| |
 |
| AR-03-06: Hiring of Nurses Directly by the Commonwealth Health Center Versus Contracting Through Manpower Agencies (Issued 8/19/03) Summary
This report presents the Office of the Public Auditor’s (OPA) evaluation of nurses provided to the Department of Public Health’s Commonwealth Health Center (CHC). The evaluation’s objective was to determine whether CHC’s practice of using manpower agencies to hire nurses saves the Department of Public Health and the Commonwealth of the Northern Mariana Islands (CNMI) money without compromising patient care. As of December 31, 2002, three manpower agencies had provided CHC with 126 of its 209 nurses and CHC had directly hired the remaining 83 nurses. OPA found that the hiring of nurses through manpower agencies is less costly than the direct hiring of nurses. However, continuing the current practice of contracting with manpower agencies rather than directly hiring nurses will perpetuate other problems, most notably the difficulty in retaining qualified nurses. More specifically:
Manpower agencies offer lower salaries and benefits than nurses hired directly by CHC receive, resulting in greater nurse turnover among manpower nurses ,which, according to four of six of CHC doctors interviewed, has adversely impacted patient care. OPA found that direct hire nurses stay in the CNMI for a considerably longer period than do manpower nurses, resulting in less turnover. The average length of employment of direct hire nurses employed by CHC was 108 months while manpower nurses average only 28 months. CHC is constantly being forced to rebuild its nursing staff with inexperienced manpower nurses who arrive to replace those leaving. Most manpower provided nurses use their CNMI job as a stepping stone to the United States (U.S.) and other countries. Data obtained indicates that once nurses obtain the NCLEX certification needed to practice in the U.S., most seek jobs elsewhere because their current salaries are not competitive with compensation they can obtain elsewhere. OPA found that many manpower provided nurses would likely stay at CHC if they were paid pay and benefits comparable to direct hire nurses; likewise many former manpower nurses, now in the U.S., would possibly return to the CNMI. More specifically, over 90 percent of the manpower nurses interviewed stated that they would remain at CHC if they were converted to direct hire status with appropriate salary increases and a benefits package similar to that provided to direct hires. While there are no easy answers, it appears that the direct hiring of non-resident nurses would allow CHC to retain nurses and thereby help improve patient care. Although the CNMI continues to face a fiscal crisis, it cannot afford to let the health care system deteriorate. In the end, nursing experience and continuity in service, and their impact on patient care, cannot be discounted when analyzing the costs of conversion. However, because the present environment of financial austerity cannot be ignored, one solution may be to convert back to direct hire of nurses over a period of time. The Acting Secretary of Public Health had no comments on this report other than to state that this issue was of great importance to the department and the community as a whole. Two of the three manpower agencies, however, provided comments. One agency advised that the Department of Public Health needed to find a compromise solution to resolve disparities and inequities at hand. It contended that CHC would have difficulty in retaining qualified nurses even if it hired them directly and if they were equally compensated. The other agency stated that more than a small pay increase was needed if CHC wanted to hire and retain qualified nurses. Further, the agency stated that CHC could improve its patient care if it improved its communication and relations with manpower companies.
| |||||||||||||||||||||||||||||||||||||||||
