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Columbia study says agency nurses take unfair share of blame

Monday March 11, 2013
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The use of agency nurses to supplement staff is not connected to poor patient outcomes, according to researchers from the Columbia University School of Nursing.

Researchers from Columbia suggest agency nurses are being blamed unfairly, according to the article titled "Hospital Use of Agency-Employed Supplemental Nurses and Patient Mortality and Failure to Rescue."

The study reveals that the seemingly negative effect of agency-employed supplemental nurses on patient outcomes may have less to do with characteristics of the supplemental nurses than with hospital work environments.

"Our findings suggest that deficient hospital work environments may be the explanation of poor patient outcomes associated with higher use of supplemental registered nurses rather than anything about the nurses themselves," Jing Jing Shang, RN, PhD, the Columbia nursing researcher heading the project, said in a news release.

The research team examined survey data from more than 40,000 RNs in 665 hospitals across the country treating more than one million patients.

Researchers initially found that higher proportions of agency-employed supplemental RNs appeared to be associated with higher mortality and failure to rescue. But when the data was adjusted to control for the quality of hospital work environments, the association between adverse outcomes and agency-employed nurses were rendered insignificant.

The research was published in the December issue of the journal Health Services Research.

Among the factors contributing to the evaluation of the hospital environment were how much nurses participated in hospital affairs, nurse manager ability, leadership and support of nurses, nurse/physician relations, nurse/patient staffing ratio, and how much educational assistance the hospital provided to agency nurses.

"When all of the nursing factors are controlled, the effect of supplemental registered nurse use is ... quite likely negligible, on both mortality and failure to rescue," the report concluded, according to a news release.

Shang added: "Hospitals with poor work environments have trouble recruiting and retaining permanent staff nurses and tend to rely on [agency nurses] to fill vacancies. [The agency nurses] are then unfairly blamed for lowering patient outcomes when they are also the victims of the same poor work environment. Hospital executives and managers should take steps to evaluate whether the work environments in their institutions are adversely impacting their success in attracting and retaining qualified permanent nurses, as well as improving patient outcomes."


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