Although I have worked for nurse banks and agencies for many years I do not like the way they are run and the effect that the use of bank and agency nurses has on the quality and continuity of care. I have since worked for an agency providing homecare staff, and was involved in the allocation of work to carers. I realise how difficult it is, as carers tend to work part-time and have other commitments.

I was lucky enough in my bank nurse job to get regular shifts on the same department and became almost like a member of the permanent staff. This was mainly because the sister in charge did not like using bank staff as they were unreliable and often incompetent. Once she realised that I was very experienced and reliable she put in a regular order for me, so I got to know how everything worked and was able to provide a better service to them and was given extra responsibilities.

There is some confusion as to what the difference between bank staff and agency staff, but mainly bank staff work in the same place all the time, whether it be a hospital or nursing home, but they may work on different wards within that place. Agencies are usually based away from the workplace and will provide staff for many different places. Most hospitals now have their own banks, based in or near the hospital.

Secombe and Buchan have written several reports on nurse absence and use of temporary staff. They believe the main reasons for absence are, illness, work related injuries, stress and family commitments. It is also clear from the report that there is a lot of conflict between maintaining staff levels and keeping costs down.

"Whilst there was a recognition that some cheaper options, in cost terms may have an adverse impact on continuity or quality of care, line management were often under pressure not to increase staffing costs." (px).

The report suggests many times that the use of bank and agency staff has a negative effect on
continuity and quality of patient care. They state that where ward staff have control over the nurses they get from the bank the effect on patient care was less of a problem.

Humm (1995) makes a point that I strongly agree with;

"Use of bank nurses can adversely effect continuity of care and make it difficult to implement training and development programmes for staff. It would appear that both employees and patient welfare take second place to economic considerations" (p42).

I agree with Humm "working for a bank was the only way I could get work whilst I was studying" but I do feel guilty that the patients may have suffered; I always endeavoured to do the best I could. I preferred to work in the same places regularly, but this was not always possible. In my job as a care co-ordinator, I tried to send the staff that I allocated to jobs to the same people regularly, as I know what it is like to be always in an unfamiliar place.

It does require extra skills to be a bank nurse; "they have to adapt to different situations at the drop of a hat," (Hurd 1998 p11). This is not always easy and takes time to develop. Unfortunately most people do not regard bank staff very highly and often treat them badly. "It would be nice if permanent staff showed consideration to fellow human beings with feelings" (ibid).

Working for a bank can also have a positive side; I developed skills to adapt quickly to different environments, to be observant and to be able to work on my own initiative. It also gave me the knowledge to be able to empathise with the staff that worked for me at the homecare agency.

I know it is difficult for wards that are short staffed when they are sent staff who do not know the area or routine, but having a bad attitude towards them will not help.

I was once in a position, whilst working in a nursing home, where I was the only permanent member of staff on a
night shift, all the other staff were from an agency as the rest of the staff were out at a Christmas party. It all went very smoothly, I showed the agency staff where things were and explained about residents that had special requirements and then told them to let me know if they wanted to know anything or needed any help. Most of the residents had been told that there would be different staff and they were as helpful as possible. I believe that a change in attitudes towards agency and bank staff could be all that is needed to iron out some of the problems.