Volume 48 | Number 3 | June 2013

Abstract List

Linda H. Aiken Ph.D., R.N., Jingjing Shang, Ying Xue, Douglas M. Sloane Ph.D.


To determine the association between the use of agency‐employed supplemental registered nurses (s) to staff hospitals and patient mortality and failure to rescue ().

Data Sources

Primary survey data from 40,356 registered nurses in 665 hospitals in four states in 2006 were linked with merican ospital ssociation and inpatient mortality data from state agencies for approximately 1.3 million patients.

Study Design

Logistic regression models were used to examine the association between use and 30‐day in‐hospital mortality and , controlling for patient and hospital characteristics, nurse staffing, the proportion of nurses with bachelor's degrees, and quality of the work environment.

Principal Findings

Before controlling for multiple nurse characteristics of hospitals, higher proportions of agency‐employed s in hospitals appeared to be associated with higher mortality ( = 1.06) and ( = 1.05). Hospitals with higher proportions of s have poorer work environments, however, and the significant relationships between s and mortality outcomes were rendered insignificant when work environments were taken into account.


Higher use of s does not appear to have deleterious consequences for patient mortality and may alleviate nurse staffing problems that could produce higher mortality.