How Do Travel Nurses Impact Patient Care?

Hospitals have leaned on travel nurses for decades to cover staffing gaps, and they're using more of them than ever. That raises a fair question: does relying on temporary staff change patient outcomes? The honest answer from the research is that it's complicated, and staffing itself may matter more than who fills the role.

Here's what the evidence shows and what it means for how hospitals use travel nurses.

The Quick Version

• Hospitals are using more travel nurses to fill staffing gaps.
• Travel nurses cost more than staff nurses.
• A limited body of research links their use to some worse outcomes, but staffing and work environment may be the real driver.

What a Travel Nurse Does

Travel nurses take shorter assignments, often out of town or out of state, to cover gaps. Sometimes they fill in for a specific nurse out on leave; other times they help a unit ride out a shortage. They earn more than staff nurses to offset the travel, the time away from home, and the lack of benefits, and they have to adapt fast to new procedures, units, and teams. RNs can travel independently or through an agency.

The trend is steep. Travel nurses' share of total hospital nursing hours jumped from 4% in January 2019 to 23% in January 2022, according to the American Hospital Association.

What the Research Found

A 2023 systematic review concluded the link between travel nurses and patient outcomes is unclear. It found limited or no effect on patient falls, the number of medication errors, or patient satisfaction. It did find a consistent correlation with hospital-acquired pressure ulcers, the severity of medication errors, and healthcare-associated (nosocomial) infections.

The pattern that held up was staffing. Travel nurse use correlated with worse outcomes largely because hospitals bring in travel nurses precisely when staffing is low, and low staffing has a strong, well-established link to worse outcomes on its own. In other words, the staffing problem and the travel nurses tend to show up together, and the staffing problem is doing much of the damage.

The evidence base is thin. The review pulled from just 21 studies, many tracking only one or two outcomes, and studies of the same outcome sometimes disagreed. A few even found better results with more travel nurse use. The takeaway is that this needs more research, not that travel nurses are the problem.

How Hospitals Can Set Travel Nurses Up to Succeed

The review also looked at hospital structure, patient risk, and travel nurse experience. None of those showed a consistent link to outcomes. What did stand out was the work environment, which had the strongest connection to patient care overall.

A positive work environment shares recognizable features: autonomy, manager support, a non-punitive culture, nurse input into error prevention, workplace civility, room for growth, and a real sense of being valued by leadership. Where those are present, travel nurses tend to do well. Where they're absent, problems follow regardless of who's staffing the floor.

That points to the underlying loop. When permanent staff find staffing thin or the environment unsupportive, they leave, which deepens the shortage and drives more travel nurse use. So when adverse outcomes track with travel nurses, the work environment and staffing levels are often the real cause. Fix those, and you address both the outcomes and the reason hospitals lean so hard on travel nurses in the first place.