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Temp Nurses: Seriously Incompetent?

Thanks to screening shortcuts, temp nurses nap on the job, steal drugs, and fail to perform critical tests.

| Mon Dec. 7, 2009 4:11 PM EST

Seal of approval

Some in the industry say staffing firms already have an able watchdog.

Since 2004, the Joint Commission, better known for accrediting hospitals, has been reviewing healthcare staffing firms. The national organization bestows its seal of approval on those that meet standards for screening applicants, following up on complaints and ensuring competency.

This seal is displayed prominently on firms' websites. Some hospitals will use only agencies that have it.

But the program is voluntary and used by a minority of temp agencies – 337 firms – in part because they must pay the commission thousands of dollars to be reviewed. Most of the largest firms are certified.

The commission doesn't release detailed findings on the firms, even to hospitals. It has withdrawn its seal of approval from temporary staffing agencies seven times this year – all but once for nonpayment of fees.

At the same time, firms that display the seal have been cited in audits, nursing board records and court files for bad judgment or behavior.

Joseph Baiden, owner of JFB Staffing in Diamond Bar, was arrested in August on charges of defrauding the state workers' compensation fund of $1.4 million by misrepresenting the number of nurses on his payroll.

Some hospitals cut ties with JFB, and authorities froze Baiden's bank accounts and seized his property.

Although Baiden has pleaded not guilty, his attorney Tracy Green said that she is working toward a resolution with the district attorney's office and that Baiden plans to repay whatever he owes.

In the meantime, on the Joint Commission's website, there is a gold seal of approval by the JFB name.

Problems no barrier

Paystaff Pacific not only hired nurse Raphael Obiora in 2007 despite his troubled past, it also kept sending him out when it learned he wasn't a skilled nurse, documents show.

In a little more than a year, seven hospitals rejected Obiora, telling Paystaff he'd made a medication error, failed to follow a doctor's order and been "inappropriate" with a patient's relative.

Hospital managers use such rejection notices, known as "Do Not Sends," to alert agencies to the shortcomings of temp nurses. But the agencies are under no obligation to act on the information.

In April 2008, the Monterey Park firm dispatched Obiora to Garfield Medical Center. There, he failed to adequately monitor the vital signs of two critically ill patients. His conduct was "unsafe," wrote Simon Marcus, the hospital's critical care director, on a form he sent to Paystaff.

Unknown to the hospital, Paystaff had already evaluated Obiora and found his competence to be below average. Shortly before he was sent to Garfield, the firm had determined that he should be fired immediately, according to agency records that became part of a regulatory proceeding.

Only after Marcus raised an alarm did Paystaff fire Obiora.

Hugh Wu, a Paystaff official, said in an e-mail that the company acted responsibly. Other complaints about Obiora were not as serious as Garfield's, he said, and Obiora had hidden state nursing board discipline against his license.

Obiora, an evangelist who preaches at a Celestial Church of Christ in Gardena, ultimately lost his California license.

Marcus said his experience with Obiora "makes you wonder" about temp nurses. "Have they made errors elsewhere? Who is monitoring them?"

Some temp firms indicated that they don't use a nurse again if they feel at all uneasy. "We just don't want to take the risk," said Jim Essey, who runs a New York-based temp agency and is a former chairman of the American Staffing Assn., an industry trade group.

Other agencies say most rejections stem from picayune problems, such as tardiness and personality clashes.

But data provided by public hospitals show this isn't necessarily so.

According to Riverside County Regional Medical Center, for example, more than 60% of the 339 temp nurses rejected since 2003 failed to demonstrate basic nursing skills on the job. Arrowhead Regional Medical Center, San Bernardino County's public hospital, reported that it had rejected 61 temp nurses since 2005 – more than half for performance problems.

Hospitals sometimes lose track of which nurses they have already booted. A nurse can be red-flagged by one unit and later sent to another.

At Lakewood Regional Medical Center in March 2008, temp nurse Kelvin Brown was found in a deep sleep at the nurses' station on a ward of patients hooked up to monitors.

An excerpt from a complaint by the California Board of Registered Nursing against nurse Kelvin Brown, who is accused of falling asleep repeatedly on the job.
He was roused but later fell asleep in a patient's room. Awakened again, he dozed off in the break room. Asked to leave the hospital, he made it as far as the intensive care waiting room before slipping into sleep once more. He left after security called police, according to the nursing board's December 2008 accusation against him.

A supervisor later discovered that Brown had had problems at the hospital before. He had fallen "heavily asleep on every shift and exhibited behavior – such as talking to and answering himself aloud – that made staff uncomfortable," the accusation said.

In fact, Brown had been placed on the hospital's "Do Not Return" list while working for another agency for such reasons, the document states.

A spokesman for Tenet Healthcare Corp., Lakewood's parent, confirmed that Brown had worked at the hospital before but disputed the state's account that he'd been previously barred from working there.

Brown could not be located for comment.

In another case, St. Jude Medical Center in Fullerton informed MedStaff Healthcare Solutions in March 2007 that it suspected nurse Donald Paradise of stealing drugs and asked that he never return, a hospital spokesman said. Six months later, Paradise was accused of stealing drugs at a sister hospital, where he also had been sent by MedStaff.

"It's absolutely not acceptable," said Kevin Andrus, a spokesman for St. Joseph Health System, which includes St. Jude.

MedStaff's contract, he said, prohibited it from sending a rejected nurse back to any hospital in the chain, but Andrus conceded that the chain doesn't keep a master list, as some entities do.

A spokesman for MedStaff said that Paradise had passed a drug screening after the St. Jude incident and that the hospital had indicated it was satisfied with that. Andrus says that was not so.

Paradise, who faces a nursing board accusation, could not be reached for comment.

In interviews, several temp nurses who had been in trouble said their employers focused more on keeping slots filled than on who filled them.

That was a lifeline for Obiora.

The agencies "just send and send and send and send," he said.

See related story: A ‘Crazy’ Way for an Industry to Operate

Lisa Schwartz, director of research at ProPublica, and researcher Kitty Bennett contributed to this report.

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