Nurses4All

Generating evidence on nursing to shape policy and improve outcomes for all.

About the Project

Nurses4All, a project initiated by the University of Pennsylvania’s Center for Health Outcomes and Policy Research, is the most extensive and long-standing survey focused on nurses and their working conditions. The initiative, funded by the National Institutes of Health, has produced compelling evidence emphasizing the importance of adequate staffing and favorable work environments for nurses. The insights gathered also serve as valuable resources for building a practical business case to advocate for increased investments in nursing.

About the Study

In 2023 and 2025-26, we’ll replicate surveys conducted in 1999, 2006, 2016, 2020, and 2021 in ten states - California, Florida, Illinois, Louisiana, New Mexico, New York, Oregon, Pennsylvania and Washington - representing 40%+ of national nurses.

This study explores how changes in nursing resources (environment, staffing, education) influence patient outcomes across settings (hospitals, clinics, schools). By assessing nurse and patient data, we’ll gauge nursing’s impact on outcomes over time. Insights will guide transformative interventions for equity, nurse well-being, and patient results.

For Participants

Thank you for your involvement in the Nurses4All study. Your contributions have been vital to the success in advancing scientific knowledge and nursing workforce improvements. Please access the Nurses4All FAQs for more information.

Our Impact

CHOPR’s efforts have initiated policy shifts benefiting nurses and enhancing patient care and outcomes nationwide and globally. Explore the impact areas below to delve into the diverse ways our work has shaped nursing.

Aiken et al., (2023). A repeated cross-sectional study of nurses immediately before and during the Covid-19 pandemic: Implications for action. Nursing Outlook.
Lasater et al., (2021). Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes. American Journal of Infection Control.
Lasater et al., (2021). Is hospital nurse staffing legislation in the public’s interest?: an observational study in New York State. Medical Care.
Lasater et al., (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study. BMJ Open.
McHugh et al., (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet.
Aiken et al., (2002). Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction. Journal of the American Medical Association, JAMA.
McHugh, et al., (2013). Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing. Health Affairs.

McHugh et al, (2012). Lower mortality in Magnet® hospitals. Medical Care.
Lake et al., (2012). Association between hospital recognition for nursing excellence and outcomes of very-low-birthweight infants. Journal of the American Medical Association, JAMA.
Kutney-Lee et al., (2011). Nurse outcomes in Magnet® and non-Magnet hospitals. JONA: The Journal of Nursing Administration.
Kutney-Lee et al., (2015). Changes in patient and nurse outcomes associated with magnet hospital recognition. Medical Care.
Kutney-Lee et al., (2009). Nursing: A Key To Patient Satisfaction. Health Affairs.
Witkoski Stimpfel et al., (2016). Hospitals known for nursing excellence associated with better hospital experience for patients. Health Services Research.
Brooks Carthon et al., (2022). Supportive practice environments are associated with higher quality ratings among nurse practitioners working in underserved areas. Journal of Nursing Regulation.

Aiken et al., (2023). Physician and nurse well-being and preferred interventions to address burnout in hospital practice: factors associated with turnover, outcomes, and patient safety. JAMA, Health Forum.
Schlak et al., (2021). Leveraging the work environment to minimize the negative impact of nurse burnout on patient outcomes. I nternational Journal of Environmental Research and Public Health.
White et al., (2020). Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction. Geriatric Nursing.

Nikpour et al., (2023). Characteristics, work environments, and rates of burnout and job dissatisfaction among registered nurses in primary care. Nursing Outlook.
Brooks Carthon et al., (2020). Supportive clinical practice environments associated with patient-centered care. The Journal for Nurse Practitioners : JNP.
Brooks Carthon et al., (2022). Supportive practice environments are associated with higher quality ratings among nurse practitioners working in underserved areas. Journal of Nursing Regulation.

Aiken et al., (2003). Education levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, JAMA.
Porat-Dahlerbruch et al., (2022). Variations in nursing baccalaureate education and 30-day inpatient surgical mortality. Nursing Outlook.
Lasater et al., (2021). Changes in proportion of bachelor’s nurses associated with improvements in patient outcomes. Research in Nursing & Health.
Harrison et al., (2019). In hospitals with more nurses who have baccalaureate degrees, better outcomes for patients after cardiac arrest. Health Affairs.

Lasater et al., (2023). Explaining racial disparities in surgical survival: a tapered match analysis of patient and hospital factors. BMJ Open.
Brooks Carthon et al., (2022). Racial disparities in stroke readmissions reduced in hospitals with better nurse staffing. Nursing Research.
Brooks Carthon et al., (2021). Better nurse staffing is associated with survival for black patients and diminishes racial disparities in survival after in-hospital cardiac arrests. Medical Care.
Brooks Carthon et al., (2012). Nurse staffing and postsurgical outcomes in black adults. Journal of the American Geriatrics Society.
Brooks Carthon et al., (2016). Unmet nursing care linked to rehospitalizations among older black AMI patients: a cross-sectional study of US hospitals. Medical Care.

Aiken et al., (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet.
Aiken et al., (2021). Patient satisfaction with hospital care and nurses in England: an observational study. BMJ Open.
Ball et al., (2018). Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study. International Journal of Nursing Studies.
Aiken et al., (2017). Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety.

Nurses4All Investigators

Linda H. Aiken, PhD, RN, FAAN
Nurses4All Principal Investigator
@LindaAiken_Penn

Linda Aiken’s pioneering research has created an evidence base showing the importance of nurses caring for fewer patients each, having most nurses with bachelor’s or higher qualifications, and improving nurse work environments.

Matthew D. McHugh PhD, JD, MPH, RN, FAAN
Nurses4All Principal Investigator
@MatthewDMcHugh

As principal investigator on multiple large-scale studies funded by NIH, AHRQ, and the Robert Wood Johnson Foundation, Dr. McHugh’s work has advanced the field of nursing outcomes and policy research by showing the value of investing in nursing as a vehicle to achieve a higher functioning health care system.

Eileen T. Lake, PhD, RN, FAAN
Nurses4All Co-Investigator
@EileenLake_Penn

Dr. Lake developed the Practice Environment Scale of the Nursing Work Index, a foundational measure of nursing care performance to demonstrate nursing’s impact on patient outcomes. Dr. Lake’s goal with the index, which is used in over 23 languages, is to motivate managers and policymakers to make nursing resources a priority investment.

Dr. J. Margo Brooks Carthon

Margo Brooks Carthon, PhD, RN, FAAN
Nurses4All Co-Investigator
@DrMargoBC

Dr. Margo Brooks Carthon is a health equity expert and was one of the first researchers to demonstrate empirical relationships between the quality of nursing care and racial inequities in outcomes. Through research, Dr. Brooks Carthon aims to determine the nursing care needs of adults with complex medical and social needs and collaborate with health system partners to develop innovative solutions to reduce health disparities.

Karen Lasater, PhD, RN, Postdoctoral Fellow

Karen B. Lasater, PhD, RN, FAAN
Nurses4All Co-Investigator
@k_lasater

Dr. Lasater’s nursing research shows that better nurse resources lead to improved patient outcomes, without increasing costs. This generates new evidence on the economic impacts of staffing decisions.

Contact Us

Email: nurses4all@nursing.upenn.edu
Phone: 866-677-4255
Mailing Address:
Attn: Center for Health Outcomes and Policy Research
University of Pennsylvania School of Nursing
413 Curie Blvd, Philadelphia, PA 19104

Nurses4All

About the Study

For Participants

Our Impact

Nurse Staffing

Nurse Work Environment and Magnet®

Clinician Wellbeing and Nurse Outcomes

Nurse Practitioners & Ambulatory Care

Education

Health Disparities

International Reach

Related Links

Contact Us