The health system consequences of agency nursing and moonlighting in South Africa

Abstract

BackgroundWorldwide, there is an increased reliance on casual staff in the health sector. Recent policy attention in South Africa has focused on the interrelated challenges of agency nursing and moonlighting in the health sector.ObjectiveThis paper examines the potential health system consequences of agency nursing and moonlighting among South African nurses.MethodsDuring 2010, a cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses providing clinical care completed a self-administered questionnaire after giving informed consent. The questionnaire obtained information on socio-demographics, involvement in agency nursing and moonlighting, and self-reported indicators of potential health system consequences of agency nursing and moonlighting. A weighted analysis was done using STATA® 13.ResultsIn the survey, 40.7% of nurses reported moonlighting or working for an agency in the preceding year. Of all participants, 51.5% reported feeling too tired to work, 11.5% paid less attention to nursing work on duty, and 10.9% took sick leave when not actually sick in the preceding year. Among the moonlighters, 11.9% had taken vacation leave to do agency work or moonlighting, and 9.8% reported conflicting schedules between their primary and secondary jobs. In the bivariate analysis, moonlighting nurses were significantly more likely than non-moonlighters to take sick leave when not sick (p=0.011) and to pay less attention to nursing work on duty (p=0.035). However, in a multiple logistic regression analysis, the differences between moonlighters and non-moonlighters did not remain statistically significant after adjusting for other socio-demographic variables.ConclusionAlthough moonlighting did not emerge as a statistically significant predictor, the reported health system consequences are serious. A combination of strong nursing leadership, effective management, and consultation with and buy-in from front-line nurses is needed to counteract the potential negative health system consequences of agency nursing and moonlighting.

Emotional well‐being and work engagement of nurses who moonlight (dual employment) in private hospitals

“…Overall, our findings were positive despite numerous occupational stressors that nurses are confronted with (Coetzee et al, 2013;Khamisa et al, 2013;Khamisa et al, 2017;Khunou, & Davhana-Maselesele, M., 2016;Wentzel & Brysiewicz, 2018) plus the challenges of moonlighting (Muller & Seekoe, 2014;Rispel & Blaauw, 2015). A possible explanation is that our respondents moonlighted in private hospitals.…”

“…This "casualization" of the nursing workforce entails employing nurses on short-term contracts without benefits. There are different types of casual work arrangements: one is moonlighting, where nurses have a full-time and one or more temporary paid nursing job(s) (Rispel & Blaauw, 2015).…”

Transforming nursing policy, practice and management in South Africa

“…In the second paper, Rispel and Blaauw examine the potential health system consequences of agency nursing and moonlighting among South African nurses ( 15 ). In the cross-sectional survey of 3,784 participants, 40.7% of nurses reported moonlighting or working for an agency in the year preceding the survey, 51.5% of all participants reported feeling too tired to work, 11.5% paid less attention to nursing work on duty, while 10.9% took sick leave when not actually sick in the preceding year ( 15 ). In a multiple logistic regression analysis, the differences between moonlighters and non-moonlighters were not statistically significant after adjusting for other socio-demographic variables.…”

Exploring the characteristics of nursing agencies in South Africa

“…Only one-fifth of agencies (21%) indicated that they conducted reference checks with past employers. Hence this is an area that needs improvement, because the failure of a nursing agency to conduct these basic quality checks could lead to serious negative incidents both for individual clients and for the health system as a whole ( 33 ).…”