Part-time and temporary workers are at much higher risk for injury illness

Often, little attention is paid to their safety

If an employee is morbidly obese, drug-impaired, or chronically sleep-deprived, you would probably suspect that this individual is at greater risk for injury or illness in the workplace. But what if the worker is part-time or hired on a temporary basis?

There is growing evidence that "contingent" workers have a far greater risk for occupational injuries and illnesses than other workers, according to a review of research on this topic.1 Here are key findings:

  • Fatal occupational injuries among self-employed workers are twice the national average for all workers, according to data from the U.S. Bureau of Labor Statistics.
  • The rate of needlestick injuries among temporary nurses caring for AIDS patients in 11 U.S. hospitals was 1.65 times higher than the rate for staff nurses working in the same units.
  • Nineteen percent of day laborers reported work-related injuries that required medical attention in the previous year, compared about 6% of all workers in construction.

Occupational health nurses (OHNs) can serve as advocates for injury and illness prevention for these employees, says Kristin J. Cummings, MD, MPH, the study's author and a researcher at the National Institute for Occupational Safety and Health. "Contingent workers now comprise a third of the workforce, [which is] 43 million workers," says Cummings. "Occupational health professionals should be aware that these employees are at higher risk and look at preventing illness and injury in this group."

Tamara Y. Blow, MSA, RN, COHN-S/CM, CBM, FAAOHN, manager of occupational health services for Altria Client Services in Richmond, VA, says use of part time and temporary workers is increasing because companies are cutting back and "trying to do more with less."

Health and safety training programs must be continuously monitored to ensure the well-being for a company's entire workforce, says Grace K. Paranzino, MS, RN, CHES, FAAOHN, national clinical manager with Kelly Healthcare Resources. "Temporary employees should be afforded the same health and safety training as permanent employees," she adds. "This is an issue that has had little attention."

To improve health and safety of contingent workers, do the following:

  • Provide education for temporary workers on safety protocols and procedures related to their workplaces.
    There should be consistent training between contingent workers and full-time workers, says Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, clinical assistant professor for the Occupational Health Nursing Program at University of North Carolina at Chapel Hill. Employees should be informed about the scope of services that they are expected to provide, recognize the associated safety risks, and understand the preventive measures they can take in order to reduce or eliminate potential exposures, says Paranzino.
  • Ask contingent workers what kind of safety training and equipment they received.
    Don't assume that a contingent worker is receiving the same benefits that other workers receive, says Cummings.
    In one case, factory employees attended a respiratory protection program and received personal protective equipment and training, but this was not offered to contract workers, says Cummings. "The contract company thought the factory should provide this, and the factory thought the contract company should provide it," says Cummings. " As a result, the contract workers didn't have any protection."
    There may be confusion over who is responsible for the safety and health concerns of employees who work part time, on a temporary basis, or on a contractual basis for a company, says Randolph. "They should receive some training by the agency," she says. "They are expected to follow the health and safety procedures where they are working."
    However, there is no question that companies are required to train temporary workers for many Occupational Safety and Health Administration (OSHA) standards, such as hazard communication, lockout-tagout, bloodborne pathogens, and confined space.
  • Include short-term workers in routine surveillance programs.
    If a company hires temporary workers for just a couple of months, they may not recognize the need to include them in their surveillance, says Cummings.
    Randolph says, "Workers may not be in one location for a long period of time, which makes it difficult to follow up on injuries."
    Know where contingent workers are working in the company in order to be aware of exposures, safety protection, and any required training, she says. "Are appropriate monitoring and surveillance records being kept? Is the temp agency keeping records?" she asks. "Health and safety should be included in the contract with a temp agency or when contingent workers are hired."
    All workers need to be screened for health and safety related to exposure to hazards, says Randolph. "To prevent it from falling through the cracks with contingent workers, the cost of the screening should be charged back to the agency or included in the contract," says Randolph. "If the worker moves on to another job, then it should be the responsibility of the agency to follow up with the worker."
    Contracted employees must pass initial clearance for respiratory fit testing or forklift driving, which is performed by the contractor's own vendors, says Blow. However, once the contractor has passed the initial surveillance exams to work at a corporation's work site, it's difficult for OHNs to monitor ongoing compliance, she says. "Many times the contractors fall through the cracks if the OHN is not proactive," Blow says. "It requires having to know all the contractors that are coming to your worksite, which may be impossible. And how are you going to monitor that?"
    Temporary workers should be included in surveillance programs, particularly as part of OSHA standards, says Randolph. However, OHNs often are unable to provide ongoing surveillance for contingent workers because of co-employment, Blow says. Co-employment is a legal doctrine that applies when two businesses exert some control over an employee's work assignments or conditions of employment, and it can expose companies to litigation, says Blow. By performing any follow-up with contingent workers, the OHN may be "walking a tightrope," she says. "Due to potential issues with co-employment, there is little incentive for the OHN to perform wellness screenings on contractors," Blow says. "Ongoing screening for blood pressure, cholesterol, or diabetes isn't done for these workers."
    However, OHNs still are obligated to respond to medical emergencies for these workers. "If they are working on the premises, we have a legal and ethical obligation to treat them," says Blow. "When a contingent workers presents for emergency care, the illness or injury is often severe because the worker has gone without treatment for a long period of time. Often, the reason for delay in care is due to being uninsured."
  • Provide education on wellness.
    Because most contingent workers lack health benefits through their employer, these workers may put off seeking care if an illness develops from occupational exposure. "The laws to protect workers were designed prior to the rise in contingent arrangements, with single employer 40-hour-a-week relationships in mind," says Cummings. "It can be hard to get contingent workers involved in wellness programs."
    Consider including contingent workers in communications about your wellness programs such as "lunch and learns," recommends Randolph.
    Blow owns a home health care company with about 40 employees, all-part time or temporary, and offers health benefits for individuals who work a certain number of hours. "We also started performing periodic health screenings and offering monthly education such as diabetes prevention," she says. "I have found that it makes my employees feel like we care for them. As a result of feeling valued, I have noticed a significant decrease in employee turnover."


1. Cummings KJ, Kreiss K. Contingent workers and contingent health: Risks of a modern economy. JAMA 2008; 299:448-450.


For more information on health and safety of contingent workers, contact:

  • Tamara Y. Blow, MSA, RN, COHN-S/CM, CBM, FAAOHN, Manager, Occupational Health Services, Altria Client Services, Richmond, VA. Phone: (804) 274-5805. Fax: (804) 274-5489. E-mail: Tamara.
  • Kristin J. Cummings, MD, MPH, National Institute for Occupational Safety and Health, Morgantown, WV. Phone: (304) 285-6102. E-mail:
  • Grace K. Paranzino, MS, RN, CHES, FAAOHN, National Clinical Manager, Kelly Healthcare Resources, Troy, MI. Phone: (248) 244-3894. Fax: (248) 244-4483. E-mail:
  • Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, Clinical Assistant Professor, Occupational Health Nursing Program, University of North Carolina at Chapel Hill. Phone: (919) 966-0979. Fax: (919) 966-8999. E-mail: