title: Hospital use of agency-employed supplemental nurses and patient mortality and failure to rescue.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA 19104, USA. laiken@nursing.upenn.edu
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
authors.forename: Jingjing
authors.initials: J
authors.lastname: Shang
authors.forename: Ying
authors.initials: Y
authors.lastname: Xue
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Sloane
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004777:Environment; D005260:Female; D006739:Hospital Administration; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D044469:Racial Groups; D016896:Treatment Outcome; D014481:United States