Amid an existing nursing workforce shortage exacerbated by the COVID-19 pandemic, many hospitals and health systems have turned to travel nurse agencies to supplement the loss of full-time RNs.
The influx of travel nurses at many hospitals raises questions about whether there are patient safety implications associated with higher proportions of travel nurses, who, given their temporary status, may be difficult to keep motivated and engaged.
Some travel nurses may be less inclined to stay at their assignments if they encounter workplace issues, such as during training. Earlier this year, four traveling nurses quit their posts at Eureka, Calif.-based Providence St. Joseph Hospital just one day after their assignments began. The hospital called the situation "an unfortunate and unique circumstance" and attributed the departures to onboarding training challenges and the nurses' lack of familiarity with its EHR system.
Before the pandemic, research already suggested that higher proportions of temporary staffing are associated with less optimal patient outcomes. A study from 2010, for example, found that nurses working on nursing units with more than 15 percent of external temporary RN hours reported greater levels of patient falls compared to those working on units that did not have temporary external nurses. It also found implications for nurse safety, with those working on units with higher levels of temporary staff hours more likely to report back injuries.
While hiring more contract nurses amid the pandemic has been a good faith effort for hospitals to ensure patient care is not disrupted, "it's important to reinforce that more staff, alone, does not constitute patient and workforce safety," Patricia McGaffigan, RN, vice president of safety programs for the Institute for Healthcare Improvement, told Becker's.
Becker's spoke to Ms. McGaffigan and other patient safety experts for best practices on how to maintain engagement among temporary nurses and foster a strong culture of safety.
Provide comprehensive orientations
As healthcare organizations onboard temporary nurses to fill care gaps, giving these workers the proper support to successfully transition to their new workplace is critical for promoting safety, Leapfrog President and CEO Leah Binder told Becker's.
"Ensuring temporary nurses have full orientations, the support and tools they need to successfully transition to a new work environment are some ways leaders can encourage contracted staff to stay engaged," she said.
Make patient, workforce safety core values
Healthcare C-suite executives and nursing leaders have a strong influence on strategies and policies throughout the organization, so their expertise and guidance is crucial for promoting a culture of workplace safety among both temporary and permanent staff.
The National Quality Forum, a patient safety and healthcare quality advocacy group, recommends leaders emphasize a culture of safety as an organizational value by integrating continuous feedback and collaboration efforts from staff.
"We need leaders and organizations to reinvigorate their full commitment to patient and workforce safety as a core value, and recommit to fostering and improving cultures of safety," Ms. McGaffigan said, adding that leaders can use practical tools such as the Institute for Healthcare Improvement's National Action Plan to advance safety initiatives.
Get current staff involved
Hospitals and health systems can get ahead of some staffing challenges by listening to and addressing the concerns of their current workforce.
Fostering an environment that encourages feedback from both permanent and temporary staff can help inform onboarding initiatives and communications about work expectations and performance, Ms. McGaffigan said.
"Permanent staff can be engaged in staffing discussions to identify challenges and codesign solutions, including considerations for necessary skills and competencies that reflect the needs of patients and ways to support both permanent and temporary staff during transitions."
Prevent communication breakdowns
Rapid changes caused by staffing challenges and shifts in public health recommendations are forcing health systems to adjust on the fly, but Ms. McGaffigan said making sure staff don't get left out of updates is key.
Ms. McGaffigan pointed to huddle meetings as a way to touch on issues and concerns. Continuity of patient assignments minimize confusion amid the clutter and serves as a way to manage strain on the job.
"Ensuring that assignments enable balanced and appropriate workloads and allow for rest and recovery is important for all staff, especially given burgeoning rates of fatigue and burnout," she said.
Celebrate and share
The National Quality Forum suggested that leaders remember to recognize staff who voice issues to improve system safety.
When staff raise concerns, leaders are provided with an opportunity to broadly educate clinicians while simultaneously encouraging improvement.
"[Celebrate] when healthcare workers report and voice safety and quality [problems]," the forum said. "Raising safety concerns must be encouraged, not scrutinized."