RN4CAST International Studies

Studying the Association Between Nurse Staffing, Education and Patient Outcomes in the United States and Around the World

European Union

Research project partners gather in Krakow, Poland in 2010 for the first international collaborat... Research project partners gather in Krakow, Poland in 2010 for the first international collaborative meeting after funding is secured. Research teams representing eighteen European countries examined data from hundreds of hospitals, 15,000 nurses, and thousands more patients to study the role nursing work environments and nursing staff deployment play in nurse recruitment, retention, productivity and patient outcomes.

The RN4CAST-EU Consortium has achieved the highest number of scientific publications of any study on any topic in EU history.

Patient safety, satisfaction, and quality of hospital care: Cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ 2012;344:e1717 (2012). Center Authors: Aiken LH, Sloane DM, Smith, HL, Kutney-Lee, A 

Prevalence, patterns, and predictors of nursing care left undone in European hospitals: Results from the multicountry cross sectional RN4CAST study. BMJ Quality and Safety doi:10.1136/bmjqs-2013-002318 (2013). Center Author: Aiken LH. 

Nursing skill mix in European hospitals: Cross sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety doi:10.1136/bmjqs-2016-05567 (2016). Center Authors: Aiken LH, Sloane D, McHugh M. 

Association of nurse staffing and education with hospital mortality in 9 European countries. The Lancet 383:1824-30 (2014). Center Authors: Aiken LH, Sloane DM, McHugh 

Organization of hospital nursing, provision of nursing care, and patient assessments of care in Europe. Medical Care Research and Review 72(6):643-664 2015. Center Authors: Smith, H.L., Sloane, D.M., Aiken, L.H. 

Nurses’ shift length and overtime working in 12 European countries. Medical Care 52(11):975-988 (2014). Center Authors: Aiken, L.H. 

Latin America 

CHOPR Researchers in partnership with scientists and colleagues from the Universidad de los Andes (University of the Andes) in Santiago, Chile, and three other top Chilean nursing schools study healthcare workforce and quality outcomes in Chile.

“Our vision is to create a nursing policy research infrastructure in other parts of the world and replicating those successes in Latin America.”

It has long been understood that Chile looks to the U.S. and Europe for innovations in healthcare. They depend on researchers and consultants from the US and Europe to evaluate the outcomes of reforms and chart a course that is appropriate to their national needs, economy, and culture.

“There is a commitment in Chile among nurses at the leading universities and hospitals to become participants in the international community of nursing outcomes and policy researchers.”

Meet the Research Team

Dr. Linda H. Aiken is a nurse sociologist, prominent health services researcher, and an authority on the causes, consequences, and solutions for nurse shortages in the United States and around the world. She conducts research on the use of performance measures to demonstrate relationships between nursing care and patient outcomes.

Dr. Jere Behrman has been engaged in research in over 40 countries in Asia, Africa and Latin America, including Chile. He is viewed as one of the leading economists concerned with analysis of the determinants and impacts of health and of education in developing countries.

Dr. David Bravo has demonstrated an ability to bridge research and policy and being instrumental in garnering political support and funding for the collection of novel data. His expertise was essential during the first longitudinal study of children in Chile.

Dr. Maria Consuelo Ceron Mackay, Dean, Faculty of Nursing and Obstetrics, University of the Andes. She was a bed side nurse in an Intensive Care Unit in a Pediatric Hospital, who later became a faculty member in the Nursing School at Universidad de los Andes. She has actively participated in the board of the Bachelor Programs in Sciences, then in the University Board as the Deputy of the General Secretary. She was de Director of the School of Nursing for five years and recently the Dean of the Faculty of Nursing and Midwifery.

Dr. Eileen T. Lake is an international leader in the theory and methods of nursing systems research. She brings over two decades of experience with large multi-site projects studying hospitals as complex organizations and using nurse survey data to understand how organizational factors relate to the safety and quality of care and patient outcomes.

Dr. Matthew D. McHugh possesses a a unique background as a clinical nurse and nurse practitioner, with advanced training in public health (focusing on healthcare policy and management), law, and health services and policy research. He has led other large research projects using comparable data and methods to those proposed and has extensive experience using the nursing data proposed for this study in both the U.S. and the European Union.

Dr. Douglas M. Sloane is an adjunct professor in the Center for Health Outcomes and Policy Research and has worked closely with Dr. Linda Aiken for over 20 years and contributed to this pioneering health services research that explores the relationship between nursing care and patient outcomes in the U.S. and abroad (Europe, China).

Dr. Herbert Smith has worked on a large number of issues in the field of population, bearing especially on social stratification, on health and health care systems, and on fertility—most with an international emphasis.

About Our Funders

Penn Global, University of Pennsylvania provides strategic direction for Penn’s global endeavors with a focus on efficient investment of university resources for global activities. Penn Global collaborates with Schools and Center across the University and seeks to catalyze cross-school collaborations to integrate knowledge that addresses key issues.

The Nursing Research Grant program from Sigma Theta Tau International encourages nurses to focus on responding to health disparities globally. STTI, along with its partners contributes more than US $200,000 annually to nursing research through grants, scholarships, and monetary awards.


RN4CAST Study Directors at the Queensland Institute of Technology in Brisbane RN4CAST Study Directors at the Queensland Institute of Technology in Brisbane The RN4CAST Australia study evaluates whether new hospital nurse staffing regulations improve patient outcomes and conditions for nursing practice.

Recognizing the importance of adequate nurse staffing, the Queensland Government examined minimum nurse-to-patient ratios as a means of assuring a safe work environment to promote optimal patient outcomes.