Temporary Nurses Have Similar Education and Experience, More Diversity than Permanent RNs

By Jennifer Larson, contributor

Supplemental, or temporary, nurses aren’t that different from permanent staff nurses, according to the latest research.

A new study conducted under the auspices of the Robert Wood Johnson Foundation’s Nurse Faculty Scholars program examined 24 years’ worth of data from the National Sample Survey of Registered Nurses and found that the two groups are relatively similar in many respects. They tend to have similar education and experience levels, although the supplemental nursing workforce tends to be more diverse.

The results of the study appeared in the November issue of Health Affairs, and the research was led by Ying Xue, DNSc, RN, associate professor, University of Rochester School of Nursing in Rochester, N.Y., and included Joyce Smith, RN, MS, senior information analyst, University of Rochester School of Nursing; Deborah A. Freund, PhD, MPH, MA, president of Claremont Graduate University in Claremont, Calif., and Linda H. Aiken, PhD, FAAN, FRCN, RN, Claire M. Fagin Leadership Professor of Nursing, professor of sociology, and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia.

The supplemental nurses studied included registered nurses on short-term contracts obtained through an external staffing agency, ranging from per diem nurses to travel nurses that may be on assignment for a few months at a time.

Supplemental nurses make up a unique niche in the healthcare workforce; they have been used to fill gaps in a variety of patient care settings for many years, but they had not been compared in detail to the permanent nursing workforce prior to this study. Given the findings, the authors noted that supplemental nurses may be a key strategy in meeting certain needs created by the projected nursing shortage--which will be exacerbated by an aging workforce, a growing population and more patients joining the ranks of the insured as implementation of the Affordable Care Act moves forward.

“We’re really excited about what we found in the study,” said Xue.

Similar experience and education, differences in diversity

According to the data, supplemental nurses tend to be younger on average than permanent nurses, and they also include a greater percentage of men. Additionally, while the majority of the supplemental nursing workforce is white, this segment of the nursing workforce is more diverse than the permanent nurse segment. For example, the study noted that one-third of the supplemental nurses in 2008 were people of color--approximately twice that of the 17 percent in the permanent nurse workforce.

“This is a critical issue because we all know the U.S. population will become more and more diverse over time,” said Xue.

However, the study found that the two groups have approximately the same education and experience qualifications.

“The proportion of nurses with a baccalaureate or higher degree increased from 34 percent in 1984 to 46 percent in 2008 among supplemental nurses and from 33 percent to 50 percent among permanent nurses,” wrote Xue and her co-authors. “In an examination of single survey years, educational level was not significantly different between the two groups in any survey year except 2008.”

The permanent nurses tended to have, on average, about three years more experience. But Xue noted that the supplemental nurses were typically younger, which could account for some of that. She also noted that nurses tend to experience a rapid gain in nursing competence earlier in their careers and then hit a plateau around the 10-year mark.

“On average, both supplemental and permanent nurses had more than 10 years of nursing experience, and the three-year average difference would have little effect on their competency levels,” she wrote.

The appeal of temporary nursing positions

Why are some nurses attracted to per diem and travel contracts?

“These positions have some benefits that appeal to nurses, such as more flexibility and greater travel opportunities,” wrote Xue and her team.

Ellarene Sanders, PhD, RN, interim executive director of the Texas Nurses Association, has seen how some nurses have gravitated to short-term nursing positions.

“Some do take temporary contracts as a way to bridge the gap between employment or to find out if they like a geographic area,” she said.

Geoff Pridham, manager of nursing administrative services for Stanford Hospital and Clinics, said he’s been pleased with the positive attitude embraced by many travel nurses who have worked for him. “They really want to get to know the staff they’re working with. They really want to get to know the units that they’re working in,” he said.

While some express concern over the expense of hiring agency nurses, or as Xue’s team wrote, “use of supplemental registered nurses is often perceived as more costly compared to hiring permanent registered nurses,” Pridham notes that hiring permanent nurses can be costly, too, since one must account for benefits and other factors.

Hiring travel nurses and other short-term contract nurses allows Pridham and his budget some much-needed flexibility. “I think it keeps us in that comfort zone of knowing that we have not over-hired, but after 13 weeks, we could reduce our nurses down to what is more comfortable for us” if necessary, he said.

Also, hospitals may not always want to hire permanent nurses in areas where their labor needs may fluctuate. For example, Sanders noted that some Texas hospitals that have a significant percentage of winter residents intentionally arrange for short-term contract nurses to meet their seasonal increase in demand.

According to Pridham, Stanford is currently operating with a higher-than-usual number of contract nurses, due to some changes the medical center has recently made. Hiring those supplemental nurses allowed them to make quicker changes to certain units while still working on deploying a long-term hiring strategy.

The future of the supplemental nursing workforce

As the nursing shortage has ebbed and flowed, the size of the supplemental nursing workforce has often changed as well, but overall the percentage of supplemental nurses has grown over the 24 years the data was collected.

Although the country’s recent economic woes caused more nurses to increase their hours and some to return to work, the reduction in the nursing shortage isn’t expected to last; experts expect a resurgence of the problem in just a few more years. “So I can see the demand for supplemental nurses might increase,” Xue said.

She added that supplemental nurses should be considered when any future policies are made that concern the national nursing workforce--because they are and will be part of the workforce. “So the supplemental nursing workforce shouldn’t be overlooked,” she said.

Sanders said that more nurses will be needed to meet the future needs of the nation’s population, so she would like to see emphasis placed on the long-term goal of producing more nurses.

“I think we have to continue to expand nursing education so that programs can maximize their production,” she said.