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

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

New research exploring the question of how travel nurses compare to staff nurses has found that travel nurses provide bedside care of the same quality as their staff nursing counterparts.

The study, which analyzed nursing quality and patient satisfaction indicators at a regional hospital in the southern United States, will be published in the August 2017 edition of the journal Nurse Leader.

Widely varying percentages of travel nurses at five hospital units produced no significant differences in the quality of care or in the patient experience, according to the study, entitled “A Single-Hospital Study of Travel Nurses and Quality: What Is Their Impact on the Patient Experience?

The researchers examined the use of travel nurses over a two-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, 2013, and September 30, 2015, from five hospital units: Adult Critical Care, Medical, Oncology, OrthoNeurology, and Surgical.

Overall, the analysis indicated that quality of care and patient satisfaction were not affected by the increased use of travel nurses.

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%.

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

Growing Body of Research on Temporary Nurses and Quality

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

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 nursing care.

The new travel nurse quality study is timely, particularly given today’s greater emphasis on care quality and the industry’s movement toward value-based healthcare reimbursement, emphasizing better patient outcomes. With care quality and the patient experience among the top priorities in the healthcare industry, the quality of care delivered by travel nurses is critical. 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.

Two National Data Sources Measure Quality

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.

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.

HCAHPS surveys also 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.

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.


A Single-Hospital Study of Travel Nurses and Quality: What is Their Impact on the Patient Experience?