Multilevel Panel Study of Effects of Changes in Nursing on Health Equity and Patient Outcomes

提供护理的组织背景在患者的健康结果中起着关键作用。 通过我们的NINR赞助的研究计划，自成立以来不断资助，我们已经产生了至关重要的 来自组织的大型和代表性样本的信息（例如，医院、疗养院、小学 护理实践）对护理背景对患者结局、健康差异和护士 well-being.感兴趣的可修改特征包括确保足够的护士人员配备和资源， 投资于护士教育，信任护士的自主权，以做出明智的临床决策和行动，培养 跨专业团队合作和尊重，并让一线护士参与政策和决策。我们 在1999年、2006年、2016年、2020年和2021年对护士进行了大规模调查，汇总了他们对 产生组织级护理措施，以及护士结果的指标（例如，burnout）that we 与来自同一组织的患者的临床结果数据相关联。大部分的工作都是交叉的- 局部的，虽然具有暗示性，但福尔斯未能提供将证据转化为主要证据所需的信心。 政策和实践改革。我们的最后一个更新应用程序将测量和分析框架扩展到 对4个州两个时间点的组织变革和成果进行纵向分析。在这次更新中， 我们将大大扩展和扩大这项工作，使我们的数据收集工作复制两次， 在7个州（加利福尼亚州，佛罗里达州，IL，新泽西州，NM，纽约州，PA）的研究期间，创建了一个独特的组织面板数据集， 在那里工作的护士，以及他们照顾的病人，可以追溯到1999年。我们利用一个新的 伙伴关系，以大幅降低数据收集的成本，并增加国家，允许新的问题， 护理变化对不同人群的不同影响。设计强调对因素的评价 诱导护理实践的变化，区分主动和有意的影响，例如，磁体 承认，政策，如人员比例，从环境和历史，例如，2019冠状病毒病疫情， 医院整合趋势，对所有年龄段患者的结局，风险因素和人口统计学。我们的目标 目的：（1）确定组织变革对护理实践是否有可持续的影响， 一系列患者人群和环境中的相关患者结局和成本; 2）确定 是否随着时间的推移，组织护理的变化会减少健康差距，如果变化及其 影响不同的少数民族服务和/或安全网组织;和3）检查，如果护理相关的政策， 干预（例如，护士与病人的比例[CA]，人员配备委员会[NY]）和组织创新（例如， 通过工作环境改革改善工作成果， 面对COVID-19这样的挑战。首要目标不仅是了解 组织变革的病人的结果，但要了解如何通过目标的组织变革， 干预，可以有健康公平的变革性影响，护士福祉，和病人的结果。

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.