Variations in outsourced nurse utilization in long term acute care hospitals: An analysis of patient outcomes

Determination of optimal levels of outsourced to permanent nursing is a critical management issue in hospital cost containment and quality outcomes. Because outsourced nurse utilization in long term acute care hospitals (LTACH) has not been studied, research was conducted to evaluate outsourcing effects on selected patient outcomes. The typical proprietary LTACH has a daily census of 36 patients with an average length of stay (LOS) five times longer that of short term acute care hospitals (STACH). The likelihood of negative quality outcomes increases when staffing effectiveness is not maintained on a shift to shift basis. This problem is significant due to current nursing workforce shortage, recruitment and retention issues.;This study examined risk-bearing factors related to quality and financial management of outsourced nursing. Outsourcing vacant shifts occurs when efforts to schedule regular employees are not successful. Findings were that variations in levels of outsourced nursing (low, medium and high defined by percentage of outsourced labor compared to total labor expense) had no effect on quality outcomes that included patient fall rates, catheter-associated urinary tract infections, medication variances, and overall satisfaction. Fluctuations in census and acuity did not have an effect on vacancy rates. Vacancy rates did not predict negative quality outcomes. Mean data on quality outcomes demonstrated LTACH results were within nationally accepted benchmarks, indicating that quality and patient satisfaction are at optimum levels in this post-acute care setting.;Critical success factors related to outsourced nursing were identified by LTACH chief nursing officers (CNOs). Costs of overtime and incentives often equal or surpass outsourcing expense. When outsourcing, CNOs prefer to engage a contract nurse willing to take on longer assignments. CNOs agreed proper orientation reduced risk, outsourced nurses are accustomed to a variety of work settings, outsourced nurses collaborate with permanent staff, and they function effectively. CNOs agreed that physicians preferred limited use of outsourcing and that families were less likely to be satisfied with care provided by an outsourced nurse, although this perception was not statistically relevant. However, they agreed that patients and families were not likely to know that the outsourced nurse was not a permanent employee.