Overuse of Travel Nurses Threatens Patient Safety
October 1, 2025 4 minutes read
By Gregory Freeman
New research suggests that relying excessively on travel nurses or nurses working overtime may threaten patient safety. Researchers at the George Washington University and Premier health system looked at this issue, which has received little attention in the past.
The results suggest that, when hospitals over-rely on travel nurses or overtime for the regular nursing staff, patient safety may be compromised, says Patricia Pittman, PhD, lead author of the study and director of the Fitzhugh Mullan Institute for Health Workforce Equity at the GW Milken Institute School of Public Health in Washington, DC.
Pitmann suggests that hospitals should investigate and monitor how much they rely on those nursing options. The study involved data from 70 U.S. hospitals from January 2019 through December 2022 and looked at the use of travel nurses and overtime — but also quality measures, such as the rate of pressure ulcers. The research indicated that using nurse overtime and agency nurses was associated with increased rates of pressure ulcers after a certain threshold. More than half of the hospitals in the study used more nurse overtime and agency hours than what the data indicated was the safe threshold. Overtime and agency nurse hours may be useful for short periods, the researchers concluded, but they are not an acceptable alternative to maintaining adequate regular nurse staffing.
(The study is available online at http://bit.ly/4oafMYo.)
The results of the study should not be surprising for those who work in healthcare, but the research may be useful for risk managers trying to show the risk posed by skimping on regular nursing hours, Pittman says.
“I hear from a lot of physicians that they were very concerned in the aftermath of COVID about the number of travel nurses, and how they were concerned that there was no institutional memory about protocols, and relationships were completely different,” she says. “No one knew each other. The word on the street, if you will, is that there’s an assumption that too many travel nurses can be dangerous. And, similarly, we know from many studies in the past that overtime can be problematic. If you’re working people too hard, there are more errors when they’re tired.”
Pittman’s research confirmed those concerns by showing with real data that, statistically, there was a significant harm in terms of pressure ulcers, she notes. The level of harm was not great until the use of travel nurses and overtime reached a certain level, but a large proportion of hospitals did so.
“(The number of) hospitals that were beyond the sort of threshold of safe use of travel nurses and overtime was very, very high. So, many, many hospitals are overusing these two traditional levers to address nurse shortages,” Pittman says. “So the question then becomes, what are the alternatives? And that’s a larger conversation about recruitment and retention and working conditions and burnout and all of that stuff.”
Identifying that break point beyond which travel nurses and overtime become detrimental was one objective of the study, but Pittman notes that the break point may be different from one facility to another or one type of health system to another.
“Hospitals themselves can do these calculations — and should do these calculations. They should not be assuming that more is better. It’s not that any kind of nurse is better. It depends on factors, such as how long the nurse has been there,” she says. “Most studies up until now on the relationship between nurse staffing and patient safety have focused either on the overall numbers, the nurse-to-patient ratio, or they focus specifically on education level. The takeaway message for risk managers and quality assurance folks in hospitals is you should set up your own data system so you can see your threshold for the safe use of travelers and the safe use of overtime.”
Hospitals rely on travel nurses and overtime to fill gaps in patient care because of staffing shortages, particularly with surges from flu season or summer tourism, and Pittman says the research results do not mean those options should never be used. But she says overreliance on those two particular levers can harm patients, so hospitals should set up monitoring systems to indicate when the safe threshold is approaching.
“Set up your reporting systems so that, over time, you will be able to see increases in patient harm and see whether they are significantly associated with staffing patterns. But people are not doing that now, so there isn’t a sense of the thresholds for overtime and travel nurses,” Pittman says. “There’s a sense that you use those options as a more expensive type of labor and, therefore, you use them only when you feel you need to but you use them as much as you need to. There’s no sense that you get to a point beyond which more is not better, even if you can’t get regular staff nurses.”
Pittman says it is important to remember that, even when necessary, travel nurses and nurses working overtime are not a one-to-one equivalent to regular staffing.
“It’s not like calories in that are all the same. You have to really understand the nutritional value, if you want to get good health outcomes,” she says. “It’s a more nuanced way of thinking about staffing. It’s likely that folks have been thinking about it in terms of the economic terms because it is more expensive to use travel nurses, but they’re not thinking about it in terms of patient safety.”
Greg Freeman has worked with Clinican.com and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Clinician.com products. In addition to his work with Clinician.com, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Source
- Patricia Pittman, PhD, Director, Fitzhugh Mullan Institute for Health Workforce Equity, GW Milken Institute School of Public Health, Washington, DC. Email: [email protected].
New research suggests that relying excessively on travel nurses or nurses working overtime may threaten patient safety. Researchers at the George Washington University and Premier health system looked at this issue, which has received little attention in the past.
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