Box 5The use of private contract nurses was widespread in the United States during COVID-19 – but it was very costly

Private nurses were used in hospitals for short term-assignments in different locations

In the United States, the use of contract nurses to augment staff nurses was ubiquitous across hospitals in response to COVID-19 (ASPE, 2022). Often referred to as ‘travel nurses’ for their ability to take short-term staff assignments in different locations, these nurses are typically employed by independent staffing agencies. Travel nurses can provide a valuable addition to health care teams during times of increased demand or staffing shortages, and they can bring specialized skills to rural and medically underserved areas. Although their use to mitigate temporary nurse staffing shortages preceded the COVID-19 pandemic, the proliferation of contracted nurse staffing in response to the pandemic was dramatic, with reports of up to 95% of health care facilities in the US hiring nurses from contract agencies (ASPE, 2022). Across American hospitals, the use of travel nurses increased 35% in 2020 compared to 2019 (ASPE, 2022).

The use of private nurses had a neutral effect on patient outcomes – but it was very costly and put much financial strains on the hospitals

Studies find neutral effects of the use of contracted travel nurses on patient outcomes, with neither positive nor negative impact (Xue et al., 2012; Faller, Dent & Gogek, 2017), although there are anecdotal reports attributing rises in hospital-acquired infections to hiring ill-trained contract staff during the pandemic (Grimm, 2021). However, COVID-19 demonstrated the importance of considering the consequences of travel nurse staffing beyond patient care delivery. Travel nurses made significantly more money than staff nurses during the pandemic – wages rose 25% in the early months of the pandemic and were reported as being as high as US$ 5–20,000 per week (ASPE, 2022), causing some staff nurses to leave their jobs for travel nurse positions (Bernstein, 2021). Contract staffing agencies’ margins increased from 15 to 62% (AHA, 2022), prompting allegations of price gouging and contract agencies’ exploitation of the health care crisis (Yang & Mason, 2022). The costs associated with employing travel nurses resulted in a tremendous financial strain on hospitals in the United States, accounting for 50% of nurse labour expenses and preventing hospitals from investing these costs into their existing workforces (AHA, 2022). The situation was exacerbated for small and rural hospitals, which were unable to compete against better resourced hospitals for nursing staff (ASPE, 2022). The use of travel nurses also contributed to the erosion of morale amongst existing staff, leading to increased turnover and staffing shortages – the exact challenges hospitals were attempting to address (AHA, 2022; ASPE, 2022).

From: POLICY BRIEF

Cover of Global Health Workforce responses to address the COVID-19 pandemic
Global Health Workforce responses to address the COVID-19 pandemic: What policies and practices to recruit, retain, reskill, and support health workers during the COVID-19 pandemic should inform future workforce development? [Internet]
Policy Brief, No. 52.
Ziemann M, Chen C, Forman R, et al.
© World Health Organization 2023 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies)

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