Amy Witkoski Stimpfel

Faculty

Amy Witkoski Stimpfel Headshot

Amy Witkoski Stimpfel

Assistant Professor

1 212 992 9387

433 First Ave
Room 658
New York, NY 10010
United States

Accepting PhD students

Amy Witkoski Stimpfel's additional information

Amy Witkoski Stimpfel is an assistant professor at NYU Rory Meyers College of Nursing and the Deputy Director of the NIOSH-funded T-42 doctoral training program in occupational and environmental health nursing. Her research explores how to optimize nurses’ work environment to improve nurse well-being, such as burnout, and clinical outcomes, like patient safety. Her scholarship draws from theories and methods used in health services research, occupational health and safety, sleep/chronobiology, and nursing. Witkoski Stimpfel’s research has been funded by the American Nurses Foundation, the National Council of State Boards of Nursing, and others and published in leading health policy and nursing journals such as Health Affairs, Health Services Research, and The International Journal of Nursing Studies.

Prior to joining the Meyers faculty, Witkoski Stimpfel completed a post-doctoral fellowship at the University of Pennsylvania in the Center for Health Outcomes and Policy Research.

Witkoski Stimpfel earned a PhD and MS at the University of Pennsylvania and a BSN from Villanova University.

PhD - University of Pennsylvania (2011)
MS - University of Pennsylvania (2009)
BSN - Villanova University (Cum Laude, 2006)

Nursing workforce
Health Services Research

AcademyHealth
American Association of Occupational Health Nurses
American Nurses Association
Eastern Nursing Research Society
Sigma Theta Tau International
Sleep Research Society

Faculty Honors Awards

T32 Post-doctoral fellowship, National Institute of Nursing Research
Connelly-Delouvrier Scholarship for International Nursing in Ireland
At-large member, Advisory Committee of the Interdisciplinary Research Group on Nursing Issues (IRGNI)
Inducted into Sigma Theta Tau International Honor Society
T01 Pre-doctoral fellowship, National Institute for Occupational Safety and Health

Publications

Dimensions of Being a Midwife and Midwifery Practice in the United States: A Qualitative Analysis

Thumm, E. B., Stimpfel, A. W., & Squires, A. (2022). International Journal of Childbirth, 12(2), 84-99. 10.1891/IJC-2021-0025
Abstract
Abstract
BACKGROUND: Midwives are a vital component of addressing maternal mortality crisis in the United States (US); however, there is scant understanding of the elements of midwifery practice that affect patient outcomes and the stability of the midwifery workforce in the country. This study investigates US midwives’ perceptions of factors influencing their practice and willingness to stay in the profession. METHODS: We applied a pragmatic qualitative design using summative content analysis techniques to code 1,035 comments from a national sample of 2,887 certified nurse-midwives and certified midwives. Two coders identified categories and themes of midwives’ perceptions of their practice environments, which were confirmed by an independent auditor. RESULTS: Eight themes emerged from the data: I love midwifery but…; feeling valued and respected…or not; workload; time and its consequences; the multilevel geography of midwifery practice; changes at odds with quality midwifery care; midwives withdrawing from practice to cope; and the ambiguity of “I just want to practice like a midwife.” CONCLUSION: Midwives readily identified aspects of their practice environment that negatively impact quality of care and stability of the midwifery workforce, including not valuing midwives, high workload, regulatory restrictions, and moral distress; however, respondents expressed strong commitment to the profession of midwifery. The findings also demonstrated the lack of a universally accepted definition of midwifery care within respondents’ professional communities and among respondents. Initiatives to increase integration of midwifery into the US perinatal health system will benefit from taking these findings into consideration.

The intellectual capital supporting nurse practice in a post-emergency state: A case study

Ridge, L. J., Liebermann, E. J., Stimpfel, A. W., Klar, R. T., Dickson, V. V., & Squires, A. P. (2022). Journal of Advanced Nursing. 10.1111/jan.15282
Abstract
Abstract
Aim: To explore the resources supporting current nurse practice in the post-emergency country of Liberia, using the nursing intellectual capital framework, as nurses work to meet the targets set by Government of Liberia's Essential Package of Health Services. Design: Case study. Methods: Data were collected in Liberia February–June 2019. Direct observation, semi-structured interviews and photographs were used to investigate how nurse practice is supported. Field notes, transcripts and photographs were coded using both directed and conventional content analysis. Reports were then generated by code to triangulate the data. Results: Thirty-seven nurses at 12 health facilities participated. The intellectual capital supporting inpatient and outpatient nurse practice differs in important ways. Inpatient nurse practice is more likely to be supported by facility-based protocols and trainings, whereas outpatient nurse practice is more likely to be supported by external protocols and trainings, often developed by the Liberian government or non-governmental organizations. This can lead to uneven provision of inpatient protocols and trainings, often favouring private facilities. Similarly, inpatient nurses rely primarily on other nurses at their facilities for clinical support while outpatient nurses often have external professional relationships that provided them with clinical guidance. Conclusion: Much has been accomplished to enable outpatient nurses to provide the primary- and secondary-care target services in the Essential Package of Health Services. However, as the Liberian government and its partners continue to work towards providing certain tertiary care services, developing analogous protocols, trainings and clinical mentorship networks for inpatient nurses will likely be fruitful, and will decrease the burden on individual facilities. Impact: Nurses are often expected to meet new service provision targets in post-emergency states. Further research into how best to support nurses as they work to meet those targets has the potential to strengthen health systems.

Original Research: Losing the Art and Failing the Science of Nursing: The Experiences of Nurses Working during the COVID-19 Pandemic

Stimpfel, A. W., Ghazal, L., Goldsamt, L. A., Zhanay, J., & Dickson, V. V. (2022). American Journal of Nursing, 122(4), 22-29. 10.1097/01.NAJ.0000827324.34143.7a
Abstract
Abstract
Purpose:RNs have served as the bedrock of the response to the COVID-19 pandemic, working under unprecedented and difficult conditions. In this study, we sought to understand the experiences of nurses working across a range of care settings in the United States during the first six months of the pandemic, and to learn more about barriers to and facilitators of their work.Methods:This is a qualitative descriptive study. We recruited participants online through regional professional nursing membership listservs, program directors of occupational health nursing training programs, and social media. After completing a survey, potential participants were invited to complete an individual semistructured interview via the Zoom platform. From June through August 2020, we conducted 34 interviews. Content analysis was performed using ATLAS.ti software.Results:The overarching theme - "Losing the art and failing the science of nursing" - underscored the barriers nurses faced in the early months of this pandemic. It reflected the deeply painful disruptions in the care nurses were accustomed to providing their patients. Themes that reflected barriers included disrupted nurse-patient connection, lack of personal protective equipment and fear of infection, lack of evidence-based guidance, and understaffing, all of which drastically altered the delivery of nursing care. Themes that reflected facilitators to nurses' work included camaraderie and strength and resourcefulness.Conclusions:The study findings give important direction to nurse leaders, researchers, and organizations concerning potential areas of support that nurses need during and after this pandemic. Future research should investigate the long-term impact of COVID-19 and similar public health crises on nurses, as well as interventions that could support the workforce after an extended crisis.

A Pilot Observational Exploratory Study of Well-Being in Hospice Interdisciplinary Team Members

Schneider, C., Bristol, A., Ford, A., Lin, S. Y., Brody, A. A., & Stimpfel, A. W. (2022). American Journal of Hospice and Palliative Medicine, 39(3), 264-269. 10.1177/10499091211023480
Abstract
Abstract
Introduction: Well-being and turnover intent represent key aspects to the promotion of a healthy workforce. Alarming levels of burnout and low levels of well-being have been documented in health professionals across care settings. Not only do high levels of burnout, low well-being and high turnover affect health professionals, but they are associated with poor patient care. However, limited research has investigated this topic specifically in hospice interdisciplinary team (IDT) members, nurses, chaplains, social workers. Thus, the purpose of this study was to explore hospice IDT members’ well-being, and turnover intent. Methods: This observational, pilot study used quantitative surveys to examine the well-being, and turnover intention at baseline and at 3 months. Twenty-five hospice IDT members at one site participated. Results: Paired t-tests and percent change demonstrated significant decreases in compassion satisfaction (44.5 vs. 42.1, p = 0.04) and secondary traumatic stress score (18.5 vs. 13.3, p = 0.0001) and a significant increase in burnout score (17.6 vs. 20.5, p = 0.03) from baseline to follow up. Employee turnover slightly decreased from baseline to follow-up. Conclusions: In this pilot study, hospice IDT members had low levels of well-being at baseline that worsened over 3-months indicating a higher potential risk for burnout. Moreover, given the COVID-19 pandemic, this may be an ominous sign of what lies ahead for hospice providers regarding turnover, leading to significant long-term staffing problems in the field. If these results hold true in a larger sample, it could necessitate developing and testing further strategies to ensure a healthy and stable workforce.

How clinicians manage routinely low supplies of personal protective equipment

Ridge, L. J., Stimpfel, A. W., Dickson, V. V., Klar, R. T., & Squires, A. P. (2021). American Journal of Infection Control, 49(12), 1488-1492. 10.1016/j.ajic.2021.08.012
Abstract
Abstract
Background: Recommended personal protective equipment (PPE) is routinely limited or unavailable in low-income countries, but there is limited research as to how clinicians adapt to that scarcity, despite the implications for patients and workers. Methods: This is a qualitative secondary analysis of case study data collected in Liberia in 2019. Data from the parent study were included in this analysis if it addressed availability and use of PPE in the clinical setting. Conventional content analysis was used on data including: field notes documenting nurse practice, semi-structured interview transcripts, and photographs. Results: Data from the majority of participants (32/37) and all facilities (12/12) in the parent studies were included. Eighty-three percent of facilities reported limited PPE. Five management strategies for coping with limited PPE supplies were observed, reported, or both: rationing PPE, self-purchasing PPE, asking patients to purchase PPE, substituting PPE, and working without PPE. Approaches to rationing PPE included using PPE only for symptomatic patients or not performing physical exams. Substitutions for PPE were based on supply availability. Conclusions: Strategies developed by clinicians to manage low PPE likely have negative consequences for both workers and patients; further research into the topic is important, as is better PPE provision in low-income countries.

Infection Prevention and Control in Liberia 5 Years After Ebola: A Case Study

Ridge, L. J., Stimpfel, A. W., Klar, R. T., Dickson, V. V., & Squires, A. P. (2021). Workplace Health and Safety, 69(6), 242-251. 10.1177/2165079921998076
Abstract
Abstract
Background: Effective management of health emergencies is an important strategy to improve health worldwide. One way to manage health emergencies is to build and sustain national capacities. The Ebola epidemic of 2014 to 2015 resulted in greater infection prevention and control (IPC) capacity in Liberia, but few studies have investigated if and how that capacity was sustained. The purpose of this study was to examine the maintenance of IPC capacity in Liberia after Ebola. Methods: For this case study, data were collected via direct observation of nurse practice, semistructured interviews, and document collection. Data were collected in two counties in Liberia. Data were analyzed using directed content and general thematic analysis using codes generated from the safety capital theoretical framework, which describes an organization’s intangible occupational health resources. Findings: Thirty-seven nurses from 12 facilities participated. Ebola was a seminal event in the development of safety capital in Liberia, particularly regarding nurse knowledge of IPC and facilities’ investments in safety. The safety capital developed during Ebola is still being applied at the individual and organizational levels. Tangible resources, including personal protective equipment, however, have been depleted. Conclusions/Application to Practice: IPC capacity in Liberia had been sustained since Ebola but was threatened by under-investments in physical resources. Donor countries should prioritize sustained support, both financial and technical, in partnership with Liberian leaders. Occupational health nurses participating in disaster response should advocate for long-term investment by donor countries in personal protective equipment, access to water, and clinician training.

Kairos care in a Chronos world: Midwifery care as model of resistance and accountability in public health settings

Niles, P. M., Vedam, S., Witkoski Stimpfel, A., & Squires, A. (2021). Birth, 48(4), 480-492. 10.1111/birt.12565
Abstract
Abstract
Background: In the United States (US), pregnancy-related mortality is 2–4 times higher for Black and Indigenous women irrespective of income and education. The integration of midwifery as a fundamental component of standard maternity services has been shown to improve health outcomes and service user satisfaction, including among underserved and minoritized groups. Nonetheless, there remains limited uptake of this model in the United States. In this study, we examine a series of interdependent factors that shape how midwifery care operates in historically disenfranchised communities within the Unites States. Methods: Using data collected from in-depth, semi-structured interviews, the purpose of this study was to examine the ways midwives recount, describe, and understand the relationships that drive their work in a publicly funded urban health care setting serving minoritized communities. Using a qualitative exploratory research design, guided by critical feminist theory, twenty full-scope midwives working in a large public health care network participated. Data were thematically analyzed using Braun & Clarke's inductive thematic analysis to interpret data and inductively identify patterns in participants’ experiences. Findings: The overarching theme “Kairos care in a Chronos World” captures the process of providing health-promoting, individualized care in a system that centers measurement, efficiency, and pathology. Five subthemes support the central theme: (1) the politics of progress, (2) normalizing pathologies, (3) cherished connections, (4) protecting the experience, and (5) caring for the social body. Midwives used relationships to sustain their unique care model, despite the conflicting demands of dominant (and dominating) medical models. Conclusion: This study offers important insight into how midwives use a Kairos approach to maternity care to enhance quality and safety. In order to realize equitable access to optimal outcomes, health systems seeking to provide robust services to historically disenfranchised communities should consider integration of relationship-based strategies, including midwifery care.

Telemedicine and Telehealth in Nursing Homes: An Integrative Review

Groom, L. L., McCarthy, M. M., Stimpfel, A. W., & Brody, A. A. (2021). Journal of the American Medical Directors Association, 22(9), 1784-1801.e7. 10.1016/j.jamda.2021.02.037
Abstract
Abstract
Objectives: Telemedicine and telehealth are increasingly used in nursing homes (NHs). Their use was accelerated further by the COVID-19 pandemic, but their impact on patients and outcomes has not been adequately investigated. These technologies offer promising avenues to detect clinical deterioration early, increasing clinician's ability to treat patients in place. A review of literature was executed to further explore the modalities' ability to maximize access to specialty care, modernize care models, and improve patient outcomes. Design: Whittemore and Knafl's integrative review methodology was used to analyze quantitative and qualitative studies. Setting and Participants: Primary research conducted in NH settings or focused on NH residents was included. Participants included clinicians, NH residents, subacute patients, and families. Methods: PubMed, Web of Science, CINAHL, Embase, PsycNET, and JSTOR were searched, yielding 16 studies exploring telemedicine and telehealth in NH settings between 2014 and 2020. Results: Measurable impacts such as reduced emergency and hospital admissions, financial savings, reduced physical restraints, and improved vital signs were found along with process improvements, such as expedient access to specialists. Clinician, resident, and family perspectives were also discovered to be roundly positive. Studies showed wide methodologic heterogeneity and low generalizability owing to small sample sizes and incomplete study designs. Conclusions and Implications: Preliminary evidence was found to support geriatrician, psychiatric, and palliative care consults through telemedicine. Financial and clinical incentives such as Medicare savings and reduced admissions to hospitals were also supported. NHs are met with increased challenges as a result of the COVID-19 pandemic, which telemedicine and telehealth may help to mitigate. Additional research is needed to explore resident and family opinions of telemedicine and telehealth use in nursing homes, as well as remote monitoring costs and workflow changes incurred with its use.

Variables Associated With Nurse-Reported Quality Improvement Participation

Djukic, M., Fletcher, J., Witkoski Stimpfel, A., & Kovner, C. (2021). Nurse Leader, 19(1), 76-81. 10.1016/j.mnl.2020.06.009
Abstract
Abstract
Lack of staff engagement in quality improvement (QI) is a persistent challenge in improving quality in health care. In this study, we examined variables associated with nurse-reported participation in QI using data from over 500 registered nurses employed in US hospitals. Of the 16 studied variables, based on the adjusted multivariate regression analysis, the following were positively associated (p < 0.05) with nurse-reported participation in QI: working in advanced practice nursing and manager roles versus staff nurse role, working a full-time work schedule versus a part-time work schedule, and reporting higher levels of procedural justice, quantitative workload, and work motivation.

Does unit culture matter? The association between unit culture and the use of evidence-based practice among hospital nurses

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