Association Between Nursing Experience and Harm Risk in Paediatric Adverse Nursing Events: Modification by Standard Operating Procedure Accessibility in a Retrospective Cohort Study

AIM: To examine the association between nursing experience and paediatric adverse nursing event (ANE) harm risk, and whether SOP accessibility modifies this association. DESIGN: Retrospective cohort study, 2015-2024. METHODS: We analysed paediatric ANEs reported from 2015 to 2024 at a tertiary children's hospital in western China. The primary outcome was whether an ANE resulted in harm (yes/no). The exposure was years of nursing experience, grouped into five categories (< 1, 1-< 3, 3-< 5, 5-< 10 and ≥ 10 years), and SOP accessibility served as an effect modifier. Multivariable logistic regression models and stratified analysis with interaction tests were applied. RESULTS: Among the 3199 paediatric ANEs, 1341 (41.92%) resulted in harm. Harm risk was highest among nurses with ≥ 10 years of experience (adjusted OR = 1.93, 95% CI: 1.33-2.81 vs. < 1 year), with no significant elevation in the intermediate nurses (1-10 years). SOP accessibility modified this association (p for interaction = 0.004). When SOPs were accessible, the elevated risk in the ≥ 10-year group persisted (adjusted OR = 1.95, 95% CI: 1.33-2.87); when SOPs were inaccessible, it was no longer evident, and a protective association appeared in the 3-< 5-year group (adjusted OR = 0.15, 95% CI: 0.03-0.76). CONCLUSIONS: Nursing experience exhibited nonlinear association with paediatric ANE harm risk, and this relationship was significantly modified by SOP accessibility. Harm risk was highest among nurses with ≥ 10 years of experience. However, given the retrospective observational design, causal inference is precluded, and the underlying mechanisms remain to be elucidated. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.