For
Linda Aiken, PhD, RN, the drive to understand and improve nurse satisfaction is a mission that has spanned two decades. "I want the best possible outcomes for people who are sick," said Aiken, the director of the Center for Health Services and Policy Research at the University of Pennsylvania School of Nursing. "And I think giving the best possible nursing care is the answer."So Aiken began to explore the connection between nurse-friendly facilities and mortality, which "tends to get people’s attention." One study, published in 1994 in the journal Medical Care, showed that the mortality rate was 4.6 percent lower at 39 so-called magnet hospitals—identified as good places to practice nursing—compared with 195 control facilities. The magnet hospitals decentralize decision-making authority, Aiken said, giving it to the clinicians closest to patients. "This is kind of a reversal from how most conventional hospitals are organized."
A similar decentralized model, Aiken said, can be seen in designated AIDS units. Hospitals granted nurses an unusual amount of autonomy to organize the units early in the epidemic, out of concern that they would have difficulty attracting staff. In a study published this year, also in Medical Care, Aiken showed that AIDS patients on the designated units were significantly happier with the nursing care than counterparts on general medical floors.
But Aiken believes that recent restructuring efforts at many hospitals are pushing decisions farther away from the clinician level. "Many, many of them are taking responsibility and autonomy away from the clinician that is closest to the patient." But necessity will change that, she said. "I think it will eventually happen, because patients are now getting so sick that hospitals are putting themselves in a position of great vulnerability in terms of having adverse consequences happen with patients."