Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Rispel, Laetitia C.; Blaauw, Duane; Chirwa, Tobias; de Wet, Katinka (2014)
Publisher: Co-Action Publishing
Journal: Global Health Action
Languages: English
Types: Article
Subjects: moonlighting, Original Article, health systems, RA1-1270, Public aspects of medicine, overtime, South Africa, human resources, moonlighting; agency nursing; nurses; human resources; overtime; South Africa, nurses, agency nursing
Background: In South Africa, nurses are the largest category of the health care providers. Their optimal performance is critical for the successful implementation of impending health sector reforms.Objective: This paper examines the occurrence of agency nursing, moonlighting, and overtime among nurses in South Africa, and the factors influencing moonlighting.Design: This cross-sectional survey was a one-stage cluster random sample of 80 hospitals in four South African provinces, selected with stratification from the public and private health sectors. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information, the questionnaire elicited information on the frequency of agency nursing, moonlighting, and overtime, and the nurses’ reasons for doing moonlighting. Survey data were weighted and analysed using STATA version 12.Results: The majority of survey participants (n=3,784) were South African (98.0%), female (92.7%), and employed in government (52.8%). Their mean age was 41.5 years (SD 10.4). The occurrence of moonlighting among nurses in the 12 months preceding the survey was 28.0% [95% CI: 24.2–32.1], the frequency of agency nursing was 37.8% [95% CI: 32.4–43.6], while 56.0% of nurses did overtime [95% CI: 51.4–60.4]. In the multiple logistic regression analysis, predictors of moonlighting were province, sector of primary employment, unit of work, category of nurse, and having children. The odds of moonlighting was 1.51 [95% CI: 1.03–2.21] times higher for private sector nurses than for public nurses, while the odds ratio for auxiliary nurses was 0.61 [95% CI: 0.47–0.79] compared to professional nurses. The odds of moonlighting was 1.49 [95% CI: 1.18–1.89] for nurses with children, compared to those without.Conclusions: Agency nursing, moonlighting, and overtime are common among South African nurses, but have received insufficient policy attention. These issues need to be addressed as part of the implementation of comprehensive health workforce strategies.Keywords: moonlighting; agency nursing; nurses; human resources; overtime; South Africa(Published: 18 March 2014)Citation: Glob Health Action 2014, 7: 23585 - http://dx.doi.org/10.3402/gha.v7.23585
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Global Health Workforce Alliance, WHO (2013). A universal truth: no health without a workforce. Geneva: World Health Organization.
    • 2. Department of Health (2011). Human resources for health South Africa: HRH strategy for the health sector: 2012/13 2016/17. Pretoria: Government Printer.
    • 3. Rispel LC, Barron P. Valuing human resources: key to the success of a National Health Insurance System. Dev South Afr 2012; 29: 616 35.
    • 4. Department of Health (2013). National Strategic Plan on nurse education, training and practice 2012/13 2016/17. Pretoria: Government Printer.
    • 5. Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet 2009; 374: 817 34.
    • 6. Averett SL. Moonlighting: multiple motives and gender differences. Appl Econ 2001; 33: 1391 410.
    • 7. Berman P, Cuizon D (2004). Multiple public private jobholding of health care providers in developing countries: an exploration of theory and evidence. London: Department for International Development Health Systems Resource Centre.
    • 8. Ferrinho P, Van Lerberge W, Fronteira I, Hipolito F, Biscaia A. Dual practice in the health sector: review of the evidence. Hum Resour Health. 2004; 2. DOI: 1186/478-4491-2-14.
    • 9. Betts SC. The decision to moonlight or quit: incorporating multiple jobholding into a model of turnover. J Organ Cult Comm Conflict 2006; 10: 63 78.
    • 10. Cohen SN, Leeds MP. The moonlighting dilemma, balancing education, service and quality care, while limiting risk exposure. JAMA 1989; 262: 529 31.
    • 11. Culler SD, Bazzoli GI. The moonlighting decisions of resident physicians. J Health Econ 1985; 4: 283 92.
    • 12. Allen WA. The moonlighting decision of married men and women: family and labor market influences. Atl Econ J 1998; 26: 190 205.
    • 13. Wickens MR. Towards a theory of the labour market. Economica 1974; 41: 278 94.
    • 14. McNeeley MF, Prabhu SJ, Monroe EJ, Iyer RS. The nature and scope of moonlighting by radiology trainees. Acad Radiol 2013; 20: 249 54.
    • 15. Singh D, McDonald FS, Beasley BW. Demographic and worklife study of chief residents: a survey of the program directors in internal medicine residency programs in the United States. J Grad Med Educ 2009; 1: 150 4.
    • 16. Steiner JW, Pop RB, You J, Hoang SQ, Whitten CW, Barden C, et al. Anesthesiology residents' medical school debt influence on moonlighting activities, work environment choice, and debt repayment programs: a nationwide survey. Anesth Analg 2012; 115: 170 5.
    • 17. Betts SC. Gender differences in multiple jobholding: moonlighting among teachers. J Bus Econ Res 2004; 2: 25 34.
    • 18. Rauch JE, Evans PB. Bureaucratic structure and bureaucratic performance in less developed countries. J Publ Econ 2000; 75: 49 71.
    • 19. Bloom G, Han L, Li X. How health workers earn a living in China. Hum Resour Health Dev J. 2001; 5: 25 38.
    • 20. Lewis M, Pettersson G (2009). Governance in health care delivery: raising performance. Policy Research Working Paper 5074. Washington, DC: World Bank: Development Economics Department & Human Development Department.
    • 21. McPake B, Asiimwe D, Mwesigye F, Ofumbi M, Ortenblad L, Streefland P, et al. Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care. Soc Sci Med 1999; 49: 849 65.
    • 22. Ferrinho P, Van Lerberge W, Julien MR, Fresta E, Gomes A, Dias F, et al. How and why doctors engage in private practice in Portuguese speaking African countries. Health Policy Plan 1998; 13: 332 8.
    • 23. Macq J, Ferrinho P, De-Brouwere V, Van-Lerberghe W. Managing Health Services in Developing countries: between the ethics of the civil servant and the need for moonlighting: managing and moonlighting. Hum Resour Health Dev J 2001; 5: 17 24.
    • 24. Jan S, Bian Y, Jumpa M, Meng Q, Nyazema N, Prakongsai P, et al. Dual job-holding of public health professionals in highly resource-constrained settings: problem or solution? Bull World Health Organ 2005; 83: 771 6.
    • 25. Public Service Commission (2007). Remunerative work outside the public service: an investigation undertaken in the Gauteng Provincial Health sector. Pretoria: PSC.
    • 26. Bhengu BR. Exploring the critical care nurses' experiences regarding moonlighting. Curationis 2001; 24: 48 53.
    • 27. Braddy PK, Washburn TA, Caroll LL. Factors influencing nurses to work for agencies. West J Nurs Res 1991; 13: 353 62.
    • 28. Buchan J, Edwards N. Nursing numbers in Britain: the argument for workforce planning. BMJ. 2000; 320: 1067 70.
    • 29. Hughes KK, Marcantonio RJ. Recruitment, retention and compensation of agency and hospital nurses. J Nurs Admin 1991; 21: 46 52.
    • 30. Peerson A, Aitken RL, Manias E, Parker JM, Wong K. Agency nursing in Melbourne, Australia: a telephone survey of hospital and agency managers. J Adv Nurs 2002; 40: 504 12.
    • 31. ILO (2006). Changing patterns in the world of work: report of the director-general to the International Labour Conference, 95th session. Geneva: International Labour Organization.
    • 32. Republic of South Africa. Nursing Act no 50 of 1978. Pretoria: Government Printer.
    • 33. Republic of South Africa (2013). Basic Conditions of Employment Act (as amended). Pretoria: Government Printer.
    • 34. Batch M, Barnard A, Windor C. Who's talking? Communication and the casual/part-time nurse: a literature review. Contemp Nurse 2009; 33: 20 9.
    • 35. Moore A (2013). Rising temporary nursing costs. London: HSJ Local Briefing.
    • 36. Li J, Tabor R, Martinez M. Survey of moonlighting practices and work requirements of emergency medicine residents. Am J Emerg Med 2000; 8: 147 51.
    • 37. Creegan R, Duffield C, Forrester K. Casualisation of the nursing workforce in Australia: driving forces and implications. Aust Health Rev 2003; 26: 207 14.
    • 38. Leiter MP, Harvie P, Frizzell C. The correspondence of patient satisfaction and nurse burnout. Soc Sci Med. 1998; 47: 1611 17.
    • 39. Stanton MW, Rutherford MK. Hospital nurse staffing and quality of care. Rockville, MD Agency for Healthcare Research and Quality; 2004. Research in Action Issue 14. AHRQ Pub. No. 04-0029.
    • 40. Urbach JR. Resident moonlighting: towards an equitable balance. South Med J 1994; 87: 794 800.
  • No related research data.
  • No similar publications.

Share - Bookmark

Cite this article