Contract nurses could help many regions avoid looming nursing shortage

Short-term, contract nurses could be the key to alleviating the projected nationwide nursing shortage, according to a study published in the November issue of Health Affairs. Despite the promising study results, not all industry experts agree that contract nurses are the answer.

Funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program, the study, “Supplemental Nurses Are Just As Educated, Slightly Less Experienced, And More Diverse Compared To Permanent Nurses,” examined data from the National Sample Survey of Registered Nurses from 1984 to 2008 for supplemental and permanent nurses. The study found 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.

The study data indicates that short-term, contract nurses are similar to permanent nurses in terms of education and experience and are capable of working across all healthcare settings, said Ying Xue, DNSc, RN, lead study researcher and associate professor of nursing at the University of Rochester School of Nursing in Rochester, New York.

Researchers also found that due to the nature of their careers, supplemental nurses are more likely to hold nursing licenses in several states simultaneously and are more likely to work in a state other than the one in which they reside. During the period surveyed, 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.

“National nurse shortages are characterized by regional variations. The greater mobility of short-term, contract nurses could help respond to regional shifts in nurse shortage,” said Xue. “We think these are important findings that call for a closer look at the role that supplemental nurses might be able to play in addressing projected nursing shortages.”

Susan Reese, chief nurse executive at Chelmsford, Mass.-based workforce management firm Kronos thinks there are pluses and minuses to using short-term, contract nurses.

There are two types of short-term contract nurses, explained Reese: local agency nurses who work on very short notice to cover a single shift and travel nurses who contract for periods of time with a single organization to fill a specific vacancy.
“The benefit to organizations in employing an agency nurse is the ability to hire the nurse on very short notice to fill an unexpected need – a sick-call, sudden increase in volume, etc.,” said Reese. “The benefit to organizations in employing a travel nurse is in the ability to fill a short-term vacancy, such as providing coverage for an employee out on short-term disability, maternity leave or military leave, without committing to an additional full-time employee.”

The convenience of filling a short-term need with a contract nurse comes at a high price, said Reese.

“Remember you are paying for the nurse and the company that is contracting the nurse,” she said. “In addition, travel nurses usually also expect to have their travel, housing and often an automobile provided. So there is clearly a financial cost to this type of resource.”

Beyond the additional cost, the use of contract nurses can pose a safety risk, noted Reese.
“Though agency nurses have usually been oriented to a hospital before being listed as able to work there, their orientations are very basic and often not unit specific… This poses risks for the patient, the staff and the organization in terms of compliance with policy, procedure and practice,” she said.

Although Reese believes contract nurses may provide some relief to the nursing shortage, she does not agree that they are the solution. “The only way (the use of contract nurses) can have a dramatic impact on the coming shortage would be to bring in more foreign nurses, thereby increasing the overall number of registered nurses,” she said.

Xue acknowledges the potential cost and safety issues involved with hiring contract nurses and points to a need for more research.

"As we have mentioned in the paper, the use of supplemental nurses is often perceived as more costly compared to hiring permanent registered nurses, and concerns have been raised about how the use of supplemental nurses affects patient outcomes," said Xue. "However, to date, the empirical evidence on the impact of using supplemental nurses on patient outcomes and cost is limited, so more research is needed in this area.”