Are Temporary Nurses More Cost-Effective Than Overtime?

A Columbia University study suggests that hospitals can cut their costs and improve the quality of patient care by paying overtime instead of hiring temporary nurses, but other recent studies tell a different story.

The study, which focused on 900,000 admissions in the Veterans Administration health system over the last four years, correlated shorter patient stays with lower costs and better treatment. Researchers also suggested that paying overtime to a core staff of nurses resulted in more positive results than bringing in temporary nurses because of the “rhythm and routines” they establish.

Columbia’s conclusions counter those of a 2012 Penn State study, as well as a different Columbia study published last year. The results of both studies indicated that poor hospital environments are the greater contributor to adverse patient outcomes, regardless of the employment status of the nurses. The Penn study went even further and cited the hiring of temporary nurse staff as a potentially life-saving move – and, at least, that their use “does not appear to have deleterious consequences for patient mortality”.

A co-leader of the earlier Columbia study pointed out in a press release that temporary nurses are often scapegoated for lower patient outcomes that result from poor work environments that turn away qualified permanent staff. Dr. JingJing Shang also touted the benefits of a traveling nurse arrangement that creates ongoing assignments for nurses in the same facility.

Other potential issues with Columbia’s cost-benefit analysis include the potential for nurses working overtime to make costly and life-threatening errors because of burnout, a result that may be mitigated by using temporary nurse staffing.

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