My research relates prominently to PARC Theme Health Care and Long-Term Care at Older Ages. I am an authority on (1) causes, consequences, and solutions for nurse shortages in both the U.S. and internationally (2) the demography of nursing: global nurse migration, its consequences, and solutions in developing and developed countries, and (3) the study of returns on human capital investment in nursing (formal education and standards, plus its interaction with the nurse working environment) on outcomes for patients and for the efficiency of the health care system. As founding Director of the Center for Health Outcomes and Policy Research (CHOPR) established in 1989, I have directed a series of large-scale studies in the U.S. and abroad about the impact of nursing on outcomes for patients with chronic illnesses, those undergoing common and specialty surgical procedures, and for persons with AIDS, cancer, and the seriously mentally ill. With colleagues from Penn and around the world, CHOPR researchers study health system organization and policy changes to produce research evidence to improve the quality of health care. Since 1997, I have had continuous funding to study the effects of hospital organization and staffing on patient outcomes (R01 NR004513, R01 NR014855, P30 NR005043, P30 NR004000, P30 AI045008, R01 HS006858, R01 HS08603, R01 NR002280, Robert Wood Johnson, Sigma Theta Tau International, and Penn Global Engagement Fund).
I have directed Advanced Training in Nursing Outcomes Research (T32 NR017104) since its inception in 1999, which funds a pre- and post-doctoral research & training program in health outcomes research and draws upon the statistical expertise of PSC colleagues Matthew McHugh, Paul Allison, Paul Rosenbaum, and Herbert Smith. I am faculty on T32 HD007242 (PI: M. Guillot). I am a Co-Investigator with Matthew McHugh PI on R01AG041099, who is my colleague and was a NINR T32 trainee in 2004.
Internationally, I led the EU’s International Hospital Outcomes Consortium studying the impact of nursing on patient outcomes (RN4Cast) in 14 countries, and directed the Nursing Quality Improvement Program in Russia and Armenia demonstrating the successful application of twinning initiatives in nursing to improved hospital quality. I am PI on R01NR014855 “Panel Study of Effects of Changes in Nursing on Patient Outcomes in Chile” and MPI (with Sermeus, KU Leuven) EU Magnet4Europe.
My research has received the highest awards in health services research, which includes the International Council of Nurses’ Christiane Reimann Prize, presented every 4 years for significant impact on the nursing profession for the benefit of humanity (2017). In addition, I’ve received the Sigma Theta Tau International Nell Watts Lifetime Achievement of Nursing Award (2017), University of Florida College of Nursing Dorothy Smith Legacy Award (2016), and the National Academy of Medicine Gustav O. Lienhard Award (2014).