Effects of Outsourced Nursing on Quality Outcomes in Long-term Acute-Care Hospitals

Abstract

Use of outsourced nurses is often a stop-gap measure for unplanned vacancies in smaller healthcare facilities such as long-term acute-care hospitals (LTACHs). However, the relationship of utilization levels (low, medium, or high percentages) of nonemployees covering staff schedules often is perceived to have negative relationships with quality outcomes. To assess this issue, the authors discuss the outcomes of their national study of LTACH hospitals that indicated no relationship existed between variations in percentage of staffing by contracted nurses and selected outcomes in this post-acute-care setting.

Patient care outcomes and temporary nurses

“…6,7 Additionally, several studies included RNs, LPNs, and unlicensed assistive personnel (UAP) in their analysis. For instance, one study evaluated the utilization level (low, medium, high variations in staffing levels) of outsourced nurses in long-term acute hospitals, whereas another study used the hours of care provided by external temporary nurses.…”

Travel nurses and patient outcomes

“…Bae et al (2014) found the association between temporary nursing staff and BSI and ventilator-associated pneumonia was not significant. Alvarez et al (2011) did not find a relationship between CAUTI and travel nurse staffing. Faller et al (2017) also found CAUTIs were not related to travel nurse rates though they reported a significant association between BSIs and travel nurse rates in two out of five nursing units.…”

“…Of the eight studies investigating medication errors, most (5, 63%) did not observe a significant association, whereas two (25%) reported beneficial relationships and one (13%) reported an adverse association with travel nurses. Alvarez et al (2011), Breckenridge-Sproat et al ( 2012), Hart and Davis (2011), Patrician et al (2011), andXue et al (2012) did not observe any significant association between travel nurses and medication errors. Conversely, Aiken et al (2007) and Bae et al (2010) suggest an improvement in medication errors associated with travel nurse usage.…”

“…However, the results have been mixed. For example, some researchers have found travel nurses to positively impact patient outcomes (e.g., Bolton et al, 2007), whereas others found travel nurses to negatively impact patient outcomes (e.g., Bartel et al, 2014) and still others found travel nurses have no significant impact on patient outcomes (e.g., Alvarez et al, 2011) relative to permanent employees. In addition, different methods, samples, research designs, and controls have been used.…”

Evidence-based practice knowledge and perfusionists’ clinical behavior

“…There was no difference in quality of care, but EBP was not examined directly in this study. 12 Respondents who scored higher on the knowledge subscale had increased scores on the EBP practice subscale. This may be a starting place for EBP interventions to increase overall adoption.…”