Nurse Leader Strives to Improve Working Conditions for Nurses

Linda Aiken created a research base to motivate hospitals to establish supportive working environments for nurses, which she discovered improves patient outcomes.

    • January 28, 2010

Linda Aiken, M.N., Ph.D., has dedicated her life to identifying organizational innovations to improve health care outcomes for patients and nurses—a cause she presses for as the only registered nurse on the 30-member editorial board of Health Affairs, the nation’s leading health policy journal.

A nurse researcher who directs the Center for Health Outcomes and Policy Research at the University of Pennsylvania, Aiken earned her place on the Health Affairs editorial board with help from a nursing initiative sponsored by the Robert Wood Johnson Foundation (RWJF) that has a goal to increase the number of nurses on the executive boards of health care organizations, including hospital systems, insurers, accrediting organizations, journals and government agencies. In its first phase, the program—called Nurse Leaders in the Boardroom—directly placed seven nurse leaders on six boards*. The program now works to achieve its goal at the local, state and national levels in partnership with the Center to Champion Nursing in America.

“As a nurse I bring a perspective of direct patient care realities that is sometimes missing in debates with strong economic and political dimensions,” she says. “My background as a nurse causes me to be mindful that health care is at its core a very human interaction that is highly dependent upon the quality of health professionals and the organizational context in which they practice. That serves as a countervailing perspective to the more dominant focus on payment policies as motivators.”

Nurses are on the front lines of patient care and have unique insights into the health care system but are often left out of discussions about how to improve health and health care in the United States. The Nurse Leaders in the Boardroom initiative is designed to address this problem by putting more nurse leaders in key decision-making positions.

Nurses, of course, aren’t the only ones who benefit from the program. As members of a top-ranked profession on questions of ethics and honesty, nurses enhance health care organizations’ credibility with patients, policy-makers, the public, and other stakeholders. Nurse leaders also help facilitate communication between patients and providers. They are also often come equipped with business skills and insights into the concerns of health care employees and patients.

For Aiken, being the only nurse in the room is nothing new. Not long after she graduated from the University of Texas at Austin in 1973 with a doctorate in sociology, she became the only nurse on the staff of the Robert Wood Johnson Foundation, which was then in its infancy.

In this role, she directed the Foundation’s research and evaluation initiatives and lobbied for the creation of two key nursing programs: the Clinical Nurse Scholars Program and the Teaching Nursing Home Program. The programs supported the development of nurse faculty in clinical research and improved nursing care in nursing homes.

Aiken left the Foundation in 1987 to teach and conduct research at the University of Pennsylvania, where she studies the impact of nursing on patient outcomes in large scale studies in the United States and abroad.

Aiken’s Work on Behalf of Nurses and Patients Dates to her Early Career

Aiken’s work on behalf of her patients and fellow nurses dates back to her first job four decades ago. As a clinical nurse in her hometown of Gainesville, Fla., she experienced the negative impact of “organizational chaos and care fragmentation” on patient outcomes and began contemplating the link between nursing work environments and patient care.

She began to study the issue in depth in 1979, when she became president of the American Academy of Nursing. After a period of rigorous research, she found that certain hospitals were able to retain nurses while others in the same geographic market experienced acute shortages.

Aiken then asked a key follow-up question: Do these successful “magnet” hospitals have better patient outcomes? The answer, she soon discovered, was ‘Yes.’ Magnet hospitals, she found, had lower mortality rates, fewer medical errors and higher patient satisfaction.

In the wake of her first study three decades ago, the American Nurses Credentialing Center (ANCC) began an accreditation program in 1994 to give hospitals with supportive work environments for nurses “Magnet” status. Today, about 5 percent of all hospitals in the country have earned Magnet status, which, she says, “is pretty incredible considering it started from nothing” less than two decades ago.

At Magnet hospitals, nurses are more likely to stay on the job because they benefit from workforce education programs; enjoy a relatively high degree of autonomy; are less likely to be overworked; and enjoy excellent professional relationships with doctors. They also play key roles in institutional policy-making­—the main principle behind the Nurse Leaders in the Boardroom project, which is founded on the belief that everyone benefits when nurses have more influence on decisions about health care.

After an extensive review process, the ANCC awards Magnet status to eligible health care organizations that meet five overarching criteria. To earn the distinction, health care organizations must show that nurse leaders at all levels in the organization have the power to transform their organization to meet present and future health care needs; that structures are in place and professional relationships are strong enough to foster an innovative environment that enables the organization to achieve desired outcomes; that the nursing staff demonstrates exemplary professional practice; that the organization puts a premium on acquiring new knowledge and applying innovations in the science of nursing; and that organizations can show excellence with empirical data.

A supportive work environment for nurses also helps the bottom line, Aiken notes. Hospitals pay the equivalent of a full-time nurse salary—between $60,000 and $80,000—to recruit and train a new nurse. “If you have a turnover rate of over 10 percent,” Aiken says, “that’s a lot of money—and it really adds up.”

Aiken estimates that about one in five hospitals currently have supportive environments for nurses. “That clearly shows that a substantial number of hospitals in the current economic climate can create these effective organizations that can attract and retain nurses;” she says. “Often hospitals say, ‘We can’t do this in the current climate.’ But if you have 20 percent of hospitals in the same location that can do it, it suggests others can too.”

Aiken is now broadening the scope of her research to include hospitals across the country and around the globe. So far, she has found the same result in every location: Patients fare better when nurses fare better.

“We’re trying to determine how hospitals can achieve the best possible outcomes for patients in an affordable way,” she says. “I think the solution is mobilizing nurses in a more creative way than has been the tradition in hospitals.”

Click here to learn more about Nurse Leaders in the Boardroom.

*Note: Nurse leaders now serve on the boards of the following health care organizations thanks to Nurse Leaders in the Boardroom:

  • Linda Aiken, M.N., Ph.D., a professor at the University of Pennsylvania and director of the university’s Center for Health Outcomes and Policy Research, serves on the board of Health Affairs, a health policy journal.
  • Faye Gary, Ed.D., R.N., F.A.A.N., a professor of nursing at Case Western Reserve University in Ohio, serves on the board of the Journal of Health and Social Policy.
  • DeAnne Messias, R.N., Ph.D., graduate director of Women's and Gender Studies and an associate professor of nursing at the University of South Carolina, and Bobbie Berkowitz, Ph.D., R.N., C.N.A., director of the Center for the Advancement of Health Disparities Research at the University of Washington School of Nursing, serve on the board of the Journal of Public Health Management and Practice.
  • Sean Clarke, Ph.D., C.R.N.P., F.A.A.N., an adjunct associate professor at the University of Pennsylvania School of Nursing and associate director of the university’s Center for Health Outcomes and Policy Research, serves on the board of Medical Care, the official journal of the Medical Care section of the American Public Health Association.
  • Joanne Disch, Ph.D., R.N., F.A.A.N., senior associate director of nursing at the University of Minnesota Hospital, serves on the board of the National Center for Healthcare Leadership, a non-profit health care organization.
  • Mary Naylor, Ph.D., R.N., F.A.A.N., a professor and director of the New Courtland Center for Transitions and Health at the University of Pennsylvania, serves on the board of RAND Health, the health care research division of RAND Corp.

Most Requested