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Studies Show Positives of Travel Nursing

Top hospitals use travel nurses and have good outcomes.

There seems to be a new stigma attached to travel nurses that is causing some hospital executives to reconsider hiring from nursing agencies to fill temporary staffing gaps caused by nursing shortages.

This unfounded belief links agency-employed registered nurses with poor patient outcomes, including higher rates of mortality and failure to rescue. But new research conducted in studies done by two prestigious universities have dispelled this myth.

Linda H. Aiken, PhD, RN, a professor of sociology and nursing and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, recently led a study about travel nurses and determined that hiring extra temporary travel nurses may save lives.

"What we found is that most hospitals use travel nurses at one time or another, and 95% of America's top hospitals use agency nurses," Aiken said. "We looked at whether hospitals that used a substantial proportion of agency nurses have worse outcomes and the answer to that was, 'no.'"


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The study examined more than 1.3 million patients and 40,000 nurses in more than 600 hospitals, and concluded that the use of such supplemental nurses "does not appear to have deleterious consequences for patient mortality."

"We find there is no association between employing travel nurses and any negative outcomes and find that the outcomes, especially in regard to preventable mortality after common surgical procedures would be greater if the hospitals had not used these agency nurses," Aiken said.

"The main benefits for patients have to do with higher quality of care and better safety outcomes," she added. "We find that these hospitals are taking an extra step of maintaining their safe levels of staffing by linking to another source outside their own group of employed nurses and the patients are the beneficiary of this."

Job Satisfaction

In the course of the research, Aiken discovered that not only are travel nurses quite satisfied with their jobs, due to the flexibility and career goals, but that nurses working for agencies had a higher job satisfaction rate than permanent nurses do.

Meanwhile, the Columbia University School of Nursing conducted a study that suggests agency nurses are taking blame unfairly, showing that the negative effect of agency-employed supplemental nurses on patient outcomes may have less to do with the characteristics of the nurses than the work environments in the hospitals where they are employed.

In the study, more than 40,000 registered nurses in 665 hospitals treating more than 1 million patients were examined and when the quality of hospital work environments was factored in, the association between adverse outcomes and agency-employed nurses were rendered insignificant.

It makes sense given hospitals with poor work environments have trouble recruiting and retaining permanent staff nurses and tend to rely on supplemental nurses to fill vacancies.

"What we find is that a poor quality of care in the 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," said Jingjing Shang, PhD, RN, OCN, assistant professor of nursing at Columbia, who served as head researcher for the project. "It's not the travel nurses; it's that the hospital has a fundamental problem with the working environment."


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Immensely Qualified

According to Shang, a travel nurse is as equally qualified as a permanent nurse, and often more so because of the high proportion of travel nurses that have national certification.

"Because of a nursing shortage, using travel nurses is a way to boost staffing in the hospital and we know from research that it improves hospital care," she said. "Hospital executives and managers should take steps to evaluate whether the work environments in their institutions are adversely impacting their success in attracting and retaining qualified permanent nurses, as well as improving patient outcomes."

Nick Angelis, author of "How to Succeed in Anesthesia School (And RN, PA, or Med School)," has worked as a travel nurse in 20 different facilities in two states, stretching his skills and volunteering for assignments in med/surg, the ED, and other places where he had little experience.

"To make it as a travel nurse, you need to possess an intuitive grasp of nursing (a lot of common sense) or have extensive knowledge about various diseases and treatments. I had the latter and found travel nursing to be an efficient way to learn the former," Angelis said.

"Travel and agency nursing worked well for me because I was always taking at least one or two graduate courses as I worked," he added. "If I was between contracts or unable to find shifts, my grades improved and I could study more."

Wanting to spend more time with children or ailing parents are other situations where the flexibility of choosing when to work trump the ability to put in 40 hours every week. The experience is also an easy way to see what other specialties offer and an excellent way to hone clinical skills if a nurse wants to become a nurse practitioner or anesthetist.

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Positions Available

The need for travel nurses ebbs and flows, and while it might seem as if it's hard to get a position, according to healthcare insiders, there are plenty of positions and opportunities available.

Megan Cummings, a current travel nurse in New York City has taken full advantage of working when she wants and enjoying her life outside of work without feeling so attached to a hospital and other duties outside of a bedside practice.

"As a PICU RN, I haven't found finding assignments to be difficult in the least. While the shift and hospital may not be your preference, an in-demand specialty will never go without temporary work," Cummings said. "Kids are always getting sick and the staff turnaround in large cities is always an issue that large hospitals have to manage."

Travel nurses are great ways to fill these gaps during maternity leaves, times of high patient census (like flu season), as well as mitigating staffing needs during vacation months.

"If anything, I feel like I have seen an increase in the number of travel nurses hired. I feel temporary staff without benefits can be more cost effective to a hospital," Cummings said. "Of course, the traveler always takes the risk that the hospital won't be able to re-sign after 13 weeks, but skilled professionals only contracted for small amounts of time give the hospital flexibility in budget when it comes to contract renewals."

Keith Loria is a freelance writer.

Articles Archives

I have been working as a traveling nurse for the past year. As an older, experienced nurse it has given me a great opportunity to improve some of my own techniques with new methods learned in each of the individual facilities. I have enjoyed the opportunity of "blending in" with the various communities on a more personal basis rather than as a tourist. Many of my travel experiences have been good ones but there were a few unfortunate ones in the mix as well. It can be daunting and difficult to walk into a strange environment and be expected to work with other healthcare workers whom you don't know. So you need to approach each assignment with a positive attitude and make the best out of the situation. We go in as invited guest to these facilities and do what we do best. Over the past year I have met some very interesting and caring people and I hope to continue to work as a traveling nurse for another few years! Let's prove that we know our stuff and keep up the good work!

Janet May 20, 2013

I have to say that my experiences as a travel nurse were great. I have since "settled" and taken a permanent post but it is my belief that travel nurses bring a wealth of experience to a facility, most are satisfied with the path they have chosen and are content to just do the job and not get involved with the politics of the organization. Being a staff nurse subjects one to yearly evaluations which leaves everyone feeling less than adequate and more times than not disgruntled, and having to comply with a grocery list of competencies does not help either. My travel company did have online competencies and my evaluation simply consisted of a short paragraph from my supervisor. I cannot say much for agency nurses except that one time I was called in to replace an agency nurse who clearly was not fit to do the job assigned. Hospitals really need to evaluate their staffing needs.

Helen ,  RNMay 01, 2013

Last job as travel nurse at a federal prison in North Carolina. Contract was terminated after one day. I was told I had to be accompanied by a staff member at all times. The nurse who was orienting me said she had personal business to attend to and left me to wait in the cafeteria. It seems that regular staff are always looking for ways to get travelers fired as soon as possible. Maybe the greed for the chance to pick up extra shifts is the only thing they care about.

I would caution any nurse to be very careful about taking a travel position. No one has any interest in your welfare.

Kenneth NechitiloMay 01, 2013


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