Employing Temporary and Agency Staff

Whether a healthcare facility faces a workforce shortage depends largely on the state where the facility is located. Differences in demographics, population shifts, the labor market, and the availability of nursing education in the state result in considerable variation in the size and adequacy of the nursing workforce (Carnevale et al.). The distribution of nursing professionals varies substantially by state, as does nurses' role in each state's healthcare workforce.

HHS's Health Resources and Services Administration (HRSA) used a healthcare workforce simulation model to develop state-level projections for the future supply and demand of registered nurses (RNs) and LPNs. No statistical model is perfect or includes every potential factor that could affect the healthcare workforce supply and demand. HRSA points out that its projections do not account for emerging healthcare delivery models that may increase demand for nurses or for changes in demand that might result from increased numbers of people seeking healthcare as a result of the implementation of ACA. See Projected Nursing Shortages by 2025.​

Sixteen states are projected to experience a smaller growth in RN supply relative to their state-specific demand, resulting in a shortage of RNs by 2025; 10 of these states are in the West, 4 are in the South, and 2 are in the Northeast region. States projected to experience the greatest shortfalls in the number of RNs by 2025 are Arizona (with 28,100 fewer RNs than needed), followed by Colorado and North Carolina (each with 12,900 fewer RNs than needed). Growth in supply is expected to exceed demand growth in the remaining 34 states, including all of the Midwestern states.

Projected changes in supply and demand for LPNs between 2012 and 2025 also vary substantially by state. Twenty-two states are projected to experience a smaller growth in the supply of LPNs relative to their state-specific demand for LPN services. Ten of these states are in the West, 5 are in the South, 5 are in the Northeast, and 2 are in the Midwest. Maryland, North Carolina, and Georgia are each expected to fall short of their 2025 projected demands by 7,000 to 8,000 LPNs, whereas Ohio and California each are projected to have an excess of 20,000 to 25,000 LPNs (HHS "The Future"). See Projected Nursing Shortages by 2025.

Awareness of similarities and differences in the characteristics of agency-supplied temporary nurses and facility-employed nurses in permanent positions may be useful when organizations consider an appropriate level and mix of nursing staff, both facility-wide and at the nursing-unit level. Permanent and temporary staff must work together, so unit mix may be a factor to consider with regard to ensuring effective communication and teamwork and determining the need for supervision. Education, contract work period, and experience in different types of nursing units can affect...