Use of supplemental nurses can be cost-effective in the short term: 4 findings

Although the hourly personnel cost may be more for supplemental RNs than for permanent RNs, minimal to modest use of supplemental RNs in certain situations could be cost-efficient or breakeven for a hospital, a study published in the Journal of Nursing Care Quality suggests.

The study revealed using supplemental RNs when there are temporary increases in patient acuity or census or short-term permanent RN shortages could be cost-efficient. However, the study found heavy reliance on supplemental RNs to meet staffing needs might not be cost-efficient, and there was no statistical difference in hourly personnel cost between the use of supplemental nurses and overtime worked by permanent nurses.

The study examined the use of agency-employed supplemental nurses on nursing personnel costs in 19 adult patient care units in a large academic medical center located in upstate New York from 2003 to 2006.

Specific findings from the study include the following.

1. After controlling for other nursing staff personnel costs, including benefits and overtime, the average hourly nursing personnel cost of using supplemental RNs was $21 higher than the average hourly cost of using permanent RNs across units in the academic medical center during the data collection period.

2. The use of supplemental RNs for more than 0 and 0.2 or less hours per patient day (equivalent to 2.8 percent of total RN hours per unit per quarter) reduced overall nursing personnel costs by $6.03 per patient day.

3. When the threshold of using supplemental RNs was more than 0.2 and 0.4 or less hours per patient day (2.8 percent to 5.6 percent of total RN hours per unit per quarter), there was no statistically significant difference in the overall nursing personnel cost per patient day compared with no use of supplemental RNs. 

4. The nursing personnel cost was higher than that for no use of supplemental RNs when the threshold of using supplemental RNs was greater than 0.4 hours per patient day (greater than 5.6 percent of total RN hours per unit per quarter), which would occur when the cost of using supplemental RNs exceeds the cost of new hires or overtime use.


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