Hiring Temporary Nurses Does Not Fully Prevent Deaths During Staff Shortages

A new JAMA Open Network study revealed that during staffing shortages in hospitals, hiring higher proportions of temporary staff was linked to an increased risk of patient deaths.

In a press release, lead author Peter Griffiths of the University of Southampton, England, said: “Our study shows that addressing low staffing levels by using temporary staff to fill gaps is definitely beneficial in avoiding deaths on wards. The harm associated with low staffing is greater than using temporary staff to rectify shortfalls. However, our findings challenge the assumption that temporary staff is a cost-effective long-term solution to maintaining patient safety.”

“Previous studies have supported a beneficial effect of using more senior staff within a team, and our findings are consistent with this. This suggests the relatively new registered nurse associate role, which will increase the proportion of senior support staff on wards, does have some benefits,” added Griffiths.

According to some prior studies, hiring temporary nursing staff members was associated with a higher risk of adverse events because of their unfamiliarity with a specific healthcare setting which could potentially lead to inefficiency within the team and lead to increased risks to patients. But other studies argued that there were no negative impacts on patient outcomes from using temporary nurses to increase any care setting’s staffing levels. One British Medical Journal study found that senior registered nurses tend to be more productive and that they could partially mitigate the negative effects of staffing shortages.

To investigate further, Griffiths and team analyzed the data of 626,313 patients who were admitted to four healthcare centers in the United Kingdom. Of all admissions, a little over 80% were emergencies, and 65.8% were due to specific medical conditions. Most patients had at least one co-morbidity at the time of their hospital admission.

Of the 514,899 patients who were admitted to the hospital on days when there was a lower number of registered nurses on duty, 5.3% died compared to 4% among patients who were not exposed to staffing shortages. That meant each day of low staffing of registered nurses was linked to almost 8% higher risk of patient deaths.

“In this cohort study, when patients were exposed to days of low nurse staffing, the risk of death was substantially increased. The mix of staff was associated with variation in the risk of death, but there was no evidence that more senior staff or temporary staff could fully compensate for the effect of low staffing. There was some evidence that having more senior staff within the nursing staff groups was associated with reduced risk of death, but results were inconsistent,” the authors wrote in the study. “Higher proportions of temporary staff were associated with an increased risk of death. Agency nursing superintendent staff had a larger adverse association than those employed through the hospital bank.”

“While the benefits of avoiding low staffing were greater than the harms associated with temporary staff, net benefits from more staff were diminished, and, in the case of agency-employed nursing superintendent staff, negligible,” the authors added.

“The harm associated with low staffing was greater than that associated with using temporary staff to rectify any shortfall. While this finding is reassuring, use of temporary staff to rectify shortfalls is unlikely to be cost-effective because outcomes are worse with likely higher costs,” they concluded.