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Use of Supplemental Nurses Is Cost-Effective Strategy to Address Hospital Short-Term Staffing Needs

New Study Also Found Hourly Personnel Costs for Supplemental Nurses Efficiently Offset Permanent Nurse Overtime Costs

The modest use of supplemental (temporary or contract) nurses is a cost-efficient strategy during temporary periods of patient census swings or short-term shortages of permanent nurses at large U.S. medical centers, according to a new study led by researchers at the University of Rochester School of Nursing. The study also found that the hourly personnel costs for supplemental nurses efficiently offset the overtime costs of permanent nurses.

This study is the first to use longitudinal hospital unit-level data to investigate the cost and cost efficiency of using supplemental nurses.

“Prior research has shown that temporary and contract nurses are just as qualified—through education and experience—as permanent nurses,” said Richard Wahlquist, president and chief executive officer of the American Staffing Association. “This study shows that supplemental nurses offer the strategic flexibility that hospitals need to augment their workforces during peak times, and to address any interim labor shortages related to leave coverage, vacancies, and expansion of services.”

Published in the April–June issue of the Journal of Nursing Care Quality, the study, “Cost Outcomes of Supplemental Nurse Staffing in a Large Medical Center: A Method for Quantifying Supplemental Nurse Cost Efficiency,” analyzed hospital nursing personnel cost data collected from a large medical center in upstate New York between July 2003 and December 2006. The data included all patient stays (465, 936) in 19 varied adult patient care units.

According to the study’s findings

  • Although the hourly personnel cost may be higher for supplemental registered nurses than permanent ones, modest use of supplemental nurses during periods of temporary increases in patient volume or interim shortages in permanent nurses is cost-effective.
  • Heavy reliance on supplemental nurses to meet staffing needs may not be cost-efficient.
  • Use of overtime by permanent nurses might not be a cost-effective strategy compared with supplemental nurse use.

“In addition to not being cost-effective, overtime hours performed by permanent nurses may equate to poor nurse and patient satisfaction,” said researcher Linda H. Aiken, Ph.D., RN, FAAN, FRCN, with the Center for Health Outcomes and Policy Research, University Pennsylvania. “Extensive research indicates that overtime work is connected to nurse burnout, turnover, and poor patient outcomes. The use of supplemental nurses can alleviate these risks.”

Read the report.


About the American Staffing Association

The American Staffing Association is the voice of the U.S. staffing, recruiting, and workforce solutions industry. ASA and its state affiliates advance the interests of the industry across all sectors through advocacy, research, education, and the promotion of high standards of legal, ethical, and professional practices. For more information about ASA, visit

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