Using supplemental nurses is not bad for patients

The use of supplemental registered nurses (SRNs) to cover staffing shortages has no adverse effects on patient outcomes including in-hospital mortality, medication errors, falls, pressure ulcers, and patient satisfaction with nurses, show US study results.

The findings account for nursing work environment (NWE), a major factor in the promotion of quality patient care, with better NWEs linked to "higher nurse-to-patient ratios and better patient outcomes," say Ying Xue (University of Rochester, New York) and colleagues.

The lack of association between SRN use and patient outcomes "has relevance for future nursing workforce development and policy," writes the team in the Journal of Nursing Administration, since "future hospital use of SRNs is expected to rise with projected future nursing shortages."

The study examined quarterly data from 19 hospital units from 2003 through 2006, including four intensive care units (ICUs) and four medical, seven surgical, and four step-down non-ICUs.

Data for patient mortality, medication errors, and falls were obtained from a national hospital database, while data for pressure ulcers were gained from the National Database of Nursing Quality Indicators, and patient satisfaction was measured via the Press Ganey satisfaction survey.

SRN use varied greatly according to unit, remark Xue and co-authors, ranging from 0.2% to 30.4% in the 18 hospital units that used them. Similarly, SRN use as a proportion of total RN hours ranged from 0.0% to 30.4% per unit quarter.

"These variations indicate that some units have consistently more vacant positions compared with other units, and some units had more vacant positions at a single time," notes the research team.

Overall, almost two-thirds of unit quarters in the study used SRNs, at 61.8%, and of these, average ICU and non-ICU use was 9.8% and 6.4%, respectively.

Despite these variations, the researchers observed no significant adverse (or positive) effects of SRN use on patient outcomes after multilevel modeling, even after adjustment for patient characteristics (including age and gender), availability of a rapid response team (which has been shown to reduce preventable deaths), and nurse staffing and unit characteristics (including NWEs).

"Future studies are needed to further explore the role of organizational and unit characteristics on SRN use and the relationship between the use of different types of SRNs on patient outcomes across a variety of hospital settings," conclude Xue et al.

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