Association of travel nursing with quality outcomes in hospitalized patients

To evaluate the impact of increased travel nursing on patient safety and infection outcomes.

Retrospective analysis of staffing data from a large tertiary center (2019-2023).

We examined associations between nurse staffing ratios, agency nurse use, hospital-acquired infections, and patient safety indicators (PSIs) using Spearman correlations, analysis of variance, and regression analyses.

Agency nursing shifts rose sharply from 70.9 per month (0.9% of shifts) in 2019 to 1206 per month (12.7%) in 2023 across inpatient units and the emergency department. Over that same period, PSI events increased from 7.1 to 9.3 per month, and total infections rose from 15.8 to 20.5 per month. Hospital-wide, greater reliance on agency nurses correlated with more pressure ulcers (PSI 03), postoperative acute kidney injury requiring dialysis (PSI 10), ventilator-associated pneumonia (VAP), total PSIs, and total infections. In critical care units, higher agency staffing was specifically linked to increased VAP, Clostridioides difficile infections, and overall infections. When agency nurses accounted for more than 10% of the workforce, there was an independent association with a higher number of PSIs, although not with infections.

Rising dependence on agency nurses coincided with increased patient safety events and selected infections. Although confounding factors may contribute to this association, these findings emphasize the need for structured integration, orientation, and monitoring of temporary staff to ensure patient safety while addressing workforce shortages.