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Principal Investigator: Matthew D. McHugh
Organization: UNIVERSITY OF PENNSYLVANIA
Fiscal Year: 2024
Award: $782,833
Funding agency: National Institute of Nursing Research
The organizational context in which nursing care is delivered plays a key role in health outcomes for patients.
Through our NINR-sponsored program of research, continually funded since inception, we have produced vital
information from large and representative samples of organizations (e.g., hospitals, nursing homes, primary
care practices) on the impact of the context of nursing care on patient outcomes, health disparities, and nurse
well-being. The modifiable features of interest include ensuring sufficient nurse staffing and resources,
investing in nurse education, trusting nurses' autonomy to make informed clinical decisions and act, fostering
interprofessional teamwork and respect, and involving frontline nurses in policy and decision-making. We
conducted large-scale surveys of nurses in 1999, 2006, 2016, 2020, and 2021, aggregating their responses to
produce organization-level nursing measures, as well as indicators of nurse outcomes (e.g., burnout) that we
link with clinical outcomes data from patients in the same organizations. The majority of the work was cross-
sectional, and while suggestive, falls short of providing the confidence needed to translate evidence into major
policy and practice reforms. Our last renewal application enlarged the measurement and analytic frame to
longitudinal analyses of organizational changes and outcomes at two points in time in 4 states. In this renewal,
we will significantly extend and expand this work to enable replication of our data collection effort twice within
the study period in 7 states (CA, FL, IL, NJ, NM, NY, PA), creating a unique panel dataset of organizations, the
nurses working there, and the patients they care for, going as far back as 1999. We leverage a new
partnership to substantially reduce the cost of data collection and add states that allow for new questions about
the differential impact of nursing changes for various populations. The design emphasizes evaluation of factors
inducing change in nursing practice, distinguishing the impact of the active and intentional, e.g., Magnet
recognition, policies like staffing ratios, from the environmental and historical, e.g., COVID-19 pandemic,
hospital consolidation trends, on outcomes for patients of all ages, risk factors, and demographics. Our aims
are: 1) to determine whether there are sustainable effects of organizational change on nursing practice and
associated patient outcomes and cost across a range of patient populations and settings; 2) to determine
whether organizational nursing changes over time diminish health disparities and if the changes and their
effects differ in minority-serving and/or safety-net organizations; and 3) to examine if nursing-related policy
interventions (e.g., nurse-to-patient ratios [CA], staffing committees [NY]) and organizational innovations (e.g.,
Magnet/Pathway) aimed at improving outcomes through work environment reform had a sustained impact over
time and in the face of challenges like COVID-19. The overarching aim is to not just understand the benefits of
organizational change for patient outcomes, but to understand how to target organizational change via
intervention that can have a transformative impact on health equity, nurse wellbeing, and patient outcomes.
Terms: <Academy><Adherence><Age><Attention><Back><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Care given by nurses><Caring><Clinical><Clinical Nursing><Clinical Protocols><Clinical Trials><Community Health Care><Community Healthcare><Complex><Coronavirus Infectious Disease 2019><Data><Data Collection><Data Set><Decision Making><Discipline of Nursing><Disparities><Disparity><Dorsum><Education><Educational aspects><Electronics><Ensure><Environment><Equity><Ethnic Origin><Ethnicity><Evaluation><Event><Fostering><Frail Elderly><Frail Elders><Frail Older Adults><Frail Seniors><Funding><Health><Healthcare><Hospitals><Intervention><Intervention Strategies><Investments><Knowledge><Link><Measurement><Measures><Medicine><Methods><Minority><Nature><Nurse's Role><Nurses><Nursing><Nursing Care><Nursing Education><Nursing Field><Nursing Homes><Nursing Profession><Nursing Staff><Organizational Change><Organizational Innovation><Outcome><Ownership><Pathway interactions><Patient Care><Patient Care Delivery><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Personal Satisfaction><Play><Policies><Policy Making><Population><Protocol><Protocols documentation><QOC><Quality of Care><Race><Races><Recommendation><Research><Research Resources><Resources><Risk Factors><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sampling><Sepsis><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Survey Instrument><Surveys><Time><Translating><Trust><Work><ages><analyzing longitudinal><authority><blood infection><bloodstream infection><burn-out><burnout><care costs><care delivery><care for patients><care of patients><care outcomes><caring for patients><clinical care><community care><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><cost><demographics><design><designing><disparate effect><disparate impact><disparate result><disparities in race><disparity due to race><disparity in ethnic><disparity in health><electronic><electronic device><ethnic based disparity><ethnic disadvantage><ethnic disparities in health><ethnic disparity><ethnic health disparity><ethnic inequality><ethnic inequity><ethnic minority><ethnicity disparity><evidence base><experience><frail older adult><health care><health care organization><health care outcomes><health care service organization><health disparity><health equity><healthcare organization><healthcare outcomes><healthcare service organization><improved><improved outcome><inequality due to race><inequitable effect><inequitable impact><inequitable outcome><inequity due to race><innovate><innovation><innovative><interest><interventional strategy><job environment><longitudinal analysis><longitudinal design><minority patient><multimorbidity><multiple chronic conditions><nurse><nursing home><nursing personnel><outcome disparities><outcome inequality><outcome inequity><pathway><patient oriented outcomes><patient population><patients from minority><patients of minority><primary care practice><professional atmosphere><programs><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparities in health><racial disparity><racial health disparity><racial inequality><racial inequity><racial minority><racial origin><racially unequal><response><safety net><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><trend><unequal effect><unequal impact><unequal outcome><well-being><wellbeing><work atmosphere><work environment><workplace climate><workplace environment>