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History of the Center The Center was established in 1989 in response to the need for better information about the crucial issues in health care that require nurse involvement. A major focus of the Center's research has been organizational effectiveness and learning more how the manipulable aspects of health care organizations potentially affect variation in patient outcomes. As a result of the Center's extensive work on the determinants of nurse and patient outcomes, the Center has been designated as the only NIH-supported core research center in nursing outcomes research. The Center began its research agenda by studying the outcomes of magnet hospitals which have been shown to have a common set of organizational attributes that nurses collectively believe are important for the delivery of excellent care. We demonstrated that magnet hospitals have lower Medicare mortality than a matched group of hospitals and determined from surveys of nurses practicing in magnet hospitals that these hospitals had organizational attributes that were different from other hospitals. Building on the results of the magnet hospital studies, we designed a study to further evaluate organizational attributes and patient outcomes from a set of "demonstration" hospitals and controls. Using hospitals with urban AIDS epicenters that had dedicated AIDS units, we found that AIDS mortality was significantly lower in both magnet hospitals and dedicated AIDS units than in matched control hospitals. We also found that patient satisfaction in magnet hospitals and dedicated AIDS units was significantly higher due to the level of control that nurses had over the practice setting. We have continued to study the impact of hospital organization on patient outcomes by undertaking a large cross-national study which includes a representative group of hospitals in the US, Canada, England, Germany, Scotland, and New Zealand. With data from over 40,000 nurses practicing in 700 hospitals, our results suggest the effects of staffing and organizational climate on hospital outcomes across sites. We are also exploring the extent to which hospital nurse organization and staffing account for the relationship between diagnosis-and procedure-specific patient volumes and patient outcomes in hospital care in a large number of hospitals in Ontario and the US. The role of nursing has not been studied in relation to the poorly-understood link between volume and outcomes and we hope to fill this gap. Our research has also expanded into other areas including the effect of racial differences in hospital outcomes, the effects of nurse staffing, hospital organization, and safety equipment on rates of nurse injuries from needlesticks, and the implementation of magnet hospital standards in hospitals in developing countries. |
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