Travel Nurses and Patient Care: Their Impact on Patient Outcomes and How Hospitals Can Help Them Succeed

Ann Feeney
Updated November 1, 2023
Edited by
    Travel nurses can help address nursing shortages, but their use can be associated with poorer patient outcomes. Learn how hospitals can address this.
    Travel nurse talking to patient in hospital bedCredit: Getty Images/iStockphoto
    • Hospitals are using more travel nurses to fill staffing gaps.
    • Travel nurses typically cost more financially than staff nurses.
    • The use of travel nurses is sometimes associated with worse patient outcomes based on limited research.

    Travel nurses help fill gaps in hospital staffing, but there are questions about their impact on patient outcomes. Hospitals have consistently relied on travel nurses for decades to fill temporary nursing shortages — and that number is only growing – so healthcare providers must understand the potential impact on patient care.

    A recently published systematic review concluded that the relationship between travel nurses and patient outcomes is unclear. The use of travel nurses may be associated with some adverse events in patient care, but these events may be due to hospital staffing and work environment issues.

    The review found limited or no impact on patient falls, the number of medication errors, or patient satisfaction but a consistent correlation with hospital-acquired pressure ulcers, the severity of medication errors, and the incidence of nosocomial infections (healthcare-associated infections).

    Discover how hospitals can better accommodate travel nurses to reduce the effect on patient outcomes.

    What Is a Travel Nurse?

    Travel nurses take on shorter-term assignments at hospitals, often traveling out of town or state to fill staffing gaps. While many of them work to fill the role of a specific staff member absent for vacation, parental leave, illness, or other reasons, employers also use travel nurses to alleviate nursing shortages.

    Travel nurses generally earn higher salaries than staff nurses because of the additional stress of travel, being away from home, and lack of benefits. Travel nurses must adapt readily to new situations, procedures, and colleagues. Registered nurses can become travel nurses as independent agents or through a travel nurse agency.

    The total hours worked by travel nurses as a percentage of the total hours worked by hospital nurses grew from 4% in January 2019 to 23% in January 2022, according to the American Hospital Association.

    How Does Patient Care Differ Between Traditional and Travel Nurses?

    According to the review, staffing levels did show a consistent correlation with travel nurses and worse patient outcomes. This finding is unsurprising since hospitals employ travel nurses to address low staffing levels. There is also a strong and consistent evidence-based association between nursing staff levels and patient outcomes, according to a qualitative study.

    Staffing levels were the key variable affecting patient outcomes, according to the systematic review. Some patient outcomes did not show a consistent correlation with the use of permanent/traditional nurses rather than travel nurses. The outcomes that did not show an association include:

    • Patient falls
    • Number of medication errors
    • Patient satisfaction

    However, some negative outcomes did show a consistent correlation with the use of travel nurses. These include:

    • Hospital-acquired pressure ulcers
    • Severity of medication errors
    • Nosocomial infections (healthcare-associated infections)

    Because the research on patient outcomes and travel nursing is still limited, the systematic review included only 21 articles. Many reviewed articles tracked only one or two patient outcomes, and sometimes, studies of the same outcome found different results. For example, some studies found better outcomes for some variables with greater use of travel nurses. More research is needed to further understand the relationship between the use of travel nurses and patient outcomes.

    How Can Hospitals Better Accommodate Travel Nurses?

    The review also examined how hospital structures, patient risk factors, and travel nurse experience levels impacted patient outcomes. Ultimately, the work environment strongly correlated to patient care.

    The study did not find that the type of unit (such as critical care) had a consistent correlation with outcomes and the use of travel nurses. Similarly, patient risk factors and travel nurse experience levels did not show a relationship between travel nursing use and patient outcomes.

    The work environment had the strongest impact on overall patient outcomes. Some, though not all, of the studies in the systematic review, indicated that work environment may be the underlying factor that determines whether travel nurse use is associated with adverse patient outcomes.

    Some of the factors associated with a positive work environment include but are not limited to:

    • Appropriate level of challenges
    • Autonomy
    • Career advancement
    • Collaborative work environment
    • Control over work environment
    • Manager support
    • A non-punitive environment
    • Nurse input into error prevention
    • Job satisfaction
    • Patient-centric culture
    • Perception of being valued by leadership
    • Support for education and development
    • Workplace civility

    Hospital work environments and staffing levels may have an association with greater use of travel nurses. If permanent staff find staffing levels inadequate or the work environment unsupportive, they may be more likely to leave. Negative work environments can fuel the nursing shortage, which may lead to greater use of travel nurses. Where adverse outcomes seem to be associated with travel nurses, it is entirely possible that the work environment and staffing levels are the underlying causes.