Performance Implications of Contract Nurse Staffing Strategies

Significant interest has been focused on the importance of nurse staffing levels on hospitals' performance (Evans, 2006; Stanton & Rutherford, 2004). In spite of this interest, little attention has been focused on understanding the implications of how this staffing is obtained (Page, 2008; Stanton & Rutherford, 2004). While evidence suggests nurse staffing levels are positively related to hospitals' performance (e.g., Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2001), virtually no attention has been devoted to the implications of various staffing options, such as the use of contract or registry nurses to sustain high staffing levels (Page, 2008; Stanton & Rutherford, 2004). This article will investigate the performance implications of using contract or registry nurse personnel in the context of a hospital's nurse staffing strategy. Specifically, the article will address whether the source of nurse staffing (i.e., contract or regular staff) affects the performance outcomes of hospitals' nurse staffing levels? Theoretically, this article will further develop understanding of the implications of using contract workers in the context of staffing strategies. Practically, it will help hospital managers evaluate decisions regarding the use of temporary versus permanent nurses when attempting to achieve a particular nurse staffing level.Staffing LevelsIncreased staffing levels generate positive benefits as they decrease the overall work load of individual employees (Brown, Sturman, & Simmering, 2001). In a hospital setting, increased nurse staffing allows nurses to pay greater attention to individual patients and their needs, allower nurses to closely monitor patient condition and response to treatment (Kovner & Gergen, 1998). This increased monitoring is clinically beneficial as it facilitates quicker detection of potential complications and adverse patient outcomes.Higher nurse staffing levels also permit nurses to exercise more attention to detail in their patient care and treatment activities. Patient care mistakes are a well recognized source of adverse outcomes in hospitals (Aiken, Clarke, Sloane, & Sochalski, 2001). By increasing nurse staffing, hospitals can decrease errors and improve patient care outcomes. Thus, increased nurse staffing is not only beneficial to the extent it gives nurses the opportunity to closely monitor patients, but also as it allows nurses greater opportunities for attention to detail in their patient care activities.The Use of Contract StaffingAlthough nurse staffing levels are an important contributor to patient care quality, the method used to obtain and maintain a specific nurse staffing level may influence their (i.e., the staffing levels) effectiveness. While hospitals have traditionally used staff nurses (i.e., nurses who are regular employees of the hospital) to maintain specific nurse staffing levels, recent shortages in nurses, combined with competitive nurse labor markets have led hospitals to increasingly use contract nurses to achieve specific staffing levels (Page, 2008). Contract nurses are nursing staff who are not regular employees of the hospital. Although contract nurses must have the same credentials and licensure as a hospital's staff nurses, contract nurses - due to their nonpermanent status - lack knowledge of the unique policies and procedures a specific institution may employ. This lack of "local knowledge" may adversely influence contract nurses performance. For instance, a contract nurse may be unfamiliar with a specific brand of equipment a hospital employs. Although the nurse understands the purpose of the equipment, they may not understand the uniqueness of operating the unfamiliar equipment. This unfamiliarity may either slow or introduce opportunities for errors in patient care. Patient care errors are a documented source of poor hospital performance and negative patient outcomes (Aiken et al., 2001). …