Hiring temporary nurses does not completely prevent deaths during staffing shortages: study

A new study finds that during hospital staffing shortages, hiring larger numbers of temporary staff was linked to an increased risk of patient death.

“Our research shows that addressing low staffing levels by using temporary staff to fill gaps is certainly beneficial in preventing deaths on wards. The damage associated with a staff shortage is greater than using temporary staff to fill shortages. However, our findings challenge the assumption that temporary staffing is a cost-effective, long-term solution for maintaining patient safety,” said lead author Peter Griffiths of the University of Southampton, England, in a press release.

“Previous studies have shown a beneficial effect of deploying more senior staff within a team, and our findings are consistent with this. This suggests that the relatively new registered nurse role, which will increase the proportion of senior support staff on wards, has some benefits,” Griffiths said. The findings were published in JAMA Open Network.

According to previous studies, hiring temporary nursing staff was associated with a higher risk of adverse events due to their unfamiliarity with a specific healthcare environment, potentially leading to inefficiencies within the team and increased risks to patients. But other studies found that there were no negative impacts on patient outcomes from using temporary nurses to augment the workforce of any healthcare facility. A British medical journal study found that senior registered nurses tend to be more productive and that they could partially mitigate the negative effects of staff shortages.

To investigate further, Griffiths and team analyzed data from 626,313 patients admitted to four healthcare centers in the United Kingdom. Of all admissions, just over 80% were emergencies and 65.8% were due to specific medical conditions. Most patients had at least one comorbidity at the time of their hospitalization.

Of the 514,899 patients hospitalized on days when fewer registered nurses were on duty, 5.3% died, compared with 4% among patients not exposed to staffing shortages. That meant that each day of low staffing of registered nurses was associated with a nearly 8% higher risk of patient death.

“In this cohort study, when patients were exposed to days with few nurses, the risk of death was significantly increased. Staff mix was associated with variation in mortality risk, but there was no evidence that more senior or temporary staff could fully offset the effect of lower staffing levels. There was evidence that having more senior staff within the nurse groups was associated with a reduced risk of death, but results were inconsistent,” the authors wrote in the study. “Higher percentages of temporary workers were associated with an increased risk of death. Agency nurse staffing had a greater negative association than staff working through the hospital bank.”

“Although the benefits of avoiding low staffing outweighed the harms associated with temporary staffing, the net benefits of increased staffing were reduced and, in the case of nurse superintendent staff employed by staffing agencies, negligible,” the authors added to.

“The damage associated with a staff shortage was greater than the damage associated with deploying temporary staff to fill any shortages. While this finding is reassuring, using temporary staff to address shortages is unlikely to be cost-effective as outcomes are worse and are likely to incur higher costs,” they concluded.