Travel Nurses, Overtime Lead to Lower Quality of Care: Study

• The increased use of travel nursing — and overtime — in the nursing industry could lead to lower quality of care for patients, a new study found. 
• The study, published in JAMA Network earlier this month, found an increase of pressure ulcers and perioperative hemorrhage or hematoma connected to “agency nurse hours.” 
• However, the 2024 Leapfrog Group report on hospital safety indicated an improvement in safety overall. 

The use of travel nursing — and overtime — exploded during the COVID-19 pandemic to help with the influx of patients. But too much reliance on those avenues to treat patients could be riskier than expected. 

An original investigation published earlier this month in JAMA Network found that “agency nurse hours were significantly associated with negative outcomes for pressure ulcers and perioperative hemorrhage or hematoma.” 

“Our study shows that when hospitals over rely on travel nurses or overtime for the regular nursing staff, patient safety care may be compromised,” Patricia (Polly) Pittman, lead author of the study and Director of the Fitzhugh Mullan Institute for Health Workforce Equity at the GW Milken Institute School of Public Health, said in a news release. “Hospitals that want to improve safety should closely track their reliance on overtime and especially nurse staffing agencies.” 

However, the 2024 Leapfrog Group report on hospital safety did show a marked improvement across the 3,000 sites it surveyed, most notably in the areas of healthcare-associated infections, hand hygiene, and medication safety. 

Effects on Hospital Safety and Quality of Care

Researchers for the JAMA Network study looked at 70 hospitals — 46 in the South, 20 in the West and four in the Northeast — in a mixture of urban and rural settings. Their results related to pressure ulcers showed that use of overtime and agency nurses overshot “safe thresholds” by 140% with agency workers and 63.6% for overtime. 

The JAMA Network study also found a “statistically significant association” between the hours that travel nurses worked and post-surgery hemorrhage or hematoma rates. 

“Given that the use of both overtime and agency nurse hours is likely necessary during a national public health crisis, and perhaps even during normal seasonal fluctuations in patient demand, the question is how much can hospitals rely on these backup strategies before they risk endangering patient outcomes?” the authors wrote. 

The State of Travel Nursing

A Persistent Market Research report released earlier this year projects the per diem nurse staffing market, of which travel nurses can be included in, will have a valuation of more than $15 billion by 2032. 

“The increasing acceptance of gig economy models in the healthcare sector is likely to further propel market growth, making per diem staffing a key component of the future healthcare workforce,” the report stated.   

However, a 2024 study in the Journal of Nursing Regulation noted that travel nurses experience “elevated work stress” compared to their full-time counterparts. 

“Healthcare regulators, travel nurse agencies, and nursing employers should be aware of the unique demographics and practice characteristics of travel nurses to develop more effective retention strategies to maintain a healthy and stable nursing workforce,” the authors stated. 

Writing for the University of Virginia’s magazine, Chloe Michaelis, MSN, APRN, AGACNP-BC, PCCN, said that travel nurses need “constant guidance” related to a hospital’s unique procedures and location of equipment. 

“While many of my traveler colleagues are highly skilled and competent, there is no way they can arrive up-to-speed on our hospital’s distinct workflows, documentation processes, and the infinite details particular to our patient care,” she wrote. “Working like this is draining, inefficient, and ultimately reduces the time each nurse can spend with patients, thereby increasing the likelihood of errors.”

The Bottom Line

A new study suggests that too much reliance on overtime and travel nurses can lower the quality of care patients receive. Some nurse leaders believe this is due, in part, to the lack of institutional knowledge travel nurses have of their assigned hospitals. While acknowledging the need for overtime and additional nurses during times of crisis or high-patient intake, the study authors question how to balance that need with proper care. 

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