The influence of clinical nursing expertise on patient outcomes has yet to be factored into outcomes research. Incorporating expertise into outcomes research entails the development of measures and models suitable for an organizational research framework. This study bridges the research traditions of Linda Aiken and Patricia Benner. I propose to develop survey measures of clinical nursing expertise and test the survey measures in outcomes research models. The survey measures will be developed using primary survey and narrative data collected from a purposive sample of staff nurses at the Hospital of the University of Pennsylvania. Nursing expertise measures will be tested in outcomes research models using nurse survey and patient outcomes data collected in an NINR-funded study by Penn's Center for Health Outcomes and Policy Research. My immediate goal is to develop valid, reliable survey measures of clinical nursing expertise. My long term goal is to build a program of research that delineates the mechanisms whereby nursing influences patient outcomes. To fulfill these goals, the research career development plan comprises training in advanced qualitative and quantitative research methods. The qualitative research methods will be required to validate the nursing expertise instrument. The quantitative research methods will be used to evaluate the psychometric properties of the expertise instrument and to develop multi-level mult-stage models linking the organization of nursing to outcomes. These models will test the direct and indirect effects of clinical expertise and other individual and organizational characteristics on outcomes employing such methods as multiple imputation, hierarchical linear modeling, and structural equation modeling.
My aims for this research career award are to: 1) gain new qualitative and quantitative research skills, 2) develop my program of research by introducing clinical expertise into outcomes research, 3) publish findings in peer- reviewed journals, 4) develop a proposal for extramural funding examining the effect of the practice environment on nursing expertise and of nursing expertise on outcomes, and 5) establish interdisciplinary collaborative relationships with experts in the fields of survey development, clinical nursing expertise, and advanced qualitative and quantitative research methods.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Scientist Development Award - Research & Training (K01)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Bryan, Yvonne E
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University of Pennsylvania
Schools of Nursing
United States
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McHugh, Matthew D; Lake, Eileen T (2010) Understanding clinical expertise: nurse education, experience, and the hospital context. Res Nurs Health 33:276-87
Lake, Eileen T; Friese, Christopher R (2006) Variations in nursing practice environments: relation to staffing and hospital characteristics. Nurs Res 55:1-9
Lake, Eileen T (2002) Development of the practice environment scale of the Nursing Work Index. Res Nurs Health 25:176-88