Royalbank (http://www.royalbank.com.au/) has an easily navigable web site where prospective Royalbank employees are invited to register on line and become a member of the
Royalbank. Should applicants require further information regarding employment opportunities on line search facility is available. Royalbank recognises it has one opportunity to present a
‘customer focus’ and aims to maximise opportunities to attract potential employees to the bank. Speedy processes exist to reduce barriers and facilitate employment at Royalbank.
23
Human Resources Management - Policies and Processes for Recruitment continued
Areas of consideration Recommended practice Process Measures of success
Policy with regard to Nurse Bank staff
being employed in other associated
agencies of health care organisation such
as Neonatal Intensive Care (NICU) Process
for terminating Nurse Bank staff if shifts in
specialty areas not accepted in an agreed
period, for example, three months.
All Nurse Bank staff are provided with clear
information and policy regarding
employment across a number of health
care organisations. If Nurse Bank staff
employed across a number of health care
organisations then a ‘parent’ organisation
identified.
Health care agency Nurse Bank is
employer of choice however sharing
and collaboration across
regions/networks/specialty clinical
areas where there are resource
limitations.
Timely, relevant information for induction
of new bank staff pack.
Where a consolidated Nurse Bank is not
feasible in a health care organisation then
Specialty Banks be considered as a sub-set
of the Nurse Bank.
Recording and monitoring of induction
processes/procedures and process for
reviewing procedures
Specialty Banks established within a health
care organisation with employment
processes including oversight of induction
reside with Nurse Bank.
All information necessary for induction
into health care organisation readily
available for Nurse Bank staff
Induction of all new Bank staff occurs
prior to commencement of employment
or within an agreed timeframe on
commencement,
Examples of good practice
Alfred Health (http://www.alfred.org.au/) Nurse Bank has developed a print based handbook for nursing staff setting out expectations of employment through Alfred Health Nurse Bank. . The
Handbook includes the following information: the administration process including booking process; time sheets annual education and assessment; dispute resolution, paging, patient
identification process and dress code. There is a chapter on the Nursing Care Delivery System which includes information related to the philosophy underpinning the nursing care provided
at Alfred Health and definition of roles in the Nursing Division. Chapter 3 provides detailed explanations of the Medication Administration Process with a self evaluation tool. Medical
Record Documentation is explained in Chapter 4 of the Handbook. Emergency Procedures included response codes and management of patients with behaviours of concern are covered in
Chapter 5 of the Handbook. Chapter 6 and 7 provide information on falls prevention, pressure ulcer prevention and infection control. Additionally, an Orientation of Nursing Staff to The
Alfred outlining individual responsibilities to ensure orientation process has been completed.
CasConnect( http://www.Casconnect.com.au/) provides a service for a number of health care organisations in a region.
24
Human Resources Management - Policies and Processes for Recruitment continued
Routes available via Nurse Bank for
ongoing nurse employment in health care
organisation.
Workplace culture cultivated that
embraces casual/supplementary staffing
and their requirements.
Establishment of a personalised service
for casual/supplementary staffing that
health care organisation becomes
employer of choice.
Systems and processes established
accommodate self-rostering and pre-
planning for Bank staff
Self-rostering and pre-planning ability Efficiency in allocation with an agreed
percentage of available shifts filled in an
agreed time frame.
Examples of good practice
Austin Health (http://www.austin.org.au/) aim to streamline employment processes with the targets to respond to an application for employment with the Nurse Bank within 24 hours and
conduct interviews within 48 hours with the intention to have applicant employed within two weeks.
Royalbank (http://www.royalbank.com.au/) aims to establish a ‘Good Practice’ service based on the ethos that attachment is important for health care employees seeking employment
through Royalbank. To successfully secure bank employees strategies have been implemented to foster the perception that when employed by Royalbank they are made to feel like a real
employee. Royalbank matches employee with request and skill mix required. Email and SMS messages are sent notifying Royalbank member of shifts available with a request to respond.
25
Human Resource Management - Conditions of Employment and Benefits
Areas of consideration Recommended Practice Process Measures of success
Car parking. Parking available at substantive health
care organisation staff rates.
Nurse Bank staff willingness to increase
availability because car parking facility.
Assistance with work related expenses
including uniform and equipment including
Internet access.
Nurse Bank staff informed of assistance
available for identified work related
expenses and equipment.
Nurse Bank staff increase employment with
health care organisation because strategies
in place to meet identified work related
expenses.
Salary packing available. Nurse Bank staff informed of benefits
available when a member or employed
through Nurse Bank.
A percentage of Nurse Bank staff negotiate
salary packaging as part of their employment
benefits.
Facilitation of employment opportunities
through the elimination of barriers in
seeking employment and/or increasing
availability for employment and uptake of
shifts
Professional development activities
available through in-service.
Information made available to all Nurse
Bank staff regarding the availability of
Professional Development Education and
Training. Additional incentives may be
considered for Nurse Bank staff who been
on the Nurse Bank staffing list for an
extended period. The length of period of
service to be determined by Nurse Bank
and health care organisation.
Nurse Bank staff can demonstrate necessary
competencies and possess requisite skill mix
and are deployable to a range of clinical
areas.
Nurse Bank staff engage in Continuing
Professional Development (CPD) activities
commensurate with Nurses Board of Victoria
requirements to be considered eligible for
continued annual registration and
endorsement to practice in their area of
practice as a Division 1 Nurse and/or
Midwife.
26
Human Resource Management - Conditions of Employment and Benefits continued
Monitoring the availability of Bank Nurse in
terms of up take of employment
opportunities
Records of securing employment in a
substantive position in the health care
organisation.
Seamless progression to substantive
employment of Nurse Bank staff when and if
substantive positions become available
hence reducing costs associated with the
employment of new substantive staff.
Seamless progression from substantive
position to Nurse Bank employment.
Employment processes including
compliance with working time regulations,
dignity at work: eliminating bullying and
harassment from the workplace and equal
opportunity.
Contract compliance is monitored
according to health care organisation wide
policies and processes.
Compliance with health care organisation
processes are evidenced with no reports of
grievance by Nurse Bank nursing and
midwifery staff.
Examples of good practice
Alfred Health (http://www.alfred.org.au/) Casual nurses employed by Alfred Health are entitled to many staff benefits and incentives including:
-The opportunity to work in a leading health service; -Employment in a values-based organisation; -salary packaging for casual staff; -a forward planning Allocations Office to match shift
availability with clinical preferences; -parking at staff rates; - Staff Health Clinic; -hospital orientation - -Access to a vast number of Nursing Education services and vast number of benefits
available to all employees. Schemes to develop skills and experience of qualified nurses are made available such as fully paid Study Day annually.
Austin Health (http://www.austin.org.au/) Casual nurses employed by Austin Health are entitled to many staff benefits and incentives including:
-The opportunity to work in a leading health service; -Employment in a values-based organisation; -salary packaging for casual staff; -a forward planning Allocations Office to match shift
availability with clinical preferences; -parking at staff rates; -Austin Health School Holiday Program ; - Staff Health Clinic; -hospital orientation - -Access to a vast number of Nursing
Education services and vast number of benefits available to all employees. In addition, such as Return to Practice program, schemes to develop skills and experience of qualified nurses
are made available.
CasConnect ( http://www.Casconnect.com.au/) members have the benefit of flexibility and choice to work for a number of health care services through a centralised web based system in
a geographically defined region of Victoria. The system has the ability to allocate CasConnect nursing and midwifery staff to a number of multiple sites coordinated at one location.
CasConnect nursing and midwifery staff are employees receive the following benefits: no cancellation policy; flexibility to choose offer; casual pay rates; recognition and priority as a health
service employee; orientation and buddy shifts available at each location; notification of vacant shifts by way of SMS with a response reply by text of shift acceptance; opportunity to work
at multiple sites; opportunity to Salary Package; greater opportunities to attend training and development sessions; centralised mandatory training and competencies record and access to
27
e-Learning. Other incentives include a Joey pouch and fob watch. Currently CasConnect are undertaking a promotion for nurses to consider working across a number of different health
services with a reward in the form of a prize.
Royalbank (http://www.royalbank.com.au/) at specifies work options and benefits including information about registration, recruitment process, visa information, clients, nursing
organisations and their unique hospitality chain. An innovative ‘hospitality chain’ offers employment opportunities with participating health care organisations in Australia and New Zealand
Royalbank offer the following benefits to bank staff including: casual pay rates; salary packaging; indemnity insurance; no cancellations; first choice of available work; paid training and
development; recognition and priority as a hospital employee; flexible working hours and opportunities and support to diversity. Incentives such as unpaid professional development and
further education offered to bank staff. Night Duty is reward based and once the predetermined and specified number of points is accrued then Royalbank member can be offered and
rewarded with a paid study day. Royalbank provide a ‘one-stop-shop’ assisting applicants to complete employment requirements such as Visa applications for international applicants.
28
Human Resource Management - Selection
Areas of consideration Recommended practice Process Measures of success
Employment Processes and selection The same pre-employment checks used in
the recruitment of nurses to the
substantive workforce should be used for
recruiting Nurse Bank
staff
Information about recruitment processes
provided to prospective employees with
entry and exit interviews being
conducted.
Health care organisation aim for
Nurse Bank staff to consider
employment at the health care
organisation as the agency of
choice and a personal goal.
Examples of good practice
Austin Health (http://www.austin.org.au/) Associate Director of Nursing and Staffing manages Human Resources processes including all aspects of recruiting, retention, reference checks,
including mandatory reporting, National Police checks; immunisation checks and Nurses Board of Victoria registration.
Human Resource Management - Induction Processes
29
Areas of consideration Recommended practice Process Measures of success
Induction and orientation to health care
organisation
Content of induction program same as for
substantive staff. Minimum information to
be provided to Nurse Bank staff before
commencing work and dependent of
position/work area:
• Description of the organisation
• Introduction to work area and
staff with whom they will be
working
• Organisation policies including
Equal Opportunity polices
• Dignity at work including
eliminating bullying and
harassment policies
• Confidentiality
• Professional expectations and
compliance
• How to access support/lines of
communication
• Health and safety issues
• Personal presentation and
conduct
• Priority policies and procedures
for the assigned work area and
where to access written
documents
• No lift policy
• Working with Children check if
applicable
• National Police Record Check
• Waste disposal
• Control of infection
Monitoring and reporting on appropriate
mandatory training.
All bank employees complete induction
programs prior to commencement of
employment.
It is essential that Nurse Bank
employees are treated in the
same way as substantive staff
and given access to appropriate
induction, professional
development and support.
Targets established for
acceptable period between being
employed and induction process.
Monitoring to ensure all bank
employees complete induction
program with specified time.
30
• Incident reporting
• Handling complaints
• Acceptance of gifts
• Location of facilities
• Documentation of induction
arrangements including date and
signatures of person undertaking
the induction and the inductee.
Examples of good practice
Alfred Health (http://www.alfred.org.au/) Nurse Bank staff are paid for an annual Study Day; orientation and first shift which is supernumerary.
Royalbank (http://www.royalbank.com.au/) bank staff are paid to complete the induction and orientation and also one day to be assessed on mandated competencies such as
medication administration, cardiopulmonary resuscitation and No Lift.
31
Human Resource Management - Mentoring, Appraisal and Ongoing Performance Management c
Areas of consideration Recommended practice Process Measures of success
Mentoring, employee appraisal and ongoing
performance mangement
Performance standards clearly articulated,
accessible and identification of an agreed
process between bank and health care
agency in terms of responsibility for
performance management.
Process identified and Australian Council
of Nursing and Midwifery (ANMC)
competencies are indicators of
performance.
On initial employment strategies in place
to such as a Buddy/Mentor system to
support Nurse Bank member.
Regular appraisal of Nurse Bank
member competency.
Similar to substantive staff
opportunities provided to
upgrade skills or performance
manage
Performance appraisal of Nurse Bank staff
consistent with organisational
policy/practice – time frame.
A number of mechanisms for Nurse Bank
staff support and feedback established
such as feedback from supervisor;
feedback from peers.
Nurse Bank staff establish a mechanism
to provide information regarding on going
performance management and
expectations of Nurse Banks staff
relevant to area of nursing practice or
vision of organisation. Strategies to
increase and enhance feedback from
supervisor
A sustainable workforce is
achieved through employment
and deployment of substantive
and supplementary staff. .
32
Performance assessment, Mandatory Training and maintenance of Bank Nurse Staff Competency Areas of consideration Recommended practice Process Measures of success
Personal development planning and
review – planned and monitored
Education and learning are essential
elements to developing a motivated,
knowledgeable and flexible workforce
as casual/supplementary staff play a
significant part in the overall quality of
service delivery.6
Extensive provision of training accessed by
Nurse Bank workforce.
Robust process for clinical staff to review
skill mix and patient dependency to
ascertain grade of Nurse Bank staff
required
Highly motivated Nurse Bank
workforce.
Skills assessment and mandatory
training
Time frame in which Nurse Bank staff
undertake mandatory training with targets
established for timeframe for Nurse Bank
staff completion. .
Time frame in which Nurse Bank staff
undertake mandatory training % of staff
and is mandatory training of all Nurse Bank
staff monitored.
Timeframe targets met with regard
to mandatory training for Nurse
Bank staff.
All Nurse Bank staff attend
mandatory training prior to
employment in an area where
those skills/competencies are
deemed essential.
Examples of good practice
Austin Health (http://www.austin.org.au/) new Nurse Bank employees receive a package of information which includes information of the Nurse Bank and health care organisation. One
day paid orientation and induction is provided for to all Nurse Bank employees once appointed. Continuous performance management processes established for Nurse Bank staff similar to
that of substantive staff employment expectations. A mentor/buddy system is in place for all new Nurse Bank employees. Austin Health support applicants to undertake a Re-entry to
Practice program which is offered by Austin Health Nurse Education and once satisfactorily completed applicants are encouraged to join the Nurse Bank. Performance management of
Nurse Bank staff is undertaken by Assistant Director of Nursing (ADON) Nursing Allocations and a process instigated based on identified problems and/or needs. If specific skills are
identified the Nurse Bank member can be provided with Mentor support. Competencies and skills assessed annually.
CasConnect (http://www.Casconnect.com.au/) Nurse Bank staff have access to professional development on line via Grampians Region e-learning packages which are made available Nurse
Bank employees and the theory is followed by demonstration in practice.
6 Fitzgerald, M., McMillan, M., & Maguire, J. M., (2007) Nursing from the casual pool: Focus group study to explore the experiences of casual nurses. International Journal of Nursing Practice, 13: 229-236.
33
Managing Employment, Deployment and Frequency of Rostering
Areas of consideration Recommended practice Process Measures of success
Targets met regarding percentage fill rate
for all available vacant shifts
Ability to monitor frequency of rostering
and location of Nurse Bank employment.
Monitor individual Nurse Bank
employees’ performance in terms
of acceptance of available shifts
against agreed targets and
timelines.
Ability to monitor rostering – streamlined
and flexible, timely in terms of deployment
of Nurse Bank staff.
Strategies to accommodate management
of Nurse Bank staff preference in terms of
filling and location of all available shifts.
Process in place to maintain
database of active Nurse Bank
employees. Process for regular
contact of Nurse Bank employees
regarding up take of shifts and an
clear time frame when employee
registration with Nurse Bank
lapses.
Nursing workforce strategy for the use of
Nurse Bank resources aiming to be
sufficient to meet the demand of
temporary cover.
Process established to maintain current
database of Nurse Bank nursing/midwifery
employees
Regular review of acceptance rates of
shifts available for individual Nurse Bank
employees
Job satisfaction is derived through
Nurse Bank employment and
Nurse Bank staff actively seek and
accept offers of employment
across all available shifts.
Examples of good practice
Austin Health (http://www.austin.org.au/) emphasise that Nurse Bank nursing and midwifery staff have the right to determine where they prefer to be allocated. Some of the Nurse Bank
staff choose to practice is the same area while some choose to work across the health care organisation.
34
All Nurse Banks visited had processes in place to monitor active nursing and midwifery members of each Bank to maintain current database. For example, Alfred Health
(http://www.alfred.org.au/) at the end of three months write to Nurse Bank staff who have not accepted shifts in that period and then requested to complete the necessary paperwork to
be removed from Nurse Bank staff list.
Royalbank (http://www.royalbank.com.au/) has an active member list. Regular monitoring to Royalbank nursing and midwifery staff and acceptance rates of shifts is regularly reviewed. If
shifts not accepted for six months Royalbank archive nursing and midwifery staff member and file will be archived and then ill be decommissioned. Royalbank has adopted a ‘drip filter’
system for releasing all available shifts achieving a match of nursing and midwifery skill mix with request for casual staff ensuring coverage is achieved across all shifts available.
35
Clinical Governance Standards
Areas of consideration Recommended practice Process Measures of success
Performance and capability
Ensuring clinical care provided is current
and effective and Nurse Bank staff
performance and capability monitored
Information available and accessible to
Nurse Bank staff.
Information available to assess the quality
of nursing care provided by Nurse Bank
staff.
Information available to assess the
management of clinical risks.
Quality assurance and performance
monitoring of Nurse Bank employees.
Achieve minimisation of clinical risk.
Buddy program in place for two or
three shifts.
Information of expected skill level
and core competencies provided to
all Nurse Bank applicants.
Health care organisation performance
manage casual staff consistent with
expectations of substantive staff.
Examples of good practice
Alfred Health (http://www.alfred.org.au/) Orientation Handbook which includes a letter of welcome, information about the administration process, nursing care delivery system,
medication administration process, medical record documentation and emergency procedures and clinical management of specified conditions.
36
Performance and Maintenance of Nurse Bank
Areas of consideration Recommended practice Process Measures of success
On going review and reconciliation of
staff establishments to ensure that
budgets can accurately reflect
requirements in terms of substantive and
Nurse Bank nursing staff.
Identified forum and reporting lines
undertaking ongoing review of
performance against organisation/DHS
policy and putting in place mechanisms to
address identified gaps/breaches of
recommended practice and deal with
problems.
The organisation should agree on the most
appropriate forum to performance
manage the Nurse Bank to ensure
organisational accountability for good
financial management, management of
Nurse Bank nursing and clerical staff;
corporate and clinical governance and
high quality patient care. This forum
should identify areas of concern and plan
strategies that can be implemented and
evaluated.
Unit Managers have a suite of indicators
to monitor the effectiveness of health care
employment policies and use of Nurse
Bank. Timely reports on performance are
prepared and presented to the
appropriate level of the organisation.
Examples of indices such as vacancy
rates/% of fill rate/% of across 24 hour
shifts; timeliness of fill rate monitored
Line management reporting of
outcomes reflecting identified
milestones and key performance
indicators.
Monitor performance against KPI based
on reports including fill rates, usage,
trends and reports generated against
agreed targets met.
Easy access to Nurse Bank Information is
consistent and timely communication
between all users of service
A variety of methods be employed to
communicate with Nurse Bank
management staff; health care agency and
administrative staff
Nurse Bank management team
demonstrate responsiveness to service
needs of health care organisation.
Examples of reports generated include
Nurse Bank timelines to fill vacant
shifts; percentage of fill rate.
37
Performance and Maintenance of Nurse Bank continued
Areas of consideration Recommended practice Process Measures of success
Systems for regular audit and surveillance
of service users’ views for the recruitment,
deployment of Nurse Bank staff including
monitoring levels of dissatisfaction with
processes, procurement, complaints
Regular contact with employer to assess
level of satisfaction with assurance that
Nurse Bank meets the needs of the service
users.
Regular contact with Nurse Bank
employee to assess level of satisfaction
with Nurse Bank employment, processes,
accessibility.
Mechanisms in place to provide
feedback regarding Nurse Bank
performance.
Nurse Bank staff are not treated less
favourably than permanent
employees.
Clear guidelines regarding the provision of
and acceptance of employment through
Nurse Bank
Obligations are set out clarifying the offer
of employment on the part of the Nurse
Bank and responsibilities of Nurse Bank
employees acceptances employment
Nurse Bank staff entrance and exit
interviews offered.
On going review and reconciliation of
staff establishments to ensure that
budgets can accurately reflect
requirements in terms of substantive and
Nurse Bank nursing staff.
Generation of data on non-filled shifts in all
areas.
Patterns of available shifts established to
assist health care agency in workforce
planning and strategies.
Monthly comparative costings between
Nurse Bank and Agency staff utilisation.
Monthly reports based on indicies such as
number of unfilled shifts/clinical areas
difficult to fill and patterns of shift
availability.
Reduction in monthly spend on
Agency staff.
From data generated workforce
strategies in place accommodating
peaks and troughs in employment
patterns.
38
Examples of good practice
Austin Health (http://www.austin.org.au/) in 2008 undertook a comprehensive review of the Nurse Bank and Allocations surveying Assistant Directors of Nursing, After
Hours Site Managers, Site Managers and Nurse Unit Managers ascertaining their views of the functioning and utilisation of the Nurse Bank. An outcome of the process
resulted in a report outlining significant findings identifying issues and a number of recommendations were made to improve functioning of the Nurse Bank. Austin Health
has an ‘open door’ policy for all Nurse Bank staff and undertake an advocacy role to support Nurse Bank employees. This report was made available to other health care
services who have established Nurse Banks.
CasConnect ( http://www.Casconnect.com.au/) reports to Project Management Team, Director of Clinical Services Stawell Regional Health and Regional Coordinator,
Rural Nurses Recruitment and Retention, Grampians Region on a three to four weekly basis. Each participating health care organisation receives a report and detailed
data on predetermined performance indicators. Reports provided to Nurse Unit Managers and other relevant staff in PDF format. Casconnect undertakes a regular NBV
nurse registration check online; reviews non-active members; distributes a six monthly newsletter to all Nurse Bank employees.
Royalbank (http://www.royalbank.com.au/) convene monthly regular user meetings and an annual review its services to its client health care organisations including
Royalbank nursing and midwifery staff. The Nursing and Midwifery Council oversights monitoring of any complaints that arise using root cause analysis. An on-line
complaint form is available which is directed to Manager of Nurse Bank. The Nurse Bank Manager is also contactable by telephone to deal with any concerns or
39
Evaluation and Benchmarking of Nurse Bank
Areas of consideration Recommended practice Process Measures of success
Is the Nurse Bank doing a good job?
Process for reviewing growth of Nurse
Bank in terms of spending/EFT and
performance against targets
Local action plan including whose
responsibility and timeframe, reporting
system that has been established to allow
monitoring the conduct and performance
of Nurse Bank activities.
Performance measured against
agreed indices.
Length of stay and retention rate of
Bank staff
Examples of good practice
All Nurse Banks visited have established processes to review the performance of their Nurse Banks. For example,
Alfred Health (http://www.alfred.org.au/) survey all Nurse Bank employees to ascertain their level of satisfaction with allocation of work; timeliness; interaction and
communication Unit Staff and Nurse Bank team. Alfred Health has an ‘Open Door” policy for feedback from Unit staff in terms of Nurse Bank utility.
40
References
Australia Institute of Health and Welfare. (2008) Australia’s Health 2008
http://www.aihw.gov.au/publications/index.cfm/title/10585. accessed 10 September 2009)
Buchan, J. (2009) The nursing workforce and global economic recession. Collegian 16, 1-2.
Buchan, J., & Thomas, S. (1995) Managing temporary nursing staff: nurse banks in Scotland.
Health Manpower Management 21: (1) 23-27.
Fitzgerald, M., McMillan, M., & Maguire, J. M., (2007) Nursing from the casual pool: Focus
group study to explore the experiences of casual nurses. International Journal of
Nursing Practice, 13: 229-236.
Report by the Comptroller and Auditor General (2006) Improving the use of temporary
nursing staff in NHS acute and foundation trusts. London: National Audit Office.