Outcomes of Nurse Practice Environments

Summary

Principal 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

  1. ncbi The relationship between UK hospital nurse staffing and emotional exhaustion and job dissatisfaction
    Louisa Sheward
    University of Paisley
    J Nurs Manag 13:51-60. 2005
  2. ncbi [Studies enhance evidence and knowledge]
    Maria Schubert
    , Basel
    Krankenpfl Soins Infirm 101:24-5, 56-7, 70-1. 2008
  3. ncbi Psychiatric nurse reports on the quality of psychiatric care in general hospitals
    Nancy 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
  4. ncbi Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data
    Koen 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
  5. ncbi Failure to rescue in the surgical oncology population: implications for nursing and quality improvement
    Christopher R Friese
    School of Nursing, University of Michigan, Ann Arbor, USA at
    Oncol Nurs Forum 35:779-85. 2008
  6. ncbi Effect of nurse staffing and education on the outcomes of surgical patients with comorbid serious mental illness
    Ann 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
  7. ncbi Solving nursing shortages: a common priority
    James Buchan
    Queen Margaret University, Queen Margaret University Drive, Edinburgh, UK
    J Clin Nurs 17:3262-8. 2008
  8. ncbi An international hospital outcomes research agenda focused on nursing: lessons from a decade of collaboration
    Sean P Clarke
    Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA 19104 6096, USA
    J Clin Nurs 17:3317-23. 2008
  9. ncbi Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals
    Masako Kanai-Pak
    University of Arizona, Tucson, AZ, USA
    J Clin Nurs 17:3324-9. 2008
  10. ncbi Transformative impact of Magnet designation: England case study
    Linda H Aiken
    Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA 19104 6096, USA
    J Clin Nurs 17:3330-7. 2008

Scientific Experts

Detail Information

Publications26

  1. ncbi The relationship between UK hospital nurse staffing and emotional exhaustion and job dissatisfaction
    Louisa 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...
  2. ncbi [Studies enhance evidence and knowledge]
    Maria Schubert
    , Basel
    Krankenpfl Soins Infirm 101:24-5, 56-7, 70-1. 2008
  3. ncbi Psychiatric nurse reports on the quality of psychiatric care in general hospitals
    Nancy 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...
  4. ncbi Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data
    Koen 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...
  5. ncbi Failure to rescue in the surgical oncology population: implications for nursing and quality improvement
    Christopher 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...
  6. ncbi Effect of nurse staffing and education on the outcomes of surgical patients with comorbid serious mental illness
    Ann 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
    ....
  7. ncbi Solving nursing shortages: a common priority
    James 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...
  8. ncbi An international hospital outcomes research agenda focused on nursing: lessons from a decade of collaboration
    Sean 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...
  9. ncbi Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals
    Masako 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...
  10. ncbi Transformative impact of Magnet designation: England case study
    Linda 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...
  11. ncbi Development of the Hospital Nurse Surveillance Capacity Profile
    Ann 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...
  12. ncbi Competence and certification of registered nurses and safety of patients in intensive care units
    Deborah 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...
  13. ncbi Economics of nursing
    Linda H Aiken
    Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA, USA
    Policy Polit Nurs Pract 9:73-9. 2008
    ....
  14. ncbi Effects of hospital care environment on patient mortality and nurse outcomes
    Linda 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...
  15. ncbi The impact of hospital nursing characteristics on 30-day mortality
    Carole 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...
  16. ncbi Multilevel modeling of a clustered continuous outcome: nurses' work hours and burnout
    Sunhee 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...
  17. ncbi Variations in nursing practice environments: relation to staffing and hospital characteristics
    Eileen 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...
  18. ncbi Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records
    Anne 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...
  19. ncbi Sharp-device injuries to hospital staff nurses in 4 countries
    Sean 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...
  20. ncbi Hospital work environments, nurse characteristics, and sharps injuries
    Sean 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...
  21. ncbi Supplemental nurse staffing in hospitals and quality of care
    Linda 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...
  22. ncbi New Zealand nurses' reports on hospital care: an international comparison
    Mary 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...
  23. ncbi Hospital nurse practice environments and outcomes for surgical oncology patients
    Christopher 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...
  24. ncbi Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study
    Maria 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...
  25. ncbi The U.S. presidential election and health care workforce policy
    Matthew 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...
  26. ncbi Factor structure of the Maslach burnout inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countries
    Lusine 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...