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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

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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


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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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.


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





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.


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





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.


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



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.


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



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


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


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.


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


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,


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.


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.


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


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.


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


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.


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


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.


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


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.


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


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.


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


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


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


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


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


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.

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