Linda H. Aiken, PhD, RN, FAAN, FRCN
Nurses hold the key to providing safer, more effective care—and achieving better outcomes for patients.
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. Dr. Aiken documented that 30-day mortality after common surgical procedures increased by 7 percent for each additional patient added to a nurse’s workload, and that for each 10 percent increase in nurses with BSN degrees, there was a 5 to 7 percent decline in risk-adjusted mortality. She has also demonstrated that organizations that support professional nursing practice by involving nurses in decision-making have better patient outcomes than matched organizations with poor work environments.
Impact on Practice and Policy
Dr. Aiken has received the major research awards in her field of health services and policy research. In 2014, she received the Gustav O. Lienhard Award from the National Academy of Medicine for her research, which has impacted practice and policy in the United States and abroad. She has received the top awards in health services research, including the Distinguished Investigator Award from AcademyHealth and the Baxter Graham Health Services Research Prize from the Association of University Programs in Health Administration. Dr. Aiken was an Inaugural Awardee in the Sigma Theta Tau International Nurse Researcher’s Hall of Fame.
“The focus of my research is to determine how the organizational context of healthcare can be modified to promote improved patient outcomes.”
- PhD, University of Texas at Austin, 1973
- MN, University of Florida, 1966
- BSN, University of Florida, 1964
Improving Health Outcomes through Research and Policy
California’s development of state-mandated nurse-to-patient ratios in hospitals and public reporting of these ratios in other states were influenced by Dr. Aiken’s research. Beyond the U.S., her research was key to the adoption of safe nurse staffing mandates in Wales, Ireland, and the state of Queensland, Australia. The National Academy of Medicine’s 2010 recommendation that 80 percent of U.S. nurses have a bachelor’s degree by 2020, and the European Parliament’s 2013 decision to recognize a bachelor’s degree educational pathway for nurses in the European Union, reflect her research.
Dr. Aiken is director and founder of Penn Nursing’s Center for Health Outcomes and Policy Research. RN4CAST, one of the center’s projects and based on Dr. Aiken’s research, is the largest study of its kind on nursing care and patient outcomes in the United States, Europe, Asia, South Africa, Australia, and Chile. RN4CAST has been implemented in 30 countries and funded by many sources, including NIH and the European Commission.
In another recent center study, Dr. Aiken and colleagues from Penn Nursing and Penn’s Leonard Davis Institute of Health Economics demonstrated that better nurse work environments produce higher value care by achieving lower mortality with similar or lower costs, especially for higher-risk surgical patients. Dr. Aiken led the effort to improve clinical work environments for nurses when she was president of the American Academy of Nursing in 1979. This led to the development of the Magnet Recognition Program®, a voluntary accreditation program for nursing that represents a high-quality working environment for nurses that results in better patient outcomes. Dr. Aiken is also an authority on nurse shortages around the world.
Major Research Prizes
- Christiane Reimann Prize, International Council of Nurses (ICN), May 27, 2017
- Gustav O. Lienhard Award, Institute of Medicine, National Academy of Sciences recognizing outstanding achievement in improving personal health care services in the United States, October 20, 2014
- Anvar and Pari Velji Global Health Project of the Year Award 2013, Consortium of Universities for Global Health, March 15, 2013
- William B. Graham Prize for Health Services Research, Baxter International Foundation and Association of University Programs in Health Administration, 2006
- AcademyHealth Distinguished Investigator Award, 2005
- Individual Ernest A. Codman Award, Joint Commission on Accreditation of Healthcare Organizations, for leadership utilizing performance measures to demonstrate relationships between nursing care and patient outcomes, 2003
- Raymond and Beverly Sackler Award for Sustained National Leadership in Health Research, Research!America, March 21, 2006
Opportunities to Learn and Collaborate at Penn Nursing
The Center for Health Outcomes and Policy Research brings together faculty, students, and pre- and post-doctoral fellows from nursing, sociology, demography, medicine, management, economics, and other disciplines. Center researchers also collaborate with researchers from around the world.
Dr. Aiken also directs the center’s NIH-funded pre- and post-doctoral research training program in health outcomes research, designed to recruit promising young nurses into research careers. She teaches undergraduate and graduate courses on current issues in health and social policy and health outcomes research in nursing and sociology.
Selected Career Highlights
- National Academy of Medicine (formerly Institute of Medicine), National Academies of Science, elected 1981
- American Academy of Arts and Sciences, elected 1998
- American Academy of Political and Social Science, elected Theodore Roosevelt Fellow, 2003
- American Academy of Social Insurance, elected 1991
- American Academy of Nursing, Former President, elected 976
- Honorary Fellow, Royal College of Nursing of United Kingdom, elected 1998
McHugh, M.D., Rochman, M.F., Sloane, D.M., Berg, R.A., Mancini, M.E., Nadkarni, V.M., Merchant, R.M., and Aiken, L.H. (2016). Better nurse staffing and work environments associated with increased survival of in-hospital cardiac arrest patients. Medical Care. 54(1):74-80. Link here.
Silber, J.H., Rosenbaum, P.R., McHugh, M.D., Ludwig, J.M., Smith, H.L., Niknam, B.A., Even-Shoshan, O., Fleisher, L.A., Kelz, R.R., and Aiken, L.H. (2016). Comparison of the value of nursing work environments in hospitals across different levels of patient risk. JAMA Surgery 151(6):527-536. Link here.
Aiken, L.H., Sloane, D.M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse., R., Diomidous, M,, Kinnunen, J., Kozka, M., Lesaffre, E., McHugh, M., Moreno-Casbas, M.T., Rafferty, A.M., Schwendimann, R., Tishelman, C., van Achterberg, T., and Sermeus, W. (2014). Association of nurse staffing and education with hospital mortality in 9 European countries. The Lancet (383), 1824-1830. Link here
Kutney Lee, A., Sloane, D.M., and Aiken, L.H. (2013). An increase in the number of nurses with Baccalaureate degrees is linked to lower rates of postsurgery mortality. Health Affairs 3(3), 579-86. Ranked among most read Health Affairs papers published in 2013. Link here
McHugh, M.D., Kelly, L.A., Smith, H.L., Wu, E.S., Vanak, J, and Aiken, L.H. (2013). Lower mortality in Magnet hospitals. Medical Care, 51(50), 382-388. Link here
Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., Busse, R., McKee, M., Bruyneel, L., Rafferty, A.M., Griffiths, P., Moreno-Casbas, M.T., Tishelman, C., Scott, A., Brzostek, T., Kinnunen, J., Schwendimann, R., Heinen, M., Zikos, D., Sjetne, I.S., Smith, H.L., and Kutney-Lee, A. (2012). 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. Link here
Aiken, L.H., Sloane, D.M., Clarke, S., Poshosyan, L., Cho, E., You, L., Finlayson, M., Kanai-Pak, M., and Aungsuroch, Y. (2011). Importance of work environments on hospital outcomes in 9 countries. International Journal of Quality in Health Care 23(4): 357-364. Link here
Aiken, L.H., Cimiotti, J., Sloane, D.M., Smith, H.L., Flynn, L., and Neff, D. (2011). The effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care 49(10): 1047-1053. Link here
Brooks Carthon, J., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders, A., Visco, F., Holland, S., Ballingoff, J., DelGuidice, M., Aiken, L.H. (2018). Association of nurse engagement with patient safety. Journal of Nursing Care Quality. J Nurs Care Qual. 2018 Jun 8. doi: 10.1097/NCQ.0000000000000334
Maier, C.B., Aiken, L.H., Busse, R. (2017). Nurses in Advanced Roles in Primary Care: Policy Levers for Implementation. OECD Health Wokring Paper, No 98, OECD Publishing, Paris. Link here.