Association of Use of Contract Nurses With Hospitalized Patient Pressure Injuries and Falls

Hospital-acquired pressure injuries (HAPIs) and falls are outcomes sensitive to quality of nursing care. Use of contract (traveler) nurses varies among organizations, but there is little research on the effect of contract nurses on nurse-sensitive outcomes.

To explore the relationship between use of contract nurses and two key nurse-sensitive outcomes, HAPIs and falls.

This was a cross-sectional study of unit-level nursing, patient, and hospital factors versus HAPIs and falls from a national nursing data consortium from 2015 to 2016. We used cluster analysis to identify similar units, and compared outcomes between clusters.

605 nursing units in 166 hospitals, 3.2 patients per nurse, and 5.3% contract nurses.

Prevalence and incidence of HAPIs and number of falls, adjusted by patient days.

For both prevalence and incidence of HAPIs, there was a statistically significant difference between the five independent cluster groups (p = .012 and p = .001, respectively). The cluster with the highest percentage of nurse travelers (>7%) had the highest HAPI prevalence (0.84%) and incidence (0.055 per 1,000 patient days) despite higher nurse staffing, compared to HAPI prevalence of 0.32% and incidence of 0.017 per 1,000 patient days in the cluster with the lowest percentage of nurse travelers (<2%). We did not identify a consistent relationship between use of contract nurses and falls.

Use of contract nurses was associated with higher HAPI prevalence and incidence, independent of staffing levels.

Our results suggest that institutions should either minimize the use of contract nurses, or engage in extensive training to confirm that contract nurses have understanding of the institutional practices around HAPIs.