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Cost Outcomes of Supplemental Nurse Staffing in a Large Medical Center

Xue, Ying DNSc, RN; Chappel, Andre R. PhD; Freund, Deborah A. PhD; Aiken, Linda H. PhD, FAAN; Noyes, Katia PhD, MPH

doi: 10.1097/NCQ.0000000000000100

Use of agency-employed supplemental nurses on nursing personnel costs was examined in 19 adult patient care units in a large academic medical center. Results indicated that the modest use of supplemental nurses was cost-efficient with regard to overall nursing personnel costs, but heavy reliance on supplemental nurses to meet staffing needs was not cost-efficient. In addition, there was no statistical difference in hourly personnel cost between the use of supplemental nurses and overtime worked by permanent nurses.

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University of Rochester School of Nursing, Rochester, New York (Dr Xue); Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, District of Columbia (Dr Chappel); Claremont Graduate University, Claremont, California (Dr Freund); Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia (Dr Aiken); and Surgical Health Outcomes and Research Enterprise (SHORE), Departments of Surgery and Preventive Medicine and Community Health, University of Rochester Medical Center, Rochester, New York (Dr Noyes).

Correspondence: Ying Xue, DNSc, RN, University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY 14642 (

This study was supported by the Robert Wood Johnson Foundation—Interdisciplinary Nursing Quality Research Initiative #62576 (Drs Xue and Freund). Dr Aiken received funding from American Staffing Association Foundation. Dr Katia received funding 1UL1 RR024160-01 from the National Center for Research Resources.

The authors declare that there is no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: October 16, 2014

Published ahead of print: December 4, 2014

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