The supply, distribution, certifications, and scope of practice of the 2.8 million RNs (including advanced practice RNs) and 690,000 licensed practical nurses currently in practice.

Registered Nurse Burnout, Job Dissatisfaction, and Missed Care in Nursing Homes

Jul. 23, 2019

Elizabeth M. White, Linda H. Aiken, Matthew D. McHugh

Abstract [from journal]

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 Jersey, and Pennsylvania.

Participants: A total of 687 direct care RNs.

Measurements: Emotional Exhaustion...

A Methodology For Studying Organizational Performance: A Multistate Survey of Front-line Providers

Jul. 3, 2019

Karen Lasater, Olga Jarrín, Linda Aiken, Matthew McHugh, Douglas Sloane, Herbert Smith 

Abstract [from journal]

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 about organizational quality and safety, which is problematic for generating inferences.

Objective: The objective of this study was to describe a novel approach to...

In Hospitals With More Nurses Who Have Baccalaureate Degrees, Better Outcomes For Patients After Cardiac Arrest

Jul. 1, 2019

Jordan M. Harrison, Linda H. Aiken, Douglas M. Sloane, J. Margo Brooks Carthon, Raina M. Merchant, Robert A. Berg, Matthew D. McHugh

Abstract [from journal]

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 With the Guidelines-Resuscitation registry (for 2013-18), RN4CAST-US hospital nurse surveys (2015-16), and the American Hospital Association (2015), we found that each 10-percentage-point increase in the


Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis

Apr. 3, 2019

Pamela B. de Cordova, Jeannette Rogowski, Kathryn A. Riman...


Public reporting is a tactic that hospitals and other health care facilities use to provide data such as outcomes to clinicians, patients, and payers. Although inadequate registered nurse (RN) staffing has been linked to poor patient outcomes, only eight states in the United States publicly report staffing ratios—five mandated by legislation and the other three electively. We examine nurse staffing trends after the New Jersey (NJ) legislature and governor enacted P.L.1971, c.136 (C.26:2 H-13) on January 24, 2005, mandating that all health care facilities...

A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes

Eileen Lake, PhD, RN
Apr. 3, 2019

Eileen Lake, Jordan Sanders, Rui Duan, Kathryn Riman, Kathryn Schoenauer, Yong Chen


Background: The nurse work environment is theorized to influence the quality of nursing care, nurse job outcomes, and patient outcomes.

Objective: The aim of this meta-analysis was to evaluate quantitatively the association of the work environment with job and health outcomes.

Research Design: Relevant studies published through September 2018 were identified. Inclusion criteria were use of a nationally endorsed work environment measure and reporting of odds ratios (ORs) and 95% confidence...

Association of Nurse Engagement and Nurse Staffing on Patient Safety

Feb. 14, 2019

J. Brooks Carthon, Linda Hatfield, Colin Plover, Andrew Dierkes, Lawrence Davis, Taylor Hedgeland, Anne Sanders, Frank Visco, Sara Holland, Jim Ballinghoff, Mary Del Guidice, Linda Aiken

ABSTRACT [from journal]

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-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the...

Improving End of Life Care – Ask the Nurses

Dec. 7, 2018

Everyone wants a dignified death – yet few actually experience one. Despite preferring to remain at home, most older adults spend their final days in hospitals, where they often undergo medical care that neither improves survival, quality of life, nor satisfaction and is often incongruent with their wishes and goals. A new study in the Journal of the American Geriatrics Society describes these problems in end of life care in nearly 500 U.S.

Cost Impact of The Transitional Care Model for Hospitalized Cognitively Impaired Older Adults

Research Brief
Nov. 19, 2018

Using advanced practice nurses to support high risk patients and their families to transition from hospital to home can reduce postacute care use and costs. A study comparing three evidence-based care management interventions for a population of hospitalized older adults with cognitive impairment found that the Transitional Care Model, which relies on advanced practice nurses to deliver services from hospital to home, was associated with lower postacute care costs when compared to two “hospital only” interventions.

Nurses' and Patients' Appraisals Show Patient Safety in Hospitals Remains a Concern

Research Brief
Nov. 5, 2018

In the report To Err is Human (1999), the National Academy of Medicine called for national action to improve patient safety in hospitals. The report concluded that improving nurse work environments—assuring adequate nurse staffing and supporting nurses’ ability to care for patients—was critical to these efforts. Two decades later, have nurse work environments improved, and has that had a noticeable impact on patient safety? To find out, a research team led by LDI Senior Fellow Linda Aiken, PhD, RN surveyed more than 800,000 patients and 53,000 nurses in 535 hospitals in 2005, and again in 2016.

A Policy Analysis of Legally Required Supervision of Nurse Practitioners and Other Health Professionals

Sep. 5, 2018

Ashley Z. Ritter, Kathryn H. Bowles, Ann L. O'Sullivan, ...

Abstract [from journal]

The use of legally required supervision occurs across health professionals who provide similar services. Legally required supervision has the potential to disrupt the production of high-quality, cost-efficient, accessible health services across disciplines.

This paper examines the effects of nurse practitioner collaborative practice agreements and similar