More Myths Debunked About Healthcare Staffing

By Debra Wood, RN 

HB Patient SatisfactionThere’s new evidence debunking myths about travel and per diem nursing. A study from the University of Pennsylvania shows that employing supplemental registered nurses does not adversely affect patient safety or patient satisfaction.

“There are no adverse outcomes for patients in hospitals that employ supplemental nurses,” said Linda Aiken, PhD, RN, Claire M. Fagin Leadership Professor of Nursing and Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia. “This is a safe strategy for hospitals to use to maintain safe staffing levels.”

The study, published in the March 2015 edition of Journal of Nursing Administration, is part of ongoing research by Aiken and colleagues at UPenn examining the use of supplemental nurses. Prior research by Aiken and the UPenn team showed there was no relationship between the use of supplemental nurses and patient mortality. In fact, mortality in those hospitals examined would have been higher without the supplemental nurses, she said.

“There has been a myth existing that the use of supplemental nurses is a proxy for poor quality of care,” Aiken said. “We’ve been systematically looking at all possible angles of the relationship of supplemental nurses and quality of care.”

This is the first study that investigates the relationship between supplemental nurses and patient satisfaction. The UPenn team measured it, Aiken said, because patient satisfaction has become an important aspect of quality of care. It also has become a factor in reimbursement from Medicare, so many hospitals are focusing on improving their patient satisfaction scores.

“Patient satisfaction is an important aspect of the outcomes hospitals are trying to achieve,” said Marcia Faller, PhD, RN, chief clinical officer for AMN Healthcare in San Diego. “This study is great, because it shows temporary nurses are a not a detractor to those results.”

For this study, the UPenn researchers linked three data sources: the University of Pennsylvania Multistate Nursing Care and Patient Safety Survey of RNs; a random sample of nurses from four large states; an American Hospital Association annual survey of hospital; and the federal government’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient survey.

The investigators found no difference in HCAHPS responses between hospitals using low or high proportions of supplemental nurses regarding patient ratings of care and whether patients would recommend the hospital to others.

“There is no negative relationship between employment of [supplemental] nurses and patient satisfaction or mortality or any other quality measure we have,” Aiken said. “Poor patient satisfaction has nothing to do with supplemental nurses and has everything to do with poor work environments in hospitals.”

While nursing remains the single most important factor in how patients perceive their experiences in hospitals, Aiken said, nurse-related negative impacts for patients stem from situations such as a bedside nurse shortage or a chaotic work environment.

Temporary nurses can actually cushion the effect of poor work environments caused by too few nurses working too many hours, Faller said. Adding temporary nurses can help stabilize a unit until it can improve its recruitment and retention of permanent staff.

“There is no reason to be concerned about supplemental nurses,” Aiken concluded. “There is a big reason to be worried about poor work environments that have not received enough attention.”