title: Supplemental nurse staffing in hospitals and quality of care.
abstract: OBJECTIVE
  To promote evidence-based decision making regarding hospital staffing, the authors examined the characteristics of supplemental nurses, as well as the relationship of supplemental staff to nurse outcomes and adverse events.
  
  
  BACKGROUND
  The use of supplemental nurses to bolster permanent nursing staff in hospitals is widespread but controversial. Quality concerns have been raised regarding the use of supplemental staff.
  
  
  METHODS
  Data from the 2000 National Sample Survey of Registered Nurses were used to determine whether the qualifications of supplemental nurses working in hospitals differed from permanent staff nurses. Data from Pennsylvania nurse surveys were analyzed to examine whether nurse outcomes and adverse events differed in hospitals with varying proportions of nonpermanent nurses.
  
  
  RESULTS
  Temporary nurses have qualifications similar to permanent staff nurses. Deficits in patient care environments in hospitals employing more temporary nurses explain the association between poorer quality and temporary nurses.
  
  
  CONCLUSIONS
  Negative perceptions of temporary nurses may be unfounded.
authors.affiliation: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19104-6096, USA. laiken@nursing.upenn.edu
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
authors.forename: Ying
authors.initials: Y
authors.lastname: Xue
authors.forename: Sean P
authors.initials: SP
authors.lastname: Clarke
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Sloane
mesh_terms: D000328:Adult; D003659:Decision Making, Organizational; D005260:Female; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000592:standards / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010414:Pennsylvania; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D012308:Risk Management; D014481:United States