• Posted April 4, 2025

Bedsores More Likely In Short-Staffed Hospitals Leaning On Nurse OT, Travel Nurses

Hospitals could be short-changing patients if they lean too heavily on nurse staffing agencies or overtime hours, a new study says.

Patients are much more likely to develop bedsores at short-staffed hospitals that regularly bring in travel nurses or require nurses to work overtime, researchers reported in JAMA Network Open.

“Our study shows that when hospitals over rely on travel nurses or overtime for the regular nursing staff, patient safety care may be compromised,” lead researcher Patricia Pittman said in a news release. She's director of the Fitzhugh Mullan Institute for Health Workforce Equity at the George Washington University Milken Institute School of Public Health.

“Hospitals that want to improve safety should closely track their reliance on overtime and especially nurse staffing agencies,” Pittman added.

Bedsores, a key patient safety indicator, develop when pressure cuts off blood flow to the skin, researchers said in background notes. They are also called pressure ulcers.

About 2.5 million cases of bedsores happen each year in the U.S., resulting in as many as 60,000 deaths, researchers said.

Adequate levels of nursing care can prevent these potentially dangerous wounds from developing, by paying attention to patients and regularly shifting their position in bed, researchers said.

For this study, researchers tracked data on 70 U.S. hospitals from 2019 through 2022, looking at nurse overtime, use of agency nurses and rates of pressure ulcers.

Previous studies have reported that use of travel nurses doubled during the COVID-19 pandemic and overtime increased by more than half, as hospitals struggled during surges caused by local outbreaks, researchers said.

Results showed that for every 10% increase in nurse overtime, there was a 0.8% increase in risk of bedsores at a hospital.

Likewise, for every 10% increase in travel nurse care, there was a 0.7% increase in bedsore risk, researchers reported.

More than half the hospitals in the study used more nurse overtime and nurse agency staffing than was safe, resulting in higher rates of pressure ulcers compared to hospitals that relied less often on those measures, researchers said.

Overall, the hospitals in the study were 140% over the safe threshold for pressure ulcer risk when it came to use of travel nurses, representing a more than 6% increased risk for bedsores among patients, researchers concluded.

The hospitals also were nearly 64% over the safe threshold for nurse overtime, representing a 2% increased risk for bedsores.

“These findings suggest that excessive use of overtime and agency nurse hours is associated with increased rates of pressure ulcers,” researchers concluded.

Hospitals sometimes have no other option, particularly during a health crisis, but researchers argue that relying too heavily on these measures risks patient health.

“The hotly debated policy question of the day is what role state and federal payers and regulators could play in incentivizing hospitals to prioritize regular staff over alternative staffing strategies,” researchers wrote.

“Some states prohibit mandatory overtime, and the American Nurses Association now advocates for federal or state legislative guardrails on overall staffing levels,” the researchers continued. “Others contend that the Centers for Medicare & Medicaid Services should mandate minimum staffing levels as a prerequisite for licensing hospitals receiving Medicare payments, mirroring the approach already implemented for nursing homes.”

More information

The Mayo Clinic has more on bedsores.

SOURCES: JAMA Network Open, April 2, 2025; George Washington University, news release, April 2, 2025