Nurses' Report on Hospital Care in Five Countries

Linda H. Aiken, Sean P. Clarke Douglas M. Sloane Julie A. Sochalski, Reinhard Busse, Heather Clarke, Phyllis Giovannetti, Jennifer Hunt, Anne Marie Rafferty, and Judith Shamian


Health Affairs. 2001;20(3) 

In This Article

Study Design

This paper provides preliminary results from a study of staffing, organization, and outcomes in 711 hospitals in five countries, conducted by the International Hospital Outcomes Research Consortium. The consortium was formed by the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research to design and implement a cross-national replication of the center s U.S. research on the effects of nurse staffing and organization on patient outcomes and nurse retention.[6] The study surveyed nurses to obtain information on organizational climate, nurse staffing, and nurse and patient outcomes. Patient discharge administrative databases were used to derive thirty-day mortality and other patient outcome measures. Various administrative databases were used to obtain hospital staffing and organization informatio o hospitals in the geographic areas of interest.[7]

This report focuses on findings from the nurse survey. The sample consists of 43,329 nurses from the United States (Pennsylvania) (13,471), Canada (17,450), England (5,006), Scotland (4,721), and Germany (2,681) working in adult acute care hospitals in 1998 and 1999. The consortium, consisting of seven interdisciplinary research teams located in participating countries and provinces, jointly developed a core nurse questionnaire that underwent minor adaptations following pilot testing to ensure that language and content were relevant to nurses in each site. Questions dealt with a variety of issues related to the nurses perceptions of their working environments and the quality of nursing care being delivered in their hospitals as well as their job satisfaction, career plans, and feelings of job burnout. All nurses sampled received self-administered questionnaires that were anonymously returned by mail.

The sampling of nurses was designed to allow survey assessments of the work climates in a substantial share of hospitals in each country or geographic jurisdiction studied. Nurse sampling designs were driven by the methods used to select target hospitals for the larger outcomes study. In the United States, all hospitals in Pennsylvania were studied. In Canada, all hospitals in the three provinces of Ontario, Alberta, and British Columbia were included. All hospital trusts in Scotland were targeted for study. Limitations in administrative patient discharge data in England and Germany necessitated the selection of hospitals participating in benchmarking organizations. In Pennsylvania 50 percent of registered nurses living in the state were sampled. In Alberta a complete census of registered nurses working in hospitals was undertaken. Representative samples were drawn of nurses employed in all acute care hospitals in Ontario, British Columbia, and Scotland. I England and Germany representative samples of nurses were drawn from hospital employment records in target hospitals. Response rates ranged from 42 percent to 53 percent across geographic jurisdictions.[8]


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