Challenging Myths About Supplemental Nurses
Ying Xue, DNSc, RN, is an associate professor at the University of Rochester School of Nursing and an alumnus of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
For the past two decades, supplemental nurses have been about 4 percent of the nursing workforce. These are nurses hired from staffing agencies to temporarily fill vacant nursing positions. The business of supplemental nurse staffing began in the 1970s as a symptom and a response to the nursing shortage. A central concern over the decades has been whether quality of patient care provided by supplemental nurses is the same as that provided by permanent nurses.
On the one hand, some argue that the temporary nature of the position (which varies from per-diem to a few months) might have an adverse effect on patient outcomes due to supplemental nurses’ lack of familiarity with unit policies and health care providers, and disruption in continuity of care. Others contend that supplemental nurses might have a positive effect on patient outcomes because they alleviate deficiencies in nurse staffing.
What’s the answer to this decades’ old question? Surprisingly, relatively little research has been conducted to provide a definitive answer, but several recent studies not only are shedding light on the issue, but helping to reframe the question by challenging some old myths.
We do know that adequate hospital nurse staffing has been linked to better patient outcomes, and so inadequate nurse staffing is not an option for hospitals. The question, therefore, is not whether hiring supplemental nurses to fill shortages is better than going short-staffed, but whether it is better than alternatives, such as increasing the hours worked by permanent nurses. Recent research has shown that nurses who work longer shifts (10 hours or longer) are more likely to experience burnout, job dissatisfaction, and intent to leave, and can negatively affect patient outcomes.
There is a long-held myth that supplemental nurses are less qualified, less educated, and less experienced than permanent nurses. But in a recent article published in Health Affairs, my colleagues and I presented data from a national survey of nurses which showed that the proportion of supplemental and permanent nurses with baccalaureate or higher nursing education was similar, and both are up from previous years. This is a promising trend, because higher nursing education has been linked to better patient outcomes. Similarly, we found that level of experience of supplemental nurses was close to that reported by permanent nurses. What’s more, supplemental nurses tended to be slightly younger, more often male, more racially diverse, and more mobile.
Mobility and flexibility of the supplemental nursing workforce may be key to meeting nurse staffing demands. Supplemental nurses have been used to meet a variety of unanticipated or temporary staffing needs that are due to staff medical leave, patient census fluctuations, planned vacation and weekend coverage to relieve permanent staff. In addition, the nursing shortage has been a consistent challenge characterized by regional variations, and a well-qualified supplemental nursing workforce enhances workforce capacity to respond to regional shifts in nurse shortages.
The question is no longer whether supplemental nurses provide better or worse care, but rather how do we best capitalize on this longstanding practice to further improve quality of patient care.