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Pioneering in South America

How can nursing and quality-of-care affect patient outcomes? Sometimes, the answer depends on where you ask. Take Marta Simonetti—an RN and faculty member at Chile’s Universidad de los Andes School of Nursing for more than 20 years.

As a nurse operating within the Chilean hospital network, Simonetti found herself running into hurdles that made it much tougher to perform what’s already a tough job. Excessive workloads, poor communication between departments, and a lack of autonomy in the workplace were among the challenges that Simonetti and her peers faced.

But today, you’ll find Simonetti on the frontlines of a movement for change in Chile’s hospitals. Working closely with Dr. Linda Aiken and Dr. Eileen Lake at CHOPR (where she just completed her PhD program) Simonetti led the first large-scale study on quality-of-care and nursing in Chile and South America. Over several summers and spring breaks, Simonetti and a team of Chilean researchers from the Universidad traveled to more than 40 hospitals to survey 1,600 nurses and 2,000 patients about their experiences. This unprecedented data collection effort revealed a troubling nurse-to-patient staffing ratio that put patients at risk and contributed to burnout among hospital nurses. Before long, Simonetti—a nurse herself—was briefing Chile’s Minister of Health and offering recommendations for how the government could respond to the study’s conclusions.

“Our first target is to decrease nursing workloads,” Simonetti told Penn Nursing. “Staffing ratios are associated with mortality and readmission. Our proposal [to the Chilean government] entails adjusting these ratios to the point where all public hospitals would have comparable standards. From there, a national standard for Chile could be established.”

Simonetti’s research across the Chilean hospital landscape has already yielded two papers and a dissertation (“Associations Among Nurse Practice Environment, Nurse Job Outcomes, and Patient Experience in Chilean Hospitals”) for which Simonetti received the Marion B. Gregory Award. Each year, this award is bestowed to a Penn Nursing PhD candidate whose dissertation offers a significant contribution to nursing knowledge. For Simonetti—whose journey from RN to international research pioneer began nearly 20 years ago, when she stumbled upon Dr. Aiken’s research on nursing—there’s a special kind of poetry to being honored this way by Penn Nursing.

“If I had stayed in Chile, I never would have learned all the things I know today,” Simonetti said. “At CHOPR, I had the opportunity to learn from an expert team of researchers. Very few Chilean nurses have PhD degrees and even fewer have had the chance to study in the US. For me, it’s a real privilege to have gotten my degree at Penn. The people I work with at CHOPR are now part of my professional network, and they are my friends.” 

Simonetti has since returned to Chile to continue her work as a changemaker in the nursing field. But the findings of her study on Chilean hospitals may have positive implications for neighboring countries in Latin America (“…especially countries with constrained economies,” Simonetti says.) As Chile begins to improve hospital environments for nurses and by extension, patients, a similar wave of research and reform could lead to better quality-of-care standards across the continent.

And for Simonetti, that might be the most satisfying outcome of all.