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Turning to temporary labor can maintain, and even boost, staff engagement

Coauthored by Casey Willis-Abner, Chief Workforce Officer

One issue almost guaranteed to generate controversy in today’s healthcare climate is the use of temporary nursing labor—often referred to as travel nurses or agency nurses. As with so many other hot-button topics (e.g., vaccines, masks, lockdowns, telehealth), we have COVID-19 to thank for this. Before the coronavirus showed up, uninvited, “travelers” were employed only sporadically, filling temporary staffing gaps. But since the start of the pandemic, we’ve seen demand for temporary nursing labor skyrocket.

Whether this is good or bad depends on whom you ask. For the travel nurse industry, the sudden and ongoing need for their services has been a windfall. Hospitals and other healthcare organizations, on the other hand, might only be considering how travelers impact their budget.

At Press Ganey, we understand both sides of the picture—an understanding illuminated by extensive data. According to our analysis, there’s clearly a time and place for travel and agency nurses. Our data strongly suggests that strategically bringing in temporary labor as it is intended—for quick, short-term fixes—will help healthcare organizations maintain, or even improve, employee engagement and quality of care.

However, we do not propose the use of travel or agency nurses as a long-term solution. It’s far too expensive. But used judiciously, it can provide much-needed relief.

A necessary response to the nursing shortage

It’s no secret we’re in the midst of a caregiver crisis. The pandemic—and the physical, mental, and emotional exhaustion it induced or worsened—was the catalytic element in a perfect storm. Also factoring into this crisis: the large percentage of nurses who were already approaching retirement age, a high rate of turnover among first-year nurses, and an aging patient population in need of higher levels of care.

As these factors manifested themselves in a severe and widespread shortage of nurses, the use of travel and agency nurses soared. Naturally, so did resentment around the perceived downsides of leaning on travel and agency nurses. The financial implication is just one of the many aspects that have drawn criticism. In addition to being significantly more expensive, the argument goes, these workers lack the requisite investment in the organization and therefore, negatively impacting staff engagement, safety, and quality of care.

But a Press Ganey analysis of data measuring multiple areas of engagement from 90,000 nurses across hundreds of organizations indicates otherwise. (It’s important to note that overall engagement takes resilience, diversity, safety, and retention into consideration.)

This analysis1, which shows the year-over-year change from 2019 to 2020 and from 2021 to 2022, illustrates that an organization’s use of travel or agency nurses does not negatively affect its staff engagement, safety, or quality of care. In fact, in 2022, for the first time since we began measuring staff engagement, it actually improved when travelers were used, compared to the previous year.

Typically, there’s resentment between hospital-employed nurses and traveler nurses due to salary differences. But during the pandemic, workload demands were such that hospital-employed nurses welcomed travelers, most likely because they provided a necessary boost in staffing. The evidence is consistent: better staffing reduces burnout and improves job satisfaction among nurses.

Only a short-term solution to healthcare staffing shortage

Despite its benefits, as previously noted, reliance on travel or agency nurses is incredibly expensive and, therefore, not sustainable. Thinking long term, healthcare organizations must find ways to engage and retain the nurses they have on staff. In the meantime, they must engage temporary workers, building and fostering trusting relationships.

We’ve previously recommended four immediate interventions that can be adapted to support temporary nurses as well as hospital-employed nurses.

4 ways to support temporary nursing staff

  1. Shift staffing models to support nurse and patient needs.
  2. Instill confidence in nurses through high reliability techniques.
  3. Recognize hard work in all its forms (and whoever performs it).
  4. Build trust by listening to nurses and acting quickly on their concerns.

During a recent visit to a large university health system, we were told that, on a team of 75 nurses, 65% of current members were temporary or agency nurses. The challenges for a leader working in that kind of environment will differ significantly from those faced by one whose organization has just two or three agency nurses covering a maternity leave, for example. At the same time, certain best practices apply in any situation.

It is essential that we, as leaders, help to create a sense of belonging and a sense of commitment to the organization’s mission. We should welcome travelers and treat them with respect. We shouldn’t lower the bar for them because they're temporary staff. Nor should we expect more of them than we do of our permanent staff. When an organization has built and fostered a positive culture, that culture will produce positive interpersonal relationships between permanent and travel staff.

Some organizations, like Bon Secours Mercy Health and Allegheny Health Network, are confronting this challenge head-on by developing their own in-house travel nursing programs. These programs offer flexibility to both the individuals as well as the organizations, allowing them to pivot and adjust to changing circumstances and needs.

That’s what healthcare is all about: meeting people’s needs, however we can. And, in some cases, that means turning to travel or agency nurses.

To stay connected to employees during challenging staffing times, it’s important to develop an ongoing communication and listening strategy. Sharing ongoing plans to recruit and retain staff goes a long way in building trust and instilling hope for the future.

Learn more about how your organization can implement these strategies to advance your workforce. Rather talk to a member of our team? Reach out here.

1. Press Ganey. (2022). RN Contractor Analysis [Data File]. 

About the author

As Chief Nursing Officer, Jeff leads Press Ganey’s focus on improving patient and caregiver experience and developing nursing leadership at healthcare organizations nationwide. He also plays an integral role in the company’s workforce initiatives, including Press Ganey’s Workforce Well-Being Collaborative, which focuses on supporting caregivers as they deal with the ongoing challenges of the pandemic. Prior to joining Press Ganey, Jeff served in various chief nursing officer roles at both community-based organizations and major academic medical centers throughout the US. In addition, he was the inaugural Vice President of the Magnet Recognition and Pathway to Excellence programs at the American Nurses Credentialing Center.

Profile Photo of Dr. Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN