Linda Aiken and colleagues at the University of Pennsylvania conducted an analysis of organizational change in 22 "better" hospitals (magnet hospitals and similar institutions), comparing data from 1986 to 1998, and looking particularly at changes in nurse staffing and practice environments. Overall, they found that hospital managers have not adequately evaluated consequences before adopting reforms. Roughly 90% of the institutions reduced staff through layoffs and attrition, despite the fact that nurse staffing levels are associated with improved patient outcomes. They found a "serious erosion" of the quality of the nursing practice environment over time. The study found that restructuring hurt caregiving in these hospitals without providing apparent benefits to offset the harm.

Aiken LH, et al. J Nurs Adm 2000;30(10):457-65.