Hospital Use of Agency-Employed Supplemental Nurses and Patient Mortality and Failure to Rescue
Article first published online: 6 DEC 2012
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 3, pages 931–948, June 2013
How to Cite
Aiken, L. H., Shang, J., Xue, Y. and Sloane, D. M. (2013), Hospital Use of Agency-Employed Supplemental Nurses and Patient Mortality and Failure to Rescue. Health Services Research, 48: 931–948. doi: 10.1111/1475-6773.12018
- Issue published online: 9 MAY 2013
- Article first published online: 6 DEC 2012
- National Institute of Nursing Research
- National Institutes of Health. Grant Numbers: R01NR04513, T32NR0714
- American Nurses Foundation
- American Staffing Association Foundation
- Supplemental nurses;
- hospital mortality;
- failure to rescue
To determine the association between the use of agency-employed supplemental registered nurses (SRNs) to staff hospitals and patient mortality and failure to rescue (FTR).
Primary survey data from 40,356 registered nurses in 665 hospitals in four states in 2006 were linked with American Hospital Association and inpatient mortality data from state agencies for approximately 1.3 million patients.
Logistic regression models were used to examine the association between SRN use and 30-day in-hospital mortality and FTR, controlling for patient and hospital characteristics, nurse staffing, the proportion of nurses with bachelor's degrees, and quality of the work environment.
Before controlling for multiple nurse characteristics of hospitals, higher proportions of agency-employed SRNs in hospitals appeared to be associated with higher mortality (OR = 1.06) and FTR (OR = 1.05). Hospitals with higher proportions of SRNs have poorer work environments, however, and the significant relationships between SRNs and mortality outcomes were rendered insignificant when work environments were taken into account.
Higher use of SRNs does not appear to have deleterious consequences for patient mortality and may alleviate nurse staffing problems that could produce higher mortality.