New Research Shows No Difference in Patient Care Quality between Travel and Staff Nurses

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A new study offers compelling data about a long-standing question in the healthcare industry: Do travel nurses provide the same quality of patient care compared to staff nurses?

According to a new study that analyzed nursing quality and patient satisfaction indicators, the answer is “yes.”

The research report, based on data from nursing units at a regional hospital in the southern United States, is published in the June 2017 edition of the journal Nurse Leader.

“We found that the varying percentages of travel nurses at five hospital units produced no significant differences in the quality of care or in the patient experience of care,” said co-author Marcia Faller, PhD, RN, Chief Clinical Officer at AMN Healthcare.

This data helps clinical managers better understand the benefits of travel nursing and travel nurse qualifications, she said.

Quality Unchanged with Increased Travel Nursing

The researchers examined the use of travel nurses over a three-year period at a regional hospital in one of the fastest-growing areas in the country. Quality indicator data was extracted on a quarterly basis between Oct. 1, 2012, and September 30, 2015, from five hospital units: Adult Critical Care, Medical, Oncology, OrthoNeurology, and Surgical.

The travel nurses, all of whom were RNs, were supplied to the hospital from 64 agencies. Use of travel nurses at the hospital ranged from 0%-44% of total nursing hours per unit per quarter and averaged 9%.

Overall, the analysis indicated that quality of care and patient satisfaction did not change when use of travel nurses increased.

“This study adds to a growing body of research showing that contingent nurses provide the same quality of care as staff nurses,” Faller said. “The importance of this research is that it examines actual examples of bedside care over a long period of time in diverse nursing units.”

With care quality and the patient experience among the top priorities in the healthcare industry, the quality of care delivered by travel nurses is critically important, she said. She noted that this is particularly relevant, given that the growing U.S. nursing shortage will necessitate increasing use of travel nurses in hospitals and other healthcare facilities for the foreseeable future.

HCAHPS and NDNQI Confirm Nursing Care Parity

In conducting the analysis, the researchers tapped two national data sources used throughout the healthcare industry to measure and compare consumer satisfaction and nursing care: the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the National Database of Nursing Quality Indicators™ (NDNQI®).

HCAHPS scores were compared among units with travel nurses to the same or similar units with few or no travel nurses. Changes in HCAHPS scores were measured as the number of travel nurses varied within and across the units.

HCAHPS surveys include a series of specific questions to patients about the care they received from nurses and other staff. There were no significant differences among answers, as travel nurse coverage changed, when patients were asked if nurses listen carefully, explained procedures in a way patients could understand, controlled pain, described medication side effects, etc.

NDNQI also were compared among units with varying numbers of travel nurses to determine the quality of nursing care; these indicators are based on standardized reporting of data from member hospitals that cover a wide range of metrics related to nursing care.

Travel Nurse Quality Evidence Strengthened

Statistical tests comparing HCAHPS and NDNQI data to travel nurse coverage within and across units showed very few statistically significant differences. Further, in the few tests where statistically significant differences did occur, there were no consistent trends.

The data from three-years of actual bedside care at one hospital amplifies the growing body of evidence showing that travel nurse quality is equal to staff nurses.

In an analysis of adverse events, data derived from 13,152 nurses working in 198 adult acute care hospitals in the National Sample Survey of Registered Nurses, published in the Journal of Nursing Administration, found that temporary nurses have qualifications similar to staff nurses, and that negative perceptions of contingent nurses were unfounded.

Another study published in the Journal of Nursing Administration, examining survey data from nurses in 427 hospitals, found that employment of contingent nurses did not detract from patients’ overall satisfaction or from patient satisfaction with nurse care.


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