National Study Shows Temporary Nurses Deliver Quality Care

By Linda Beattie, contributor  

A new study conducted by some of the nation's top healthcare researchers has shown that temporary nurses are just as qualified, if not more qualified, than permanent staff nurses and help hospitals deliver quality patient care.

This study, conducted by the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania, also found that supplemental nurses tend to have higher levels of education (more hold BSNs or higher degrees), more current educational experience, and help staff nurses experience less burnout. Their presence accounts for more positive patient outcomes and can help hospitals experiencing quality issues minimize the risk of adverse events.

These findings were published in the July/August 2007 issue of the Journal of Nursing Administration (JONA), and based on a scientific analysis of two large data studies. The study was supported by the National Institute of Nursing Research and the American Staffing Association.

After analyzing the data from thousands of nurses and hundreds of hospitals, the research team came to a conclusion, "Our research found that there is no reason to be concerned about quality of care with supplemental nurses," according to CHOPR director and leading researcher, Linda H. Aiken, Ph.D., FAAN, FRCN, RN.

Aiken is a renowned researcher in the area of healthcare workers and patient outcomes, and the recipient of several national recognitions. In addition to her role as the CHOPR director, she serves as the Claire Fagin Leadership Professor of Nursing and Professor of Sociology at the University of Pennsylvania and is Co-Director of the Council on Physician and Nurse Supply.

Addressing Current Perceptions

"There are some commonly-held myths in healthcare that are simply not true," explained Aiken. "One that got our attention was the assumption that the use of temporary nurses was proxy for poor quality of care. Our research for the last decade has shown that having more nurses in hospitals improves patient care, so how could this belief be true?"

Aiken acknowledged that some previous research has connected adverse outcomes at hospitals with higher levels of supplemental nurses. "But these studies did not address the cause and effect. Are adverse events caused by the higher level of temporary nurses, or are other factors at work?"

With the nursing shortage expected to increase and the need for supplemental staff continuing, the CHOPR team decided to conduct a scientific study to determine the link and provide hospitals with evidence that could be used to make better staffing decisions.

Using a national study of more than 10,000 permanent and 695 supplemental registered nurses and a survey of more than 13,000 RNs working at 198 adult acute care hospitals in Pennsylvania, Aiken and her team measured the qualifications and characteristics of supplemental nurses and studied the relationship of supplemental staff to nurse outcomes and adverse events

Supplemental nurses were defined as those employed by hospital per diem pools, external agencies and permanent staff who "float" to different units. Hospital characteristics and sufficiency of staffing and other resources were also measured, and the researchers used several control variables in their analyses.

"Our research found that staffing agencies are doing a good job of recruiting quality nurses," Aiken said. "When looking at hospitals with high levels of supplemental staff and controlling for variables within the hospital environment, we found that any higher levels of adverse events or problems had nothing to do with the nurses."

"These hospitals had flaws in their own environments that kept them from recruiting and retaining enough full-time nurses in the first place—it was those flaws that explain the poor outcomes…Supplemental nurses obviously can't change these factors but they can help diminish risk factors by improving staffing levels and continuity of care."

The published study pointed out that "…higher levels of nonpermanent staff were actually associated with lower levels of such [adverse] events, suggesting that resource adequacy is the deeper underlying problem."

The data also showed that job satisfaction levels for permanent nurses in hospitals with more nonpermanent staff were equal to those using fewer supplemental nurses, and nurses were much less likely to experience job burnout.

According to Marcia Faller, chief clinical officer and executive vice president for AMN Healthcare, this new study is an important step in clearing up misperceptions about temporary nurses.

"This is the first report of its kind," she said, "but it reinforces what we know about our own travelers." Both Faller and Aiken see the need for more follow-up research in this area, and Aiken's team has larger studies already underway.

"This study's demographics are similar to those at AMN regarding our nurses' higher educational levels, recent training, and the like," Faller continued. "AMN works very hard to recruit and screen quality candidates, match competencies to needs, and provide ongoing education. Our quality assurance program, along with these new findings on temporary nurses, can help clients rest assured that their patients are in good hands."

To Learn More:

AMN will host a live Webcast with Linda Aiken based on this study on October 10, 2007, at 11:00 am Pacific Time. The entire presentation will be archived on AMN's Web site the day following the live event at If you would like information about participating in the live Web cast, please email

To learn more about the published study, "Supplemental Nurse Staffing in Hospitals and Quality of Care" in The Journal of Nursing Administration, July/August 2007, visit

If you have questions regarding AMN's temporary healthcare staffing options, please contact our Client Services Team at (866) 871-8519 or email: