Use of temporary nurses and nurse and patient safety outcomes in acute care hospital units

Background: To deal with nursing shortages and inadequate hospital nurse staffing, many solutions have been tried, including utilizing temporary nurses. Relatively little attention has been given to use of temporary nurses and its association with both nurse and patients outcomes. Purpose: The purpose of this study is to investigate the association between use of temporary nurses and nurse (needlesticks and back injuries) and patient (patient falls and medication errors) safety outcomes at the nursing unit level. Methodology/Approach: Data came from a large organizational study which investigated the relationship between registered nurse (RN) staffing adequacy, work environments, organizational, and patient outcomes. The sample for this study was 4,954 RNs on 277 nursing units in 142 hospitals. Findings: Nurses working on nursing units with high levels (more than 15%) of external temporary RN hours were more likely to report back injuries than nurses working on nursing units that did not use external temporary RNs. Nurses working on these nursing units also reported greater levels of patient falls compared with those who did not use temporary RNs. This study found that nurses working on nursing units with moderate levels (5-15%) of external temporary RN hours reported fewer medication errors than those without using any external temporary RNs. Practice Implications: Hospitals need to monitor the levels of temporary nurse use and maintain a level of approximately 15% to ensure both nurse and patient safety outcomes. The temporary nurse use to manage nursing shortfall may provide both benefit and harm to nurse and patient safety depending on the level of the use.