Linda H Aiken
Biographic Data
| ID | 123134 |
|---|---|
| NAME | Linda H Aiken |
| GIVEN NAMES | Linda H |
| FAMILY NAME | Aiken |
| SIGNATURE | AIKEN L H |
| AFFILIATIONS | University of Pennsylvania |
| ORCID | 0000-0001-8004-3630 |
| VERIFIED | Yes |
| TOTAL WORKS | 55 |
| TOTAL CITATIONS | 45 |
| AUTHOR COUNT | 55 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1976 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 4 |
Magnet4Europe Intervention to Improve Clinician and Patient Well-Being: A Quasi-Experimental Study of 56 Hospitals in 6 European Countries
BACKGROUND: Descriptive studies have documented high hospital nurse burnout and turnover but there are few, if any, large-scale evaluations of organizational interventions to improve clinician retention. The Magnet model is an organizational hospital intervention associated with better clinician and patient outcomes but there is insufficient evidence as to whether the Magnet model based on structural empowerment of clinicians results in better ou…
Hospital Nursing Has Not Returned to Pre-Covid Conditions: Time for a Different Approach
BACKGROUND: Hospital nurse burnout, job dissatisfaction, and intent to leave were high before the COVID-19 pandemic and reached alarmingly new heights during the pandemic. OBJECTIVE: Evaluate whether hospital nurses' job outcomes and evaluations of patient safety, quality of care, and hospital management responsiveness have returned at least to prepandemic levels. DESIGN: Cross-sectional study of survey data from 50,044 nurses in New York and Ill…
How Organizational Inclusion Shapes Patient Satisfaction in Magnet Hospitals
OBJECTIVE: Magnet hospitals exhibit higher patient satisfaction than non-Magnet hospitals, yet the underlying mechanisms driving these differences remain underexplored. This study examined the associations between Magnet status, hospitals' inclusion efforts for diverse populations, and patient satisfaction, and whether inclusion efforts explain Magnet hospitals' higher satisfaction. METHODS: This cross-sectional study analyzed 2023 secondary data…
Nurses’ intention to leave, nurse workload and in-hospital patient mortality in Italy: A descriptive and regression study
Higher nurse-to-patient ratios are associated with poor patient care and adverse nurse outcomes, including emotional exhaustion and intention to leave. We examined the effect of nurses' intention to leave and nurse-patient workload on in-hospital patient mortality in Italy. A multicentered descriptive and regression study using clinical data of patients aged 50 years or older with a hospital stay of at least two days admitted to surgical wards li…
Alternative Models of Nurse Staffing May Be Dangerous in High-Stakes Hospital Care
BACKGROUND: Hospitals are resurrecting the outdated "team nursing" model of staffing that substitutes lower-wage staff for registered nurses (RNs). OBJECTIVES: To evaluate whether reducing the proportion of RNs to total nursing staff in hospitals is in the best interest of patients, hospitals, and payers. RESEARCH DESIGN: Cross-sectional, retrospective. SUBJECTS: In all, 6,559,704 Medicare patients in 2676 general acute-care US hospitals in 2019.…
Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover, Outcomes, and Patient Safety
This cross-sectional survey study of physicians and nurses practicing in US Magnet hospitals found that hospitals characterized as having too few nurses and unfavorable work environments had higher rates of clinician burnout, turnover, and unfavorable patient safety ratings. Clinicians wanted action by management to address insufficient nurse staffing, insufficient clinician control over workload, and poor work environments; they were less intere…
Nurse Work Environment and Hospital-Onset Clostridioides difficile Infection
BACKGROUND: Clostridioides difficile is the leading cause of hospital-onset diarrhea and is associated with increased lengths of stay and mortality. While some hospitals have successfully reduced the burden of C. difficile infection (CDI), many still struggle to reduce hospital-onset CDI. Nurses-because of their close proximity to patients-are an important resource in the prevention of hospital-onset CDI. OBJECTIVE: Determine whether there is an …
Association of Registered Nurse Staffing With Mortality Risk of Medicare Beneficiaries Hospitalized With Sepsis
The results of this cross-sectional study suggest that hospitals that provide more registered nurse hours of care could likely improve SEP-1 bundle compliance and decrease the likelihood of mortality in Medicare beneficiaries with sepsis
Leveraging the Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes
Improving the work environment remains a solution for hospitals looking to concurrently improve nurse burnout and patient outcomes. Administrators may look to the Magnet recognition program as a blueprint to better support nurses in providing safe, high quality care
Value of Nurse Practitioner Inpatient Hospital Staffing
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 outcomes net of RN staffing. RESEARCH DESIGN: This was a 2015-2016 cross-sectional data on 579 hospitals link…
Electronic Health Record Usability: Associations With Nurse and Patient Outcomes in Hospitals
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 (inpatient mortality and 30-day readmission) outcomes. METHODS: A cross-sectional analysis of linked American H…
Is Hospital Nurse Staffing Legislation in the Public’s Interest: An Observational Study in New York State
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 staffing in NY hospitals and its association with adverse outcomes (ie, mortality and avoidable costs). RES…
Better Nurse Staffing Is Associated With Survival for Black Patients and Diminishes Racial Disparities in Survival After In-Hospital Cardiac Arrests
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 Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and Patient Saf…
A Methodology For Studying Organizational Performance: A Multistate Survey of Front-line Providers
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: …
Effect of Changes in Hospital Nursing Resources on Improvements in Patient Safety and Quality of Care: A Panel Study
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. RESEARCH DESIGN: Multilevel logistic response models, using data from a panel of 737 hospitals in which cro…
Better Nurse Staffing and Nurse Work Environments Associated With Increased Survival of In-Hospital Cardiac Arrest Patients
BACKGROUND: Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. OBJECTIVES: To determine the association between nurse staffing, nurse work environments, and IHCA survival. RESEARCH DESIGN: Cross-sectional study of data from: (1) the American Heart Association's G…
Nonphysician Health Professionals
Organization of Hospital Nursing and 30-Day Readmissions in Medicare Patients Undergoing Surgery
BACKGROUND: Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing—a critical organizational component of hospital service system—in relation to readmissions. OBJECTIVES: To determine the relationships between hospital nursing factors—nurse work environment, nurse staffing, and nurse education—and 30-day readmissions among Medicare patients undergoing general…
Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition
BACKGROUND: Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes. OBJECTIVE: To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remai…
Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study
Nurses’ Shift Length and Overtime Working in 12 European Countries: The Association With Perceived Quality of Care and Patient Safety
BACKGROUND: Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs. OBJECTIVES: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care…
Home Health Agency Work Environments and Hospitalizations
BACKGROUND: An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs. OBJECTIVES: To determine the relationship between home health agency work environments and agency-level rates of acute hospitalization and di…
Baccalaureate Nurses and Hospital Outcomes: More Evidence
Lower Mortality in Magnet Hospitals
BACKGROUND: Although there is evidence that hospitals recognized for nursing excellence--Magnet hospitals--are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. OBJECTIVES: To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most like…
Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States
OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospit…
Effects of Hospital Staffing and Organizational Climate on Needlestick Injuries to Nurses
Objectives. This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. Methods. We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units …
Hospital nurses' occupational exposure to blood: Prospective, retrospective, and institutional reports
OBJECTIVES: This study examined nurses risk of exposure to blood resulting from injuries with needles and sharps, the methods of estimating those risks, and the factors affecting risks. METHODS: Nurses on 40 medical units in 20 hospitals in cities with a high incidence of AIDS were studied. Percutaneous injuries were documented for every shift during a 30-day period. These prospective reports were compared with retrospective and institutional rep…
Effects of Specialization and Client Differentiation on the Status of Nurses: The Case of Aids
This is a study of how change in the organization of work within hospitals affects the disputes over contested professional jurisdictions. We employ the natural experiment in hospital work reorganization motivated by the AIDS epidemic to empirically document the effects of specialization and client differentiation on the increased intra-organizational status of nurses. We demonstrate that specialized AIDS units represent a form of hospital reorga…
Effects of Organizational Innovations in Aids Care on Burnout among Urban Hospital Nurses
Data from a survey of more than 800 nurses who care for AIDS patients revealed that the organizational form of the unit and hospital in which care was provided significantly affected the likelihood of nurses reporting that they were emotionally exhausted. Nurses who worked in dedicated or specialized AIDS units, or in 'magnet' hospitals known to possess organizational characteristics attractive to nurses, exhibited lower levels of emotional exhau…
Intermarriage and Unwanted Fertility in the United States
Health and Illness: A Social Psychological Analysis
Intermarriage and Unwanted Fertility in the United States
Program Evaluation in the Health Fields, Volume II
Hospices: Perspectives on the public policy debate
Hospices: Perspectives on the public policy debate
Private foundations in health affairs: A case study of the development of a national initiative for the chronically mentally ill
Private foundations in health affairs: A case study of the development of a national initiative for the chronically mentally ill
Evaluation Studies Review Annual, Vol. 10
Applications of Social Science to Clinical Medicine and Health Policy
Applications of Social Science to Clinical Medicine and Health Policy
Aids: The health policy context
Very little progress has been achieved in the US in developing an appropriate service response to persons already infected and seriously ill with the acquired immunodeficiency syndrome (AIDS). The nation's health care system is primarily organized to provide acute care of short duration to those with the means to pay. AIDS manifests itself in a variety of acute and chronic conditions. The disease does not fit neatly into one of the medical sub-sp…
Books in review
Institutionalizing Divergent Approaches in the Sociology of Health and Healing: A Review of Medical Sociology Readers
Lower Medicare Mortality Among a Set of Hospitals Known for Good Nursing Care
The objective of this study is to investigate whether hospitals known to be good places to practice nursing have lower Medicare mortality than hospitals that are otherwise similar with respect to a variety of non-nursing organizational characteristics. Research to date on determinants of hospital mortality has not focused on the organization of nursing. We capitalize on the existence of a set of studies of 39 hospitals that, for reasons other tha…
Intensifying Care: The Hospital Industry, Professionalization, and the Reorganization of the Nursing Labor Process
Contemporary debates on health care have given relatively little attention to the effects of recent changes on health care workers. When such questions are raised, debates have centered on the effect of corporatization and state intervention on the medical profession rather than on the much larger work force of less esteemed, gender-segregated occupations that constitute the majority of health care workers.Intensifying Care contributes to overcom…
Buying the Best: Cost Escalation in Elite Higher Education
Hospital nurses' occupational exposure to blood: Prospective, retrospective, and institutional reports
OBJECTIVES: This study examined nurses risk of exposure to blood resulting from injuries with needles and sharps, the methods of estimating those risks, and the factors affecting risks. METHODS: Nurses on 40 medical units in 20 hospitals in cities with a high incidence of AIDS were studied. Percutaneous injuries were documented for every shift during a 30-day period. These prospective reports were compared with retrospective and institutional rep…
Evaluating the Consequences of Hospital Restructuring
From the Center for Health Services and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania. †From the Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania. Address correspondence to: Linda Aiken, PhD, Center for Health Services and Policy Research, University of Pennsylvania, 420 Guardian Dr., Philadelphia, PA 19104-6096
Hospital Restructuring in the United States, Canada, and Western Europe: An Outcomes Research Agenda
Restructuring of the hospital workforce and redesign of work in inpatient settings is widespread and markedly similar across North American and Europe, and warrants systematic study. Cross-national studies of the impact of restructuring inpatient care on patient outcomes would yield valuable lessons about the cost-quality tradeoffs in hospital redesign and re-engineering, as well as inform national planning about the numbers and types of nurses n…
Studying Outcomes of Organizational Change in Health Services
OBJECTIVES: The rapidly changing organizational context within which health care is delivered is altering provider-patient relations and processes of clinical decision-making, with significant implications for patient outcomes. Yet definitive research on such effects is lacking. The authors seek to underscore the contribution of organizational research to studies of clinical outcomes and demonstrates several approaches to further such efforts. ME…
Satisfaction with Inpatient Acquired Immunodeficiency Syndrome Care: A National Comparison of Dedicated and Scattered-Bed Units
OBJECTIVES: This study sought to determine whether there were differences in acquired immunodeficiency syndrome (AIDS) patients' satisfaction with inpatient nursing care on dedicated AIDS units compared with conventional, multidiagnosis medical units. METHODS: Interview data were collected from more than 600 consecutive AIDS admissions in 40 patient care units in 20 hospitals in 11 high AIDS incidence cities. Ten hospitals with dedicated AIDS uni…
Effects of Specialization and Client Differentiation on the Status of Nurses: The Case of Aids
This is a study of how change in the organization of work within hospitals affects the disputes over contested professional jurisdictions. We employ the natural experiment in hospital work reorganization motivated by the AIDS epidemic to empirically document the effects of specialization and client differentiation on the increased intra-organizational status of nurses. We demonstrate that specialized AIDS units represent a form of hospital reorga…
Effects of Organizational Innovations in Aids Care on Burnout among Urban Hospital Nurses
Data from a survey of more than 800 nurses who care for AIDS patients revealed that the organizational form of the unit and hospital in which care was provided significantly affected the likelihood of nurses reporting that they were emotionally exhausted. Nurses who worked in dedicated or specialized AIDS units, or in 'magnet' hospitals known to possess organizational characteristics attractive to nurses, exhibited lower levels of emotional exhau…
Organization and Outcomes of Inpatient Aids Care
OBJECTIVE: To compare differences in AIDS patients' 30-day mortality and satisfaction with care in dedicated AIDS units, scattered-bed units in hospitals with and without dedicated AIDS units, and in magnet hospitals known to provide good nursing care. METHODS: Data were obtained on 1,205 consecutively admitted patients in 40 units in 20 hospitals and on 820 of their nurses. RESULTS: Mortality was lower and satisfaction was higher for AIDS patien…
Nurses’ Reports On Hospital Care In Five Countries
The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hosp…
Medicine (40 works) · Nursing (34 works) · Nursing education and management (20 works) · Political science (19 works) · Staffing (18 works) · Family medicine (17 works) · Health care (17 works) · Odds ratio (16 works) · Psychology (16 works) · Emergency Medicine (15 works)