With the recent global economic downturn, companies worldwide are looking for ways to trim costs. Within the healthcare industry, the Affordable Care Act of 2010 was designed to address some of these fiscal concerns by requiring employers with 50 or more full-time employees to offer health insurance coverage to their full-time staff. Opponents of the law claim that this will increase healthcare costs for employers and will thus cause a massive shift toward temporary and part-time labor. Evidence of this trend has already begun to surface, with the U.S. Bureau of Labor Statistics citing a steep rise in the hiring of temporary and contracted healthcare workers, mirroring the trend all across the service industry. By hiring more part-time labor, companies (hospitals included) are able to circumvent the Affordable Care Act’s full-time employee health insurance mandate. Contracted health workers are not afforded the same protections as full-time employees, and typically are not given equivalent vacation time, pay, or health insurance benefits.
Hospitals face even more incentive to hire temporary and contracted healthcare workers due to their somewhat unique fluctuations in labor demand. Severe injuries and illnesses that warrant a hospital stay do not often stay within established predictive metrics. This causes hospital administrators difficulties when planning schedules for hospital employees, and these difficulties may be further compounded by a local shortage of nursing personnel, physicians, or other specialized labor. When faced with the choice of either not being able to provide quality healthcare services to their patients or the prospect of hiring more temporary labor, hospitals typically choose the latter.
Though hospitals and other companies may trim their health insurance premiums by hiring more contracted healthcare workers, we must ask: what about the impact on patient safety? Do contracted healthcare workers pose more of a risk than the labor savings are ultimately worth? Some studies indicate that temporary hospital employees, particularly nurses, have often been trained more recently than full-time career nurses and that training shows up in better overall hospital performance.
Other assessments are not as optimistic, however. Many hospitals, especially when demand for labor is high, do not have rigorous screening procedures for hiring new temporary employees. This practice puts patient safety at risk by exposing vulnerable people to potentially harmful employees. Not surprisingly, impact on patient safety is difficult to measure when placed in financial terms. Should incidences of misconduct perpetrated by contracted healthcare workers begin to gain attention, hospitals may see reduced admission rates, leading to financial crises and other problems.