Use of supplemental RNs (SRNs) is common practice among US hospitals to fill gaps in nurse staffing. The objective of this study was to examine the relationship between use of SRNs and patient outcomes. Multilevel modeling was performed to analyze hospital administrative data from 19 hospital units in a large tertiary medical center for the years 2003 to 2006. Patient outcomes included in-hospital mortality, medication errors, falls, pressure ulcers, and patient satisfaction with nurses. Use of SRNs ranged from 0% to 30.4% of total RN hours per unit quarter. Among 188 of the 304 unit quarters in which SRNs were used, the average SRN use was 9.8% in non-ICUs and 6.4% in ICUs. All observed effects of SRN use on patient outcomes were nonsignificant. Use of SRNs was substantial and varied widely by unit. No evidence was found that links SRN use to either adverse or positive patient outcomes.
Author Affiliations: Associate Professor of Nursing, School of Nursing, University of Rochester (Dr Xue), New York; The Claire M. Fagin Leadership Professor of Nursing, Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research, University of Pennsylvania (Dr Aiken), Philadelphia; President and University Professor, Claremont Graduate University (Dr Freund), California; Professor and Chief, Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center (Dr Noyes), New York.
This study was supported by the Robert Wood Johnson Foundation–Interdisciplinary Nursing Quality Research Initiative #62576. Dr Noyes was also supported in part by the University of Rochester CTSA (UL1 RR024160) from the National Center for Research Resources, a component of the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research.
The authors declare no conflicts of interest.
Correspondence: Dr Xue, 601 Elmwood Ave, Box SON, Rochester, NY 14642 (firstname.lastname@example.org).
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