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Effects of Changes in Labor and Delivery Nursing Organizational Characteristics on Obstetric Outcomes

Award Number: R01NR021047
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/25/2024
PERIOD OF PERFORMANCE END DATE: 04/30/2028

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Effects of Changes in Labor and Delivery Nursing Organizational Characteristics on Obstetric Outcomes - The rising rates of maternal morbidity and mortality in the United States demand answers. Childbirth is the most common reason for hospital care, comprising 1 in 9 hospitalizations. Maternal morbidities, including postpartum hemorrhage and peripartum infection, are principal determinants of maternal mortality. Cesarean delivery in low-risk women is associated with significantly higher maternal and infant morbidity. These three outcomes vary widely across hospitals and are marked by stark differences among women of different backgrounds. There is a compelling need to examine factors in the health care system that account for these variations and differences. Labor and delivery registered nurses are frontline care providers responsible for monitoring and early recognition of, and intervention for the prevention of, these outcomes. They provide continuous bedside care that is critical to achieving optimal birth outcomes. Evaluating the influence of nursing on obstetric outcomes, however, has been largely ignored. In other hospital populations, patient outcome variation has been linked to variation in nursing organizational characteristics, such as the nurse work environment, nurse workload, and the percentage of Bachelor of Science in Nursing (BSN) degree-prepared registered nurses. The clear clinical basis for nursing organizational characteristics to influence obstetric outcomes and differences creates a critical need to investigate these relationships to inform professional guidelines and nursing unit organization to transform practice. We propose a novel, geographically representative, multi-hospital cross-sectional and longitudinal study. We will determine whether cross-sectional differences in nursing organizational characteristics (work environment, workload, BSN percentage), relate to differences in three obstetric outcomes and differences in outcomes in 867 hospital observations from 2005, 2015, 2019, or 2023 in 26 states (Aim 1). We will study how longitudinal changes across time points, including “post”-pandemic, in nursing organizational characteristics influence changes in the three outcomes and differences in these outcomes in a panel of 173 hospitals in 19 states (Aim 2). The Aim 2 panel comprises 309,670 deliveries per year. The study will capitalize on the availability of four national data sets, comprising nurse survey (National Database of Nursing Quality Indicators, RN4CAST) and patient data (Healthcare Cost and Utilization Project State Inpatient Data, state patient discharge data). This study addresses the NINR mission: “To solve pressing health challenges and inform practice and policy—optimizing health for all.” Our longitudinal and cross-sectional approaches along with broad geographic representation will provide actionable evidence for hospital administrators and professional groups.


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: 2026 ( Subtotal = $355,469 )
2026	2026	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	3	4/3/2026	NON-COMPETING CONTINUATION	$355,469
														Subtotal = $355,469

Issue Date FY: 2025 ( Subtotal = $355,469 )
2025	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	2	6/20/2025	NON-COMPETING CONTINUATION	$355,469
														Subtotal = $355,469

Issue Date FY: 2024 ( Subtotal = $406,250 )
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	1	7/25/2024	NEW	$365,625
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	1	9/26/2024	NEW	$40,625
														Subtotal = $406,250

Grand Total All Awards = $1,117,188

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Effects of Changes in Labor and Delivery Nursing Organizational Characteristics on Obstetric Outcomes

Award Number: R01NR021047

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

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

PERIOD OF PERFORMANCE START DATE: 07/25/2024

PERIOD OF PERFORMANCE END DATE: 04/30/2028

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