Associations Between Specialty Registered Nurse Certification and Patient Outcomes: A Nurse–Patient Level Analysis

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Abstract
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 patient data to nurses providing their care across four hospitals (42,078 patients; 2,683 nurses). Mixed-effects regression models examined associations between specialty-certified RN care and outcomes, adjusting for patient and nurse characteristics.Findings: Twenty-seven percent of an average patient’s care was delivered by specialty-certified RNs. Greater exposure to specialty-certified-RN care was associated with lower odds of in-hospital mortality, pressure injury, urinary catheter-associated bacteriuria, and central line–associated bloodstream bacteremia, independent of BSN-or-higher–prepared RN care.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.