Association of Use of Contract Nurses With Hospitalized Patient Pressure Injuries and Falls

Abstract

Background Hospital‐acquired pressure injuries (HAPIs) and falls are outcomes sensitive to quality of nursing care. Use of contract (traveler) nurses varies among organizations, but there is little research on the effect of contract nurses on nurse‐sensitive outcomes. Objectives To explore the relationship between use of contract nurses and two key nurse‐sensitive outcomes, HAPIs and falls. Research Design This was a cross‐sectional study of unit‐level nursing, patient, and hospital factors versus HAPIs and falls from a national nursing data consortium from 2015 to 2016. We used cluster analysis to identify similar units, and compared outcomes between clusters. Subjects 605 nursing units in 166 hospitals, 3.2 patients per nurse, and 5.3% contract nurses. Measures Prevalence and incidence of HAPIs and number of falls, adjusted by patient days. Results For both prevalence and incidence of HAPIs, there was a statistically significant difference between the five independent cluster groups (p = .012 and p = .001, respectively). The cluster with the highest percentage of nurse travelers (>7%) had the highest HAPI prevalence (0.84%) and incidence (0.055 per 1,000 patient days) despite higher nurse staffing, compared to HAPI prevalence of 0.32% and incidence of 0.017 per 1,000 patient days in the cluster with the lowest percentage of nurse travelers (<2%). We did not identify a consistent relationship between use of contract nurses and falls. Conclusions Use of contract nurses was associated with higher HAPI prevalence and incidence, independent of staffing levels. Clinical Relevance Our results suggest that institutions should either minimize the use of contract nurses, or engage in extensive training to confirm that contract nurses have understanding of the institutional practices around HAPIs.

The impact of nurse staffing on falls performance within a health care system: A descriptive study

“…Indeed, our study found that units that were high performing in terms of falls used sitters less than low‐performing units, supporting the finding that sitters may not be as effective in reducing falls. Whereas no significant relationship was identified between use of travellers and patient falls, Ferguson et al (2020) found that higher use of travel nurses was associated with a higher rate of hospital‐acquired pressure injuries. Likewise, several studies have found a positive relationship between patient safety outcomes and the amount of overtime hours worked, with higher amounts of overtime leading to higher rates of adverse events, such as falls and health care‐associated infections (He et al, 2016; Son et al, 2019).…”

“…Annual terminations are those staff who have left the health system. Travellers , also known as contract nurses, are nurses deployed in a temporary position and are not permanent employees (Ferguson et al, 2020). Sitters , also called companions, are staff who provide one‐to‐one observation of high‐risk patients (Greeley et al, 2020).…”

“…Though not as consistently used, several other staffing variables can contribute to the quality of patient outcomes, including staffing ratios, years of experience, skill mix, overtime hours, nursing turnover and nursing position (e.g., registered nurse, nursing assistant, etc.) (Bowden et al, 2019; Cho et al, 2020; Ferguson et al, 2020; Kim et al, 2019; Kouatly et al, 2018).…”

Rural and urban disparities in quality of home health care: A longitudinal cohort study (2014‐2018)

“…It could be that rural home health agencies were not able to provide care of comparable quality as urban agencies due to staffing issues. It has been reported that rural agencies rely more on contracted nurses or therapists to provide skilled care, 16,17 and care facilities that have a higher proportion of contracted nurses are more likely to have poor patient outcomes 18 . In addition, providers from home health agencies in rural areas usually spend more time traveling to patient homes for care delivery.…”

“…It has been reported that rural agencies rely more on contracted nurses or therapists to provide skilled care, 16,17 and care facilities that have a higher proportion of contracted nurses are more likely to have poor patient outcomes. 18 In addition, providers from home health agencies in rural areas usually spend more time traveling to patient homes for care delivery. These working conditions could result in less efficiencies in care delivery, which ultimately result in poorer patient outcomes, such as higher rates of hospitalization and ED visits.…”