G Hatfield is the nursing editor for HealthLeaders   

Nurses want to work with in-house teams that they can rely on, but it’s complicated.

Key takeaways from a leadership perspective, outsourcing is a tool that is used to fill gaps among nursing ranks in order to continue providing patient care. To nurses, outsourcing means a revolving door of staff that are less reliable and potentially less qualified. Outsourcing is an issue that needs to be addressed in order to maintain the relationships between nurses and their health systems.

Across the country, nursing unions are citing compensation, working conditions, and staffing issues- and now most recently, outsourcing—as their reasons to go on strike.

Registered nurses at SMM Health Saint Louis University Hospital have announced that they will hold a two-day strike beginning on December 27 to protest the outsourcing of RN jobs and management’s attempts at union-busting. This announcement was made by the National Nurses Organizing Committee (NNOC) and National Nurses United (NNU) following a vote on December 8 that authorized the nurse bargaining team to call a strike.


Outsourcing is not a new phenomenon in healthcare, according to Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association.

“Leaders opt to outsourcing after doing capital and operational cost analysis if they feel that there is a market for certain talents or expertise and they are unable to compete,” she says.

According to the NNU, SMM Health has been outsourcing nurse positions rather than hiring full-time nurses, which the union believes creates a revolving door of staff that do not become as involved in the surrounding community. This has been a concern throughout the industry during the ongoing nursing shortage, and with turnover rates as high as they are now.


From the CNO perspective, there are two sides to the issue.

“Nurses would rather work with permanent members of the team and not a rotating group of nurses that seemingly have less requirements from a system perspective,” Boston-Leary says. “And that is making more money than them, [and] in some cases have lesser experience.”

On the other hand, outsourcing may sometimes be one of the only available options.

 “Leaders have to maintain operations by utilizing outsourced talent when they are unable to recruit,” Boston-Leary states. “As much as they abhor [the] high labor spend.”

Even without enough nurses, patients still need staff to care for them, and health systems still need to provide the people to do so.

“When you think about it, a nurse can resign [from] a position with as little as two weeks’ notice, but it could take one to three years to replace that nurse,” says Boston-Leary. “In the meantime, emergency and surgical departments are busy and they need staffed beds, which [are] also at a premium.”

The perspective of the nurses at Saint Louis University Hospital who are going on strike is clear. They believe that the ever-changing staff interrupts patient care and will impact the future of their health system for a long time.

“Temporary, outside agency staff should only be used to fill occasional gaps,” said Sarah DeWilde, RN in the medical-surgical unit at SLUH in the NNU statement. “Outsourcing will only exacerbate the current staffing crisis and further erode the quality of patient care for years to come.”