Use of Temporary Nursing Staff and Nosocomial Infections in Intensive Care Units, a Pilot Study

Purpose:

The use of this temporary nursing staff is controversial issues. Although hiring temporary nursing staff can help to increase staffing levels, it can also affect other nursing staff as well as care process, which leads to poorer patient care (Alonso-Echanove et al., 2003; Castle, 2009). Higher use of temporary staff can increase administrative burdens, disrupt routines and teamwork, and require additional supervision by permanent staff (Bae, Mark, & Fried, 2010). In a similar vein, empirical findings in this topic are also mixed. Some studies found that use of temporary nurses was related to the spread of nosocomial infection among patients (Alonso-Echanove et al., 2003), back injuries among nurses and patient falls (Bae et al., 2010). On the other hand, other studies found no relationships between the use of temporary nursing staff and quality indicators (Aiken, Shang, Xue, & Sloane, 2013; Xue, Aiken, Freund, & Noyes, 2012). Arguments behind this relationship are that temporary nursing staff are not less qualified than permanent staff (Aiken et al., 2013; Aiken, Xue, Clarke, & Sloane, 2007; Xue, Smith, Freund, & Aiken, 2012). An empirical study found that using temporary nursing staff were not related to poor quality of patient care, but poor work environments are the factor contributing to poor quality of care (Aiken et al., 2013; Xue, Aiken, et al., 2012). Although the intensive care units (ICU) are the work setting where temporary nursing staff spent most of their time, in the previous studies, researchers did not distinguish temporary and permanent nursing staff in their nurse staffing measures. Therefore, the purpose of the present study is to describe the nature and prevalence of the use of temporary nursing staff and to examine relationships between the use of temporary nursing staff and nosocomial infections in the ICUs.

Methods:

A secondary data analysis was conducted with data from the Western New York Center for Nursing Workforce and Quality. This data consisted of nursing unit level data on 14 ICU from 6 hospitals located in New York State. All data were collected monthly. A total of 144 ICU-month data points were used for the analysis sample. Nosocomial infections include central line associated blood stream infections (CLABSI), ventilator associated pneumonia (VAP), and total number of nosocomial infections combining those two. The use of temporary nursing staff was measured by nursing care hours per patient day provided by temporary nursing staff (in total & only by registered nurses). Also other nursing unit characteristics (nurse staffing, skill mix, unit size, and practice environment) were collected as control variables. Logistic regression models were used to examine the relationship between the temporary staffing and nosocomial infections.

Results:

The monthly means of CLABSI and VAP were 1.89 per 1,000 central line days and 2.18 per 1,000 ventilator days. In total, 2.73 nosocomial infections per 1,000 patient days occurred monthly. On average, 0.30 temporary nursing care hours per patient day were provided and 0.26 care hours by only temporary RNs. From the logistic regression models, we found that the use of temporary RN staff was not related to neither CLABSI nor VAP after controlling for other nursing unit characteristics.

Conclusion:

The findings of this pilot study suggests that the use of temporary nursing staff in ICUs was not related to nosocomial infections. As more temporary nursing staff are used to increase nurse staffing levels in ICUs, it is important to evaluate the impact of those temporary nurse staffing on patient outcomes. To make a conclusive decision about this relationship, future studies need to use a larger sample with other control variables which might affect both the use of temporary nursing staff and nosocomial infections.