New Study Suggests Short-Term Contract Nursing Workforce Could Help Offset Looming Nursing Shortage

    • November 5, 2012

Princeton, N.J.―Registered nurses (RNs) who work on short-term contracts through external staffing agencies (or supplemental nurses) have similar education levels and, on average, only slightly less work experience than permanent RNs, according to a new study. This, coupled with being younger, more diverse and more flexible when it comes to relocating, suggests that this segment of the nursing workforce may be key to meeting the challenges posed by an aging nursing workforce, the projected nursing shortage, and an increasingly diverse U.S. population.

The study, published in the November issue of Health Affairs, was conducted by a research team led by Ying Xue, DNSc, RN, associate professor at the University of Rochester School of Nursing. The study was funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program. Researchers compared data from the National Sample Survey of Registered Nurses from 1984 to 2008 for supplemental and permanent nurses.

According to the study, compared with permanent nurses, supplemental nurses tend to be younger, are more likely to be male, and more likely to be Hispanic, Asian or Pacific Islander, or African American. Roughly one-third (33.2%) of supplemental nurses in 2008 were people of color compared with fewer than one in five (17.4%) permanent nurses. In 2008, people of color comprised roughly a third of the U.S. population.

Supplemental RNs are keeping pace with the trend toward more baccalaureate degree prepared nurses. The 2010 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, recommended that 80 percent of nurses hold a bachelor’s degree or higher. The study finds that over time, the proportion of RNs in both groups holding bachelor’s degrees in nursing (BSN) increased from 1984 to 2008, from 34 percent to 46 percent for supplemental nurses and from 33 percent to 50 percent for permanent nurses. What’s more, on average, supplemental nurses had only three years less nursing experience than permanent nurses, averaging 15 years’ experience in 2008, compared with 18 years for permanent RNs.

“Our study shows that supplemental nurses have roughly the same education and experience qualifications as permanent nurses,” said Xue. “Especially important is that they are increasingly earning bachelor’s degrees, and there is growing evidence that higher proportions of nurses with bachelor’s degrees or higher are associated with better outcomes for patients. The nursing shortage, is now projected to return in 2018. We would expect to see the demand for these nurses increase in the future.”

Due to the nature of their careers, supplemental nurses are more likely to hold nursing licenses in several states simultaneously and more likely to work in a state other than the one in which they reside. During the period surveyed (1984–2008) between 4.4 percent and 13.7 percent of supplemental nurses worked in states in which they didn’t reside, compared with 2.6 to 4.5 percent of permanent nurses.

The study’s authors noted that supplemental nurses’ annual incomes were only moderately lower than those of permanent nurses. Across all the survey years, supplemental nurses earned an average of $2,150 less, and for the majority of individual years, earnings between the two groups weren’t significantly different.

Xue is an RWJF Nurse Faculty Scholar, and was one of only 15 nurse educators across the country selected in 2008 to participate in the program and to receive a three-year $350,000 grant to conduct research. Xue’s research focuses on how the nursing care process, work environment, and the nature of the nursing workforce affect organizational and quality of care outcomes in acute care settings. The goal of the Robert Wood Johnson Foundation Nurse Faculty Scholars program is to develop the next generation of national leaders in academic nursing through career development awards for outstanding junior nursing faculty. The program aims to strengthen the academic productivity and overall excellence of nursing schools by providing mentorship, leadership training, and salary and research support to young faculty. It is funded by the Robert Wood Johnson Foundation and administered through the Johns Hopkins University School of Nursing. It is directed by Jacquelyn Campbell, PhD, RN, FAAN, who is the Anna D. Wolf chair and professor at the Johns Hopkins University School of Nursing. The program is now in its 5th year. To learn more, visit

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