Poor Work Environments May Be Giving Nurse Temps a Bad Reputation

Hospital executives sometimes think twice before hiring from nurse agencies to fill the temporary staffing gaps caused by nursing shortages because of the negative perceptions linking agency-employed registered nurses with poor patient outcomes, including higher rates of mortality and failure to rescue. But new research from the Columbia University School of Nursing suggests that agency nurses are taking the blame unfairly.

The Columbia Nursing finding reveals that the seemingly negative effect of agency-employed supplemental nurses on patient outcomes may have less to do with the characteristics of the supplemental nurses than the work environments in the hospitals where they are employed.

Researchers pored over survey data from more than 40,000 registered nurses in 665 hospitals treating more than one million patients and initially found that higher proportions of agency employed supplemental registered nurses appeared to be associated with higher mortality and failure to rescue. But when the data was adjusted to control for the quality of hospital work environments, the association between adverse outcomes and agency-employed nurses were rendered insignificant.

The research was published in the December issue of Health Services Research.

“Our findings suggest that deficient hospital work environments may be the explanation of poor patient outcomes associated with higher use of supplemental registered nurses rather than anything about the nurses themselves,” said JingJing Shang,Ph.D. the Columbia University School of Nursing researcher heading the project.

Among the factors contributing to the evaluation of the hospital environment were how much nurses participate in hospital affairs, nurse manager ability, leadership and support of nurses, collegial nurse-physician relations, nurse/patient staffing ratio, and how much educational assistance the hospital provided to the agency nurses.

“When all of the nursing factors are controlled, the effect of supplemental registered nurses use is even less apparent and quite likely negligible, on both mortality and Failure to Rescue,” concluded the report.

“Hospitals with poor work environments have trouble recruiting and retaining permanent staff nurses and tend to rely on SRNs to fill vacancies,” said Shang. “And the SRNs are then unfairly blamed for lowering patient outcomes when they are also the victims of the same poor work environment. Hospital executives and managers should take steps to evaluate whether the work environments in their institutions are adversely impacting their success in attracting and retaining qualified permanent nurses, as well as improving patient outcomes.”