Rethinking Agency Nurses

More states and hospitals are saying no to mandatory nurse overtime, while at the same time, experts are predicting a shortage of registered nurses that's expected to get worse as baby boomers age.

So what's an understaffed, overworked nursing department supposed to do?

At least one solution might come from increasing the use of short-term contract nurses, a group that hasn't traditionally gotten a whole lot of love in the nursing world. Agency nurses are billed as an expensive last resort, inexperienced, unfamiliar with the culture of the health systems where they get assigned, and at worst, detrimental to patient safety.

One nurse manager I spoke with earlier this year boasted that his hospital hadn't used any agency nurses since it started using self-scheduling software. Over the years, HealthLeaders has written about other ways to reduce the use of agency nurses.

But a study in the November issue of Health Affairs paints a different picture. The study, conducted by researchers at the University of Rochester School of Nursing and funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program, found that RNs who work as contract nurses have similar education levels and, on average, only slightly less work experience than permanent RNs.

They're also younger, more culturally diverse, and more flexible when it comes to relocating. And supplemental nurses earned an average of $2,150 less per year than permanent nurses.

Let's break down those findings, which come from comparing data on supplemental and permanent nurses from the National Sample Survey of Registered Nurses from 1984 to 2008.

When it comes to education, the study finds that from 1984 to 2008, the number of RNs with bachelor's degrees in nursing increased from 34% to 46% among supplemental nurses and from 33% to 50% among permanent nurses. On the experience side, researchers found that supplemental nurses had only three years less nursing experience than permanent nurses; they averaged 15 years' experience in 2008, compared with 18 years for permanent RNs.

Now, let's take a look at demographics. Compared with permanent nurses, supplemental nurses tend to be younger, are more likely to be male, and more likely to be Hispanic, black, or Asian or Pacific Islander. Roughly one-third (33.2%) of supplemental nurses in 2008 were people of color compared with fewer than just 17.4% permanent nurses.

I just wrote about several grant and scholarship programs that aim to bring more minorities into nursing, since according to the latest National Sample Survey of Registered Nurses, they remain underrepresented in the RN population when compared to the general population.

Although only about 65% of the U.S. population is white, non-Hispanic, about 83% of RNs are white, non-Hispanic. The demographics of agency nurses more closely resemble that of the United States.

Then there's the fact that agency nurses are willing to travel, and as a result are more likely to hold nursing licenses in several states simultaneously. The research also found that during the period surveyed, between 4.4% and 13.7% of supplemental nurses worked in states in which they didn't reside, compared with 2.6% to 4.5% of permanent nurses.

In a perfect world, nurses would all hold at least a bachelor's degree or higher. They'd get paid tons of money, never be asked to work overtime, never get sleepy or burned out, and never get slapped around by patients or disrespected by doctors.

I'm not saying that agency nurses are the perfect solution. But if a nursing shortage is on the horizon, at least this study can reassure leaders that when it comes to education and experience, agency nurses are holding their own.