As a child, when Nursing and Sociology professor Linda Aiken read Helen Wells and Julie Tatham's Cherry Ames -- the nursing version of the Nancy Drew series -- she probably never dreamed that, in time, she too would become a sort of nurse-investigator extraordinaire.
Aiken, who also directs the Center for Health Outcomes and Policy Research, conducted a large-scale research project along with fellow colleagues to investigate the quality of care and how nurse staffing levels affect patient safety in Pennsylvania hospitals. The study, whose results were published in the Journal of the American Medical Association in 2002, will be extended in the future to include California hospitals, and has brought fame and recognition to the group of researchers.
"For nursing research, it would be hard to beat Penn," says Joanne Spetz, associate professor of Nursing at the University of California, San Francisco.
The study found that, when the nurse-to-patient ratio decreases and the number of nurses with baccalaureate degrees increases in hospitals, the patient mortality rate is significantly lowered. In fact, when the average patient-to-nurse ratio decreases from eight patients per nurse to four patients per nurse, the patient mortality rate decreases by 30 percent.
Aiken and her team deduced these findings by analyzing the results of 86,000 surveys sent to Pennsylvania hospital nurses. The surveys asked for information about their employers, nurse staffing conditions, the quality of their hospitals and patient discharge records.
The groundbreaking findings of this study resulted in a myriad of awards for Aiken and her team.
"We won every award in nursing, literally," Aiken says.
Most recently, Aiken was listed as No. 10 among the 100 most powerful people in health care by the Modern Healthcare journal, making her the highest-ranked researcher in the country.
In addition, Aiken was awarded the Individual Codman Award for her research efforts throughout her career. The award, given by the Joint Commission on Accreditation of Healthcare Organizations, is the top award in the health care industry.
"I was very honored," Aiken says. "It suggests that people are hearing the message."
Spetz contends that, because the researchers' paper was published in a medical journal instead of a nursing publication, it received more attention.
"I hate to be cynical, but if the doctors are convinced that nurse staffing is important to quality of care, then policy is more likely to move in that direction," Spetz says.
However, Aiken's team is not idly resting on its laurels. New research is already being planned to investigate the effects of the new safe-staffing law in California, a law that requires hospitals to have a minimum nurse-to-patient ratio. The study will compare the patient mortality rates of California and Pennsylvania, which does not have legislation concerning nurse-staffing levels. The same survey procedure used in Aiken's study of Pennsylvania hospitals will be employed in the upcoming study.
The California safe-staffing law mandates that, by January 2005, hospitals must maintain a minimum of one nurse per five patients on medical-surgical units. When Aiken's research was published soon after the passing of this law, she said that it added to the validity to what the California government wanted to do.
However, with the current nursing shortage caused by a rapidly retiring nurse workforce and an increasing senior citizen population, the news that even more nurses should be hired increases the burden on hospitals to provide effective health care.
And although Aiken's team members are thrilled that their findings seem to be affecting society today, they don't want their research to prevent access to hospitals.
"All legislation can have unintended consequences," Aiken says.
The Stanford University Medical Center, where conditions have improved since the passage of the safe-staffing law, was forced to lay off many nurse assistants in order to have enough money to hire additional registered nurses to meet the new state quota.
"Everyone is struggling with the ratios," Stanford's Manager of Nursing Administrative Services Geoff Pridham says.
The Santa Teresita Hospital in Duarte, Calif., was even forced to close because of the safe-staffing law. However, Spetz doubts that the legislation was the sole reason the debt-ridden hospital closed.
Another unexpected consequence of the law is that hospitals that previously had nurse staffs larger than the newly prescribed ratios are using the law as an excuse to reduce staffing -- a move that diminishes, rather than improves, the quality of health care.
"A lot of times when you set a minimum, it becomes a standard," Aiken says.
Aiken's upcoming comparative study of California and Pennsylvania nursing will show whether her research and the safe-staffing law have helped or harmed health care.
"Nursing is a very large factor in patient safety. ... If you want to improve patient safety ... you have to fix this problem," Aiken says.
Aiken's colleagues believe that their research has already had a positive effect.
"It was an enjoyable experience working with Linda, and it was gratifying to see that our work resulted in having a significant effect on policy," says Associate Professor of Pediatrics, Anesthesia and Healthcare Systems Jeffrey Silber, who is also the Director for the Center for Outcomes Research at the Children's Hospital of Philadelphia.
"We did something that had never been done before," says Sean Clarke, associate director for the Center for Health Outcomes and Policy Research in Nursing.
Other states like Massachusetts and New Jersey are considering enacting legislation similar to California's safe-staffing law.
