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Multilevel Panel Study of Effects of Changes in Nursing on Patient Outcomes

Award Number: R01NR014855
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/15/2014
PERIOD OF PERFORMANCE END DATE: 01/31/2026

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Multilevel Panel Study of Effects of Changes in Nursing on Patient Outcomes - The organizational context in which nursing care is delivered plays a key role in health outcomes for patients. Through our NINR-sponsored program of research, continually funded since inception, we have produced vital information from large and representative samples of organizations (e.g., hospitals, nursing homes, primary care practices) on the impact of the context of nursing care on patient outcomes, quality of care, and nurse well-being. The modifiable features of interest include ensuring sufficient nurse staffing and resources, investing in nurse education, trusting nurses’ autonomy to make informed clinical decisions and act, fostering interprofessional teamwork, and involving frontline nurses in policy and decision-making. We conducted large-scale surveys of nurses in 1999, 2006, 2016, 2020, and 2021, aggregating their responses to produce organization-level nursing measures, as well as indicators of nurse outcomes (e.g., burnout) that we link with clinical outcomes data from patients in the same organizations. Most of the work was cross-sectional, and while suggestive, falls short of providing the confidence needed to translate evidence into policy and practice reforms. Our last renewal application enlarged the measurement and analytic frame to longitudinal analyses of organizational changes and outcomes at two points in time in 4 states. In this renewal, we will significantly extend and expand this work to enable replication of our data collection effort twice within the study period in 7 states (CA, FL, IL, NJ, NM, NY, PA), creating a unique panel dataset of organizations, the nurses working there, and the patients they care for, going as far back as 1999. We leverage a new partnership to substantially reduce the cost of data collection and add states that allow for new questions about the impact of modifying organizational features of nursing. The design emphasizes evaluation of factors inducing change in nursing practice, distinguishing the impact of the active and intentional, e.g., Magnet recognition, policies like staffing ratios, from the environmental and historical, e.g., COVID-19 pandemic, hospital consolidation trends, on outcomes for patients of all ages and clinical risk. Our aims are: 1) to determine whether there are sustainable effects of organizational change on nursing practice and associated patient outcomes and cost across a range of patient populations and settings; 2) to determine whether organizational nursing changes over time diminish outcome variance and if the changes and their effects are conditional on other organizational features; and 3) to examine if nursing-related policy interventions (e.g., nurse-to-patient ratios [CA], staffing committees [NY]) and organizational innovations (e.g., Magnet/Pathway) aimed at improving outcomes through work environment reform had a sustained impact over time and in the face of challenges like COVID-19. The overarching aim is to not just understand the benefits of organizational change for patient outcomes, but to understand how to target organizational change via interventions that can have a transformative impact on quality of care, nurse wellbeing, and patient outcomes.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $729,853 )
2025	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	9	6/17/2025	NON-COMPETING CONTINUATION	$729,853
2025	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	8	4/23/2025	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $729,853

Issue Date FY: 2024 ( Subtotal = $867,792 )
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	004	8	4/30/2024	SUPPLEMENT FOR EXPANSION	$84,959
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	002	8	2/1/2024	NON-COMPETING CONTINUATION	$704,550
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	005	8	5/2/2024	NON-COMPETING CONTINUATION	$78,283
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	003	7	2/1/2024	SUPPLEMENT FOR EXPANSION	$0
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	7	2/1/2024	NON-COMPETING CONTINUATION	$0
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	7	1/23/2024	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $867,792

Issue Date FY: 2023 ( Subtotal = $1,020,853 )
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	7	1/11/2023	NON-COMPETING CONTINUATION	$793,353
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	002	7	9/14/2023	NON-COMPETING CONTINUATION	$0
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	7	6/20/2023	NON-COMPETING CONTINUATION	$0
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	003	7	9/14/2023	SUPPLEMENT FOR EXPANSION	$227,500
														Subtotal = $1,020,853

Issue Date FY: 2022 ( Subtotal = $815,404 )
2022	2022	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	6	3/31/2022	COMPETING CONTINUATION	$815,404
														Subtotal = $815,404

Issue Date FY: 2021 ( Subtotal = $0 )
2021	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	5	2/1/2021	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $0

Issue Date FY: 2020 ( Subtotal = $0 )
2020	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	5	6/25/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2019 ( Subtotal = $0 )
2019	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	5	1/8/2019	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2018 ( Subtotal = $895,696 )
2018	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	5	9/14/2018	SUPPLEMENT FOR EXPANSION	$406,403
2018	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	5	6/4/2018	NON-COMPETING CONTINUATION	$489,293
														Subtotal = $895,696

Issue Date FY: 2017 ( Subtotal = $489,293 )
2017	2017	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	4	6/29/2017	NON-COMPETING CONTINUATION	$489,293
														Subtotal = $489,293

Issue Date FY: 2016 ( Subtotal = $577,827 )
2016	2016	UNIVERSITY OF PENNSYLVANIA	3451 WALNUT STREET	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	3	6/15/2016	NON-COMPETING CONTINUATION	$577,827
														Subtotal = $577,827

Issue Date FY: 2015 ( Subtotal = $654,229 )
2015	2015	UNIVERSITY OF PENNSYLVANIA	3451 WALNUT STREET	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	2	6/24/2015	NON-COMPETING CONTINUATION	$654,229
														Subtotal = $654,229

Issue Date FY: 2014 ( Subtotal = $679,904 )
2014	2014	UNIVERSITY OF PENNSYLVANIA	3451 WALNUT STREET	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	1	9/12/2014	NEW	$679,904
														Subtotal = $679,904

Grand Total All Awards = $6,730,851

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Multilevel Panel Study of Effects of Changes in Nursing on Patient Outcomes

Award Number: R01NR014855

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/15/2014

PERIOD OF PERFORMANCE END DATE: 01/31/2026

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