David Ryamukuru, Lara Khadr, Kathryn A. Lee, Deanna Marriott, Thủy Nguyễn, Rhonda Schoville, Geoffrey J. Hoffman, Ronda Hughes, Deena Kelly Costa, Marianne Weiss, Olga Yakusheva
BACKGROUND: Specialty registered nurse (RN) certification signifies advanced clinical expertise, yet evidence linking certified RNs providing direct patient care to outcomes is lacking. PURPOSE: To examine the association between specialty RN certification and patient outcomes and the moderating effect of nurses' formal education level. METHODS: A retrospective observational study linked individual patient data to nurses providing their care across four hospitals (42,078 patients; 2,683 nurses). Mixed-effects regression models examined associations between the proportion of specialty-certified RN care and outcomes, adjusting for patient and nurse characteristics. DISCUSSION: Specialty RN certification is associated with better patient outcomes. Organizations should prioritize supporting, incentivizing, and retaining specialty-certified RNs to improve patient outcomes and reduce the costs of preventable complications. CONCLUSION: A higher proportion of care delivered by specialty-certified RNs was associated with improved patient outcomes, independent of nurses' education level. Supporting and expanding specialty RN certification may be an effective strategy to strengthen clinical expertise and enhance patient care quality and safety in hospital settings.