University of Florida College of Nursing, Health Professions, Nursing and Pharmacy Complex, PO Box 100187, Gainesville, FL 32610-1087, USA.
Int J Qual Health Care. 2013 Sep;25(4):366-72. doi: 10.1093/intqhc/mzt042. Epub 2013 Jun 4.
To determine whether, and under what circumstance, US hospital employment of non-US-educated nurses is associated with patient outcomes.
Observational study of primary data from 2006 to 2007 surveys of hospital nurses in four states (California, Florida, New Jersey and Pennsylvania). The direct and interacting effects of hospital nurse staffing and the percentage of non-US-educated nurses on 30-day surgical patient mortality and failure-to-rescue were estimated before and after controlling for patient and hospital characteristics.
Data from registered nurse respondents practicing in 665 hospitals were pooled with patient discharge data from state agencies.
MAIN OUTCOMES MEASURE(S): Thirty-day surgical patient mortality and failure-to-rescue.
The effect of non-US-educated nurses on both mortality and failure-to-rescue is nil in hospitals with lower than average patient to nurse ratios, but pronounced in hospitals with average and poor nurse to patient ratios. In hospitals in which patient-to-nurse ratios are 5:1 or higher, mortality is higher when 25% or more nurses are educated outside of the USA than when <25% of nurses are non-US-educated. Moreover, the effect of having >25% non-US-educated nurses becomes increasingly deleterious as patient-to-nurse ratios increase beyond 5:1.
Employing non-US-educated nurses has a negative impact on patient mortality except where patient-to-nurse ratios are lower than average. Thus, US hospitals should give priority to achieving adequate nurse staffing levels, and be wary of hiring large percentages of non-US-educated nurses unless patient-to-nurse ratios are low.
确定美国医院雇用非美国教育背景护士是否与患者结局相关，以及在何种情况下相关。
对来自四个州（加利福尼亚州、佛罗里达州、新泽西州和宾夕法尼亚州）2006 年至 2007 年医院护士调查的原始数据进行观察性研究。在控制患者和医院特征之前和之后，估计医院护士配置和非美国教育背景护士比例对 30 天手术患者死亡率和抢救失败的直接和相互作用影响。
将在 665 家医院执业的注册护士应答者的数据与来自州机构的患者出院数据合并。
30 天手术患者死亡率和抢救失败。
在患者与护士比例低于平均水平的医院中，非美国教育背景护士对死亡率和抢救失败的影响为零，但在患者与护士比例为平均水平和较差水平的医院中，影响显著。在患者与护士比例为 5:1 或更高的医院中，当 25%或更多的护士接受美国以外的教育时，死亡率高于当 <25%的护士接受非美国教育时。此外，随着患者与护士比例超过 5:1，拥有 >25%非美国教育背景护士的效果变得越来越有害。
雇用非美国教育背景护士对患者死亡率有负面影响，除非患者与护士比例低于平均水平。因此，美国医院应优先考虑达到足够的护士配置水平，并在患者与护士比例较低的情况下谨慎雇用高比例的非美国教育背景护士。
