School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA 19104, USA.
Health Serv Res. 2013 Jun;48(3):931-48. doi: 10.1111/1475-6773.12018. Epub 2012 Dec 6.
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.
确定代理雇佣补充注册护士（SRN）来配置医院与患者死亡率和未能抢救（FTR）之间的关系。
2006 年，从四个州的 665 家医院的 40356 名注册护士中获取了初步调查数据，并与美国医院协会和州机构的住院患者死亡率数据进行了关联，涉及约 130 万名患者。
使用逻辑回归模型来检验 SRN 使用与 30 天住院死亡率和 FTR 之间的关系，同时控制患者和医院特征、护士配置、拥有学士学位的护士比例以及工作环境质量。
在未控制多个医院护士特征的情况下，医院中代理雇佣的 SRN 比例较高似乎与更高的死亡率（OR=1.06）和 FTR（OR=1.05）相关。然而，拥有更高比例 SRN 的医院工作环境较差，而当考虑工作环境时，SRN 与死亡率结果之间的显著关系变得不显著。
更高的 SRN 使用似乎不会对患者死亡率产生有害影响，并且可能缓解可能导致更高死亡率的护士人员配备问题。
