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| Outcomes of Nurse Practice EnvironmentsSummaryPrincipal Investigator: Linda Aiken Affiliation: University of Pennsylvania Country: USA Abstract: We seek to develop through a revised competing continuation (NR04513) a greater understanding of the effects of nurse staffing and the nurse practice environment on nurse and patient outcomes by exploiting natural experiments that are anticipated to change staffing and practice environments and exploring the effects of those factors over time, and across different states, using multiple methods and measures. We propose to extend our 1999 study of the outcomes of nurse staffing and nurse practice environments in 182 Pennsylvania hospitals at a second point in time (in 2006) and, in that same year, extend our study to include parallel data from roughly 402 hospitals in California, where mandatory nurse staffing ratio legislation has created the largest natural experiment ever in hospital nurse staffing change. We will also, for all hospitals in both states, and for every year from 1998 to 2007, compile hospital-level data on staffing and hospital-level and patient-level data on mortality and other adverse events. The expanded cross-sectional data for 2006 will enable us to resolve many of the questions involving how best to measure and disentangle the potentially interactive effects of nurse staffing (including nurse education) and nurse practice environments on nurse and patient outcomes. The repeated cross-sectional data from Pennsylvania, and the longitudinal data on staffing and patient outcomes from both states, will provide better evidence for establishing the causal relationships between nurse staffing, nurse education, nurse practice environments, and nurse and patient outcomes, since investigating changes in hospitals over time involves using each hospital as its own control. The use of patient outcomes beyond mortality and failure to rescue will allow us to more completely capture the effects of nurses and nursing on the large number of patients who, while not at great risk of dying, are nonetheless vulnerable to a wide range of unfavorable outcomes. This research has the potential to advance the field of nursing outcomes research and to yield critical insights relevant to stemming the flight of nurses from front line care roles and improving hospital outcomes. Funding Period: 1997-07-15 - 2009-05-31 more information: NIH RePORT Top Publications
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Publications
The relationship between UK hospital nurse staffing and emotional exhaustion and job dissatisfactionLouisa Sheward
University of Paisley
J Nurs Manag 13:51-60. 2005..CONCLUSIONS: Increasing numbers of patients to nurses was associated with increasing risk of emotional exhaustion and dissatisfaction with current job...
[Studies enhance evidence and knowledge]Maria Schubert
, Basel
Krankenpfl Soins Infirm 101:24-5, 56-7, 70-1. 2008- Psychiatric nurse reports on the quality of psychiatric care in general hospitalsNancy P Hanrahan
Center for Health Outcomes and Policy Research, Leonard David Institute of Health Economics, University of Pennsylvania School of Nursing, Philadelphia 19104, USA
Qual Manag Health Care 17:210-7. 2008..Collectively, the results from this study underscore the organizational problems and quality-of-care issues that cause psychiatric nurses in general hospital settings to evaluate their work environments negatively... - Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative dataKoen Van den Heede
Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35 4, Leuven B 3000, Belgium
Int J Nurs Stud 46:928-39. 2009..Studies have linked nurse staffing levels (number and skill mix) to several nurse-sensitive patient outcomes. However, evidence from European countries has been limited... - Failure to rescue in the surgical oncology population: implications for nursing and quality improvementChristopher R Friese
School of Nursing, University of Michigan, Ann Arbor, USA at
Oncol Nurs Forum 35:779-85. 2008..To analyze the frequency, type, and correlates of postoperative complications for surgical patients with cancer to illustrate practical application of the failure to rescue concept in oncology nursing practice... - Effect of nurse staffing and education on the outcomes of surgical patients with comorbid serious mental illnessAnn Kutney-Lee
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Blvd, 3R NEB, Philadelphia, PA 19104 6096, USA
Psychiatr Serv 59:1466-9. 2008.... - Solving nursing shortages: a common priorityJames Buchan
Queen Margaret University, Queen Margaret University Drive, Edinburgh, UK
J Clin Nurs 17:3262-8. 2008..This paper provides a context for this special edition. It highlights the scale of the challenge of nursing shortages, but also makes the point that there is a policy agenda that provides workable solutions... - An international hospital outcomes research agenda focused on nursing: lessons from a decade of collaborationSean P Clarke
Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA 19104 6096, USA
J Clin Nurs 17:3317-23. 2008..To describe the origins, design and outcomes of an international hospital outcomes collaboration focused on nursing issues... - Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitalsMasako Kanai-Pak
University of Arizona, Tucson, AZ, USA
J Clin Nurs 17:3324-9. 2008..To describe nurse burnout, job dissatisfaction and quality of care in Japanese hospitals and to determine how these outcomes are associated with work environment factors... - Transformative impact of Magnet designation: England case studyLinda H Aiken
Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA 19104 6096, USA
J Clin Nurs 17:3330-7. 2008..To test the impact of the implementation of Magnet principles of improving nurses' work environments... - Development of the Hospital Nurse Surveillance Capacity ProfileAnn Kutney-Lee
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104 4217, USA
Res Nurs Health 32:217-28. 2009..Greater nurse surveillance capacity was significantly associated with better quality of care and fewer adverse events. The profile may assist administrators to improve nurse surveillance and patient outcomes... - Competence and certification of registered nurses and safety of patients in intensive care unitsDeborah Kendall-Gallagher
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104 6096, USA
Am J Crit Care 18:106-13; quiz 114. 2009..The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing... - Economics of nursingLinda H Aiken
Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA, USA
Policy Polit Nurs Pract 9:73-9. 2008.... - Effects of hospital care environment on patient mortality and nurse outcomesLinda H Aiken
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19104 6096, USA
J Nurs Adm 38:223-9. 2008..The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education... - The impact of hospital nursing characteristics on 30-day mortalityCarole A Estabrooks
Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
Nurs Res 54:74-84. 2005..The institutional and hospital nursing characteristics explained an additional 36.9%. DISCUSSION: Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients... - Multilevel modeling of a clustered continuous outcome: nurses' work hours and burnoutSunhee Park
School of Nursing, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA 19104, USA
Nurs Res 54:406-13. 2005..Multilevel models were designed to analyze data generated from a nested structure (e.g., nurses within hospitals) because conventional linear regression models underestimate standard errors and, in turn, overestimate test statistics... - Variations in nursing practice environments: relation to staffing and hospital characteristicsEileen T Lake
Department of Sociology, University of Pennsylvania, Philadelphia, PA 19104 6096, USA
Nurs Res 55:1-9. 2006..While improvements in nursing practice environments are considered essential to address the nursing shortage, relatively little is known about the nursing practice environments in most hospitals... - Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge recordsAnne Marie Rafferty
Florence Nightingale School of Nursing and Midwifery, King s College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
Int J Nurs Stud 44:175-82. 2007..Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention... - Sharp-device injuries to hospital staff nurses in 4 countriesSean P Clarke
Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
Infect Control Hosp Epidemiol 28:473-8. 2007..To compare sharp-device injury rates among hospital staff nurses in 4 Western countries... - Hospital work environments, nurse characteristics, and sharps injuriesSean P Clarke
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104 6096, USA
Am J Infect Control 35:302-9. 2007..A growing body of research links working conditions, such as staffing levels and work environment characteristics, with safety for both patients and workers in health care settings, including sharps injuries in hospital staff nurses... - Supplemental nurse staffing in hospitals and quality of careLinda H Aiken
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19104 6096, USA
J Nurs Adm 37:335-42. 2007..To promote evidence-based decision making regarding hospital staffing, the authors examined the characteristics of supplemental nurses, as well as the relationship of supplemental staff to nurse outcomes and adverse events... - New Zealand nurses' reports on hospital care: an international comparisonMary Finlayson
University of Auckland, New Zealand
Nurs Prax N Z 23:17-28. 2007..The implications of these findings are discussed in light of recent changes in the hospital environment... - Hospital nurse practice environments and outcomes for surgical oncology patientsChristopher R Friese
Dana Farber Cancer Institute, Harvard School of Public Health, 44 Binney Street SM 271, Boston, MA 02115, USA
Health Serv Res 43:1145-63. 2008..To examine the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery... - Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes StudyMaria Schubert
Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH 4056 Basel, Switzerland
Int J Qual Health Care 20:227-37. 2008..Rationing was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Additional data were collected using an adapted version of the International Hospital Outcomes Study questionnaire... - The U.S. presidential election and health care workforce policyMatthew D McHugh
University of Pennsylvania, Philadelphia, USA
Policy Polit Nurs Pract 9:6-14. 2008..Three general themes are highlighted for their implications on the physician and nurse workforce supply, including (a) expansion of health care coverage, (b) workforce investment, and (c) cost control and quality improvement... - Factor structure of the Maslach burnout inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countriesLusine Poghosyan
Bouve College of Health Sciences, School of Nursing and School of Health Professions Masters of Public Health MPH, Northeastern University, 103 Robinson Hall, 360 Huntington Avenue, Boston, MA 02115 5000, USA
Int J Nurs Stud 46:894-902. 2009..Job burnout is an important predictor of nurse retention. Reliable and valid measures are required to monitor this phenomenon internationally...