Healthcare Staffing Report: Apr. 17, 2014


Report claims nurse overtime more cost effective than temps

Patients get the best care when treated in units staffed by nurses with the most experience, and hospitals paying their own nurses overtime rather than bringing in nurses from staffing firms may be more cost effective, according to a study released by the Columbia University School of Nursing and the Columbia Business School.

Other studies have argued temporary nurses are just as good and that they could save lives. And having nursing teams that work seamlessly doesn’t have to be mutually exclusive with a hospital using supplemental nursing, said Cynthia Kinnas, executive vice president for Randstad Healthcare and president of the National Association of Traveling Healthcare Organizations. “Quite the contrary — a smart supplemental staffing model will actually enhance the hospital’s efforts in this regard.”

The Columbia study reviewed more than 900,000 patient admissions over four years at hospitals in the Veterans Administration Healthcare System. The researchers analyzed payroll records for each nurse and medical records for each patient to see how changes in nurse staffing impacted length of stay.

Shorter lengths of stay indicated better treatment and are more cost-effective, according to the study.

“Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care,” senior study author Patricia Stone, centennial professor of health policy at Columbia Nursing, said in a press release.

“When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care,” Stone said. “Hospitals need to keep this in mind when making staffing decisions — disrupting the balance of a team can make quality go down and costs go up.”

The study also indicated it may be more cost effective for hospitals to pay their own nurses overtime than bring in nurses from staffing firms because overtime resulted in shorter lengths of stay than hours worked by nurses from staffing firms.

The study was published this month in American Economics Journal: Applied Economics. Co-authors are Nancy Beaulieu, independent contractor, Massachusetts Institute of Technology, and Ciaran Phibbs, professor at the VA Health Economics Resource Center and at Stanford University School of Medicine.

Other studies have also looked into temporary nurses, quality and cost. Supplemental nurses could save lives during times of critical nurse shortages, according to one study by researchers at the University of Pennsylvania School of Nursing. The National Association of Travel Healthcare Organizations did a study in 2011 that found the cost for temporary nurses was not much different from traditionally hired nurses.

A separate study, also by the Columbia University School of Nursing, last year found that poor work environments at hospitals may be giving temporary nurses a bad name. “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,” JingJing Shang, the Columbia University School of Nursing researcher co-leading the project, said in a press release on that study.

Kinnas reported the travel nurse contracts where nurses come on for a minimum three to six months (often longer) supports hospitals’ goal of a cohesive nursing team and providing continuity of care. To read Kinnas’ full comments, click here.


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