Temporary nurse deployments: a time-series analysis of shift scheduling dynamics and staffing level alignment

Area of Science:

• Healthcare Management
• Nursing Workforce Studies
• Hospital Operations

Background:

• Hospitals frequently utilize temporary nurses to manage staffing fluctuations.
• Existing evidence on the patterns and drivers of temporary nurse deployment is limited.
• Understanding these dynamics is crucial for effective healthcare workforce planning.

Purpose of the Study:

• To analyze the deployment patterns of temporary nurses in response to shift-level schedule deviations.
• To identify factors influencing the use of temporary nurses in a tertiary hospital setting.
• To evaluate the extent to which temporary nurses address shortfalls in planned nursing schedules.

Main Methods:

• A four-month time-series analysis of 1344 shifts across medical and surgical units.
• Collected data included nursing staff numbers, skill mix, absences, patient count, and turnover.
• Generalized linear mixed models were used to identify drivers of temporary Registered Nurse (RN) deployment.

Main Results:

• Temporary nurses were deployed on 12.2% of shifts, primarily as Registered Nurses (RNs).
• RN absence (OR=2.14) and increased patient load (OR=1.11 per patient) significantly increased temporary RN deployment.
• Deployment was 3.96 times higher when RN staffing was below average, but 57.1% of absences remained unaddressed.

Conclusions:

• Temporary nurse deployment is infrequent and does not fully compensate for staffing gaps.
• Deployment strategies need optimization, especially on high-demand units.
• Enhanced workforce resource management is essential for maintaining high-quality patient care.