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

提供护理服务的组织环境对患者的健康结果起着关键作用。 通过我们的NINR赞助的研究计划，自成立以来一直得到资助，我们产生了至关重要的 来自具有代表性的大样本组织的信息(例如，医院、疗养院、初级 护理实践)关于护理环境对患者结局、健康差距和护士的影响 幸福。感兴趣的可修改特征包括确保足够的护士人员配置和资源， 投资于护士教育，相信护士在做出明智的临床决策和行动时的自主性，培养 跨专业的团队合作和尊重，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 制定组织级别的护理措施，以及护理结果的指标(例如，职业倦怠) 与同一组织中患者的临床结果数据相关联。大部分工作都是交叉的- 部分，虽然具有提示性，但不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。我们上一次的续订申请将测量和分析框架扩大到 对4个州两个时间点的组织变化和结果进行纵向分析。在这次更新中， 我们将大幅扩展这项工作，以便在年内两次复制我们的数据收集工作 在7个州(加州、佛罗里达州、伊利诺伊州、新泽西州、新墨西哥州、纽约州、宾夕法尼亚州)的研究期间，创建了一个独特的组织小组数据集， 在那里工作的护士和他们照顾的病人，最早可以追溯到1999年。我们利用新的 建立合作伙伴关系，大幅降低数据收集成本，并增加允许对以下问题提出新问题的州 护理变更对不同人群的不同影响。设计强调对因素的评估 诱导护理实践的变化，区分主动和有意的影响，例如磁铁 认识，如工作人员比例等政策，来自环境和历史，如新冠肺炎大流行， 医院合并趋势，关于所有年龄段患者的结果、风险因素和人口统计学。我们的目标 1)确定组织变革对护理实践是否有可持续的影响 在一系列患者群体和环境中关联的患者结果和成本；2)确定 组织护理随时间的变化是否会缩小健康差距，以及这些变化和他们的 在少数群体服务和/或安全网组织中效果不同；以及3)检查与护理相关的政策 干预措施(例如护士与病人的比例[CA]、人员编制委员会[纽约])和组织创新(例如， 磁铁/路径)旨在通过工作环境改革改善结果，对 时间和面对新冠肺炎这样的挑战。最重要的目标不仅仅是了解 针对患者结果的组织变革，但要了解如何通过 能够对健康公平、护士福祉和患者结果产生变革性影响的干预措施。

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.