As a consequence of a shortage of nurses in Denmark, the hospitals use agency nurses to make up the shift schedule. It has not been possible to identify studies which examine how permanent nurses experience the use of agency nurses.
The purpose of this case study is to provide new knowledge about which factors permanent nurses, in a department where there is a large shortage of nurses, has an impact on the collaboration with agency nurses, and how the appearance of agency nurses affects the psychosocial working environment in the department from the permanent nurses’ perspective. Our research design is a case study, and for the collection of empirical data, we have made four focused observations and five semi-structured interviews with permanent nurses from the same ward. It is concluded that permanent nurses experience that five trust parameters and six adaptation strategies are important for trust and cooperation with the individual agency nurse. The trust parameters are the degree of trust that the permanent nurses have in the agency workers, and this is the agency nurses' skills, degree of responsibility, attitude to work and experience from the hospital department. The adaptation strategies are division of work tasks, training of substitutes, recognition, own systems and control, doing things yourself or stopping collaboration. The permanent nurses are dependent on the labor of the agency nurses to ease the high work pressure on the ward. Overall, the permanent nurses experience that the psychosocial working environment is perceived as unsafe because of the agency nurses. A large number of changing nurse substitutes contributes to the experience of a lack of structure, lack of influence, lack of meaningfulness and great unpredictability in the work. The permanent nurses experience that the use of agency nurses contributes to the experience of high physical and emotional demands. At the same time, the permanent nurses experience increased work pressure because they have to double-check and introduce new agency nurses. The permanent nurses find it unfair that the agency nurses receive a higher salary while at the same time feeling that they take on a lesser degree of responsibility, and at the same time that no demands are made to the competences of the agency nurses, but high demands are placed on the competences of the permanent nurses.
An important finding from this case study shows that a lack of guidelines for training and competence development of agency nurses increased work pressure for the permanent nurses and the experience of an unsafe working environment. There is a need for political focus on this issue as well as further research in this field.