Hospitals are increasingly being cited for how they supervise nursing care — and, above all, for how they oversee the contract and travel nurses they leaned on during the workforce crisis, according to a Becker’s analysis of CMS inspection data.
Citations for inadequate supervision of contract staff appeared in 285 hospital inspections in 2025, up from just 18 in 2019 — a roughly fifteenfold increase. So far in 2026, the deficiency has already been cited in 176 inspections, or 4.9% of all inspections — a higher rate than in any prior full year.
The climb of contract-staff supervision citations:
| Year | Inspections cited | Share of all inspections |
| 2019 | 18 | 0.3% |
| 2020 | 28 | 0.6% |
| 2021 | 108 | 2.3% |
| 2022 | 119 | 2.4% |
| 2023 | 140 | 2.6% |
| 2024 | 258 | 4.2% |
| 2025 | 285 | 4.7% |
| 2026 (through Aug. 24) | 176 | 4.9% |
The trend tracks hospitals’ expanded use of agency and travel clinicians during and after the pandemic. Even as systems have scaled back that reliance, surveyors continue to flag gaps in how contract nurses are oriented, supervised and held to the same standards as employed staff.
Contract staffing is not the only nursing pressure point. Deficiencies tied to the nursing-services condition of participation overall were cited in 763 inspections in 2024 and 753 in 2025, up from 586 in 2023.
The most frequently cited nursing-services deficiencies in 2025:
1. RN supervision of nursing care — 341 citations
2. Supervision of contract staff — 285 citations
3. Nursing services (overall condition) — 243 citations
4. Nursing care plan — 138 citations
5. Administration of drugs — 129 citations
6. Staffing and delivery of care — 84 citations
Citations for RN supervision of nursing care — the single most common nursing deficiency — rebounded to 379 inspections in 2024 after dipping during the pandemic, while citations naming the overarching nursing-services condition rose to 249 that year, both near their highest levels in the dataset.
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