Linda H Aiken's research while affiliated with University of Pennsylvania and other places

Publications (344)

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Background Depression is common, costly, and has deleterious effects in older adult surgical patients. Little research exists examining older adult surgical patient outcomes and depression and the potential for nursing factors to affect these outcomes. The purpose of this study was to determine the relationship between hospital nursing resources, 3...
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Introduction The increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the wel...
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Importance: Sepsis is a major physiologic response to infection that if not managed properly can lead to multiorgan failure and death. The US Centers for Medicare & Medicaid Services (CMS) requires that hospitals collect data on core sepsis measure Severe Sepsis and Septic Shock Management Bundle (SEP-1) in an effort to promote the early recogniti...
Preprint
Background: Depression is common, costly, and has deleterious effects in older adult surgical patients. Little research exists examining older adult surgical patient outcomes and depression and the potential for nursing factors to affect these outcomes. The purpose of this study was to determine the relationship between hospital nursing resources,...
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Background The COVID-19 pandemic has stimulated interest in potential policy solutions to improve working conditions in hospitals and nursing homes. Policy action in the pandemic recovery period must be informed by pre-pandemic conditions. Purpose To describe registered nurses’ (RNs’) working conditions, job outcomes, and measures of patient safet...
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Background Deployment of nurse practitioners (NPs) to health professional shortage areas (HPSA) may help to address challenges in patient access to care. However, restrictive scope of practice imposed by regulatory and state legislative bodies or unsupportive organizational climates in clinical practice settings may constrain NP care delivery and p...
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Objectives Sepsis is a serious inflammatory response to infection with a high death rate. Timely and effective treatment may improve sepsis outcomes resulting in mandatory sepsis care protocol adherence reporting. How the impact of patient-to-nurse staffing compares to sepsis protocol compliance and patient outcomes is not well understood. This stu...
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The US is experiencing a shortage of primary care providers, which could be reduced by the addition of nurse practitioners. However, the ability to increase the supply of nurse practitioners is limited by a shortage of clinical preceptors. The Affordable Care Act's Graduate Nurse Education Demonstration provided federal funding to offset the clinic...
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Objective To evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals. Design Cross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data. Settin...
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Background In 2010, the IOM recommended an increase in the proportion of bachelor's-prepared (BSN) nurses to 80% by 2020. This goal was largely based on evidence linking hospitals with higher proportions of BSN nurses to better patient outcomes. Though, evidence is lacking on whether outcomes differ by a hospital's composition of initial BSN and tr...
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Despite concerted research and clinical efforts, sepsis remains a common, costly, and often fatal occurrence. Little evidence exists for the relationship between institutional nursing resources and the incidence and outcomes of sepsis after surgery. The objective of this study was to examine whether hospital nursing resource quality is associated w...
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Introduction: Substantial research over several decades has documented high burnout rates among hospital nurses globally. However, improvements in nurses' work environments to reduce burnout have been lacking. The Covid-19 pandemic has generated renewed interest in how to reduce nurse burnout. Aims: To determine the extent to which high burnout...
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Aims and Objectives To characterise the problem of missed nursing care in Chilean hospitals and to test associations with hospital organisational variables. Background Missed nursing care is a common problem in different countries, but it has not been studied in Chile. Design Multihospital cross-sectional study (Supplementary file 1: STROBE guide...
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Background: Racial minorities are disproportionately affected by stroke, with Black patients experiencing worse post-stroke outcomes than White patients. A modifiable aspect of acute stroke care delivery not yet examined is whether disparities in stroke outcomes are related to hospital nurse staffing levels. Objectives: To determine whether 7- a...
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Background: Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown. Objective: The objective of this study was to determine whether the presence of more NPs produces better inpatient outcom...
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Background Unrest in Chile over inequalities has underscored the need to improve public hospitals. Nursing has been overlooked as a solution to quality and access concerns, and nurse staffing is poor by international standards. Using Chile's new diagnosis-related groups system and surveys of nurses and patients, we provide information to policy mak...
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This study uses data from two cross-sections in time (2006, 2016) to determine whether changes over time in hospital employment of bachelor's of science in nursing (BSN) nurses is associated with changes in patient outcomes. Data sources include nurse survey data, American Hospital Association Annual Survey data, and patient administrative claims d...
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Background Substantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient rati...
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Objective: The aim of this study was to determine whether there are modifiable characteristics of nurses and hospitals associated with nurse specialty certification. Background: Hospitals, nurses, and patients benefit from nurse specialty certification, but little actionable evidence guides administrators seeking higher hospital certification ra...
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Background: Electronic health record (EHR) usability issues represent an emerging threat to the wellbeing of nurses and patients; however, few large studies have examined these relationships. Objective: To examine associations between EHR usability and nurse job (burnout, job dissatisfaction, and intention to leave) and surgical patient (inpatie...
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Stroke is among the most common reasons for disability and death. Avoiding readmissions and long lengths of stay among ischemic stroke patients has benefits for patients and health care systems alike. Although reduced readmission rates among a variety of medical patients have been associated with better nurse work environments, it is unknown how th...
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Background: The Safe Staffing for Quality Care Act under consideration in the New York (NY) state assembly would require hospitals to staff enough nurses to safely care for patients. The impact of regulated minimum patient-to-nurse staffing ratios in acute care hospitals in NY is unknown. Objectives: To examine variation in patient-to-nurse staf...
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Background: Burnout remains a persistent issue affecting nurses across the US health system. Limited evidence exists about the direct impact of nurse burnout on patient outcomes. This study explores the relationship between nurse burnout and mortality, failure to rescue, and length of stay, while also considering the effect of a good work environm...
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Background Despite nurses’ responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis. Methods Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a la...
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Background: Racial disparities in survival among patients who had an in-hospital cardiac arrest (IHCA) have been linked to hospital-level factors. Objectives: To determine whether nurse staffing is associated with survival disparities after IHCA. Research design: Cross-sectional data from (1) the American Heart Association's Get With the Guide...
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Aims and objectives To evaluate differences in hospitals’ proportion of specialty certified nurses and to determine whether and to what extent individual nurse characteristics and organisational hospital characteristics are associated with a nurse's likelihood of having specialty certification. Background Prior research has shown that patients in...
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Background: International evidence shows that there are organizational factors and nurse job outcomes that may negatively affect healthcare quality. Aim: To measure and analyze associations between nurse organizational factors, such as staffing ratios and skill mix, and job outcomes in public hospitals in Chile. Material and Methods: An observati...
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Objectives: To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses. Design: Analysis of cross-sectiona...
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Aim To describe nurses’ reported missed nursing care activities among hospitalized adult patients medical and surgical wards and explore gaps in service provision. Background In 2015, Italy replicated the RN4CAST study, which heralded the exposition of missed care as an international phenomenon. In Italy nurse‐patient workload is high, with high l...
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Background Nursing resources, such as staffing ratios and skill mix, vary across hospitals. Better nursing resources have been linked to better patient outcomes but are assumed to increase costs. The value of investments in nursing resources, in terms of clinical benefits relative to costs, is unclear.Objective To determine whether there are differ...
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Introduction Efforts to enact nurse staffing legislation often lack timely, local evidence about how specific policies could directly impact the public’s health. Despite numerous studies indicating better staffing is associated with more favourable patient outcomes, only one US state (California) sets patient-to-nurse staffing standards. To inform...
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The complexity of modern burn care requires an integrated team of specialty providers working together to achieve the best possible outcome for each burn survivor. Nurses are central to many aspects of a burn survivor’s care, including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabi...
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Objectives: The purpose of this study was to evaluate quality and safety of care in acute pediatric settings from the perspectives of nurses working at the bedside and to investigate hospital-level factors associated with more favorable quality and safety. Methods: Using data from a large survey of registered nurses in 330 acute care hospitals,...
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Background There are known clinical benefits associated with investments in nursing. Less is known about their value. Aims To compare surgical patient outcomes and costs in hospitals with better versus worse nursing resources and to determine if value differs across these hospitals for patients with different mortality risks. Methods Retrospectiv...
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Introduction The complexity of modern burn care requires an integrated team of clinicians working together to achieve the best possible outcome for each survivor. Nurses are central to many aspects of a burn survivor’s care including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabili...
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A lack of organizational supports in clinical settings may prevent nurse practitioners (NPs) from providing patient-centered care. Using a cross-sectional survey design, data were collected from NPs in 1,571 practices across 4 states to investigate clinical practice environments and the extent to which they are associated with NP integration of pat...
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Background: Burnout among nurses is associated with lower patient satisfaction, yet few system-level solutions have been identified to improve outcomes. Purpose: The purpose of this study was to examine the relationship between nurse burnout and patient satisfaction and determine whether work environments are associated with these outcomes. Met...
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Background: The Graduate Nurse Education (GNE) Demonstration seeks to increase the number of advanced practice registered nurses (APRNs) in clinical practice. With the overall increase in APRN programs and, particularly, enrollment in nurse practitioner (NP) programs, there is growing competition among students to secure quality clinical preceptin...
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The objective of this cross-sectional study was to examine the relationships between work environment, care quality, registered nurse (RN) burnout, and job dissatisfaction in nursing homes. We linked 2015 RN4CAST-US nurse survey data with LTCfocus and Nursing Home Compare. The sample included 245 Medicare and Medicaid-certified nursing homes in fou...
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In 2010, prompted by compelling evidence that demonstrated better patient outcomes in hospitals with higher percentages of nurses with a bachelor of science in nursing (BSN), the Institute of Medicine recommended that 80 percent of the nurse workforce be qualified at that level or higher by 2020. Using data from the American Heart Association's Get...
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Background: Rigorous measurement of organizational performance requires large, unbiased samples to allow inferences to the population. Studies of organizations, including hospitals, often rely on voluntary surveys subject to nonresponse bias. For example, hospital administrators with concerns about performance are more likely to opt-out of surveys...
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Objectives: To examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes. Design: Cross-sectional secondary analysis of linked data from the 2015 RN4CAST-US nurse survey and LTCfocus. Setting: A total of 540 Medicare- and Medicaid-certified nursing homes in California, Florida, New Je...
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Introduction The current shortage of physicians in the United States has potential to dramatically limit access to healthcare. Nurse practitioners (NPs) can provide a cost-effective solution to the shortage, yet few states allow NPs to practice independently. Purpose The purpose of this study was to provide an up-to-date description of the NP work...
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Background Despite evidence suggesting higher quality and safer care in hospitals with comprehensive electronic health record (EHR) systems, factors related to advanced system usability remain largely unknown, particularly among nurses. Little empirical research has examined sociotechnical factors, such as the work environment, that may shape the r...
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Introduction: The ongoing challenge for Chilean hospitals of meeting population health needs merits attention to the health care workforce. No studies have explored how nursing might contribute to addressing this challenge. International research shows that organizational characteristics of the nursing workforce and practice environment are associ...
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Objectives The purpose of this study is twofold: (1) to describe the quality of end‐of‐life care in US hospitals from the perspective of hospital nurses; and (2) to evaluate the relationship between the nurse practice environment and end‐of‐life care quality. Design Cross‐sectional analysis of multiple linked secondary data sources. PARTICIPANTS...
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Objectives: Eighteen years ago, the Institute of Medicine estimated that medical errors in hospital were a major cause of mortality. Since that time, reducing patient harm and improving the culture of patient safety have been national health care priorities. The study objectives were to describe the current state of patient safety in pediatric acu...
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The Institute of Medicine concluded in To Err Is Human in 1999 that transformation of nurse work environments was needed to reduce patient harm. We studied 535 hospitals in four large states at two points in time between 2005 and 2016 to determine the extent to which their work environments improved, and whether positive changes were associated wit...
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Background: Evidence shows hospitals with better nursing resources have better outcomes but few studies have shown that outcomes change over time within hospitals as nursing resources change. Objectives: To determine whether changes in nursing resources over time within hospitals are related to changes in quality of care and patient safety. Res...
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Despite decades of public and private investment, the United States continues to have a shortage of primary care capacity. Only 2699 graduating U.S. medical students - about 17% of graduates from allopathic and osteopathic schools - matched with primary care residencies in 2016.1 Studies show that nurse practitioners (NPs) provide highquality prima...
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Background: Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention. Purpose: Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings. Methods: A secondary analysis of linked cross...
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RN4CAST-Chile builds upon two decades of global nursing outcomes research and the successful implementation of the RN4CAST study in 30 countries around the world to replicate this research for the first time in South America. Over 70 scientific papers in leading nursing and interdisciplinary journals have resulted just from the RN4CAST-EU study, ma...
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Introduction For over half a century, hospitals in the United States have actively recruited foreign-educated nurses (FENs) in response to nurse shortages in hospitals and nursing homes. Little attention has been paid to the quality of care in the United States related to employment of FENs. Aims The purpose of this retrospective study was to dete...
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Objectives To inform healthcare workforce policy decisions by showing how patient perceptions of hospital care are associated with confidence in nurses and doctors, nurse staffing levels and hospital work environments. Design Cross-sectional surveys of 66 348 hospital patients and 2963 inpatient nurses. Setting Patients surveyed were discharged i...
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Some authors argue that it is not longer ethically correct to expose hospitalized patients to death risks associated with understaffing (Nickitas, 2014). Also the Care Quality Commission (CQC, an independent regulator of all health and social care services in England) has included staffing levels as one of the auditing quality standards when inspec...
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Background: Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Aim: Examine if miss...
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Objectives: A growing literature suggests that missed nursing care is common in hospitals and may contribute to poor patient outcomes. There has been scant empirical evidence in pediatric populations. Our objectives were to describe the frequency and patterns of missed nursing care in inpatient pediatric settings and to determine whether missed nu...
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Background: There are two largely distinct research literatures on the association of the nurse work environment and the safety climate on patient outcomes. Objective: To determine whether hospital safety climate and work environment make comparable or distinct contributions to patient mortality. Design: Cross-sectional secondary analysis of l...
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Background Unlike the Magnet® Recognition Program, the newer Pathway to Excellence® Program designed to improve work environments in a broader range of organizations has not yet been the focus of substantial research. Purpose To examine the association of Pathway to Excellence Program Standards with better patient care quality and workforce outcom...
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Safety net settings care for a disproportionate share of low-resource patients often have fewer resources to invest in nursing research. To address this dilemma, an academic-clinical partnership was formed in an effort to increase nursing research capacity at a safety net setting. Penn Presbyterian Medical Center and the Center for Health Outcomes...
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New research reports a link, but the underlying mechanism remains unclear
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Many countries, including Israel, face health workforce challenges to meet the needs of their citizens, as chronic conditions increase. Provider shortages and geographical maldistribution are common. Increasing the contribution of nurse practitioners and other advanced practice nursing roles through task-shifting and expansion of scope-of-practice...
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Opportunities for research-focused doctoral education must be available to nurses early in their careers in order to ensure the further development of nursing science. Early entry into the research doctorate through an integrated BSN-PhD program is one innovative approach. This approach highlights the value of integrating post-licensure clinical tr...
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Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic r...