Temporary Nurse Staffing in the Context of Nursing Shortages: A Narrative Review of Workforce Flexibility, Organizational Trade-Offs, and Patient Safety

Nursing shortages require hospitals to balance staffing adequacy with flexibility in responding to vacancies, fluctuating demand, and unexpected service pressures. This focused narrative review examines temporary nurse staffing in acute hospitals, with primary emphasis on agency, travel, and contract registered nurses, and integrates evidence on workforce demand, operational flexibility, economic and workforce consequences, clinical integration, and patient safety. Evidence was identified through targeted PubMed and Scopus searches, citation tracking, and supplementary literature discovery. Temporary staffing can provide adaptive capacity by redistributing available nursing labor and reducing exposure to unfilled staffing requirements, but it does not eliminate underlying workforce scarcity. The evidence does not support treating temporary nurses as intrinsically less competent or inherently unsafe. Outcomes instead vary with the intensity and persistence of temporary staff use, baseline staffing adequacy, work environment, familiarity with local systems, orientation, and organizational integration. Limited supplementation may be operationally and economically useful in some contexts, whereas recurrent high reliance may increase coordination demands, workforce strain, and costs and may be associated with selected adverse outcomes. Temporary staffing is therefore best evaluated as one component of the overall staffing configuration and against realistic alternatives, including permanent staffing, overtime, flexible internal staffing, reduced capacity, or unresolved understaffing.