Sean Clarke, RN, PhD, FAAN, is a nurse academic and health services researcher who comes to the Rory Meyers College of Nursing at New York University after serving as Professor and Associate Dean, Undergraduate Program, at the Connell School of Nursing, Boston College in Chestnut Hill, MA from 2014-2018. Prior to his move to Boston, he was on faculty at the University of Pennsylvania School of Nursing for 7 years, held an endowed chair in cardiovascular nursing at the University of Toronto and was an endowed chair directing a special donor-funded set of projects intended to advance collaboration between the School of Nursing and its affiliated teaching hospitals at McGill University.
Dr. Clarke’s research has focused on quality and safety issues in acute care hospitals, workforce issues, occupational safety of nurses and the influences of economic and political factors on health care delivery and the nursing profession. He is perhaps best known for research on nurse staffing in hospitals and surveys of nurse working conditions. He has authored or coauthored over 100 peer-reviewed articles and 30 book chapters, he has been a principal investigator on projects supported by the National Institute of Nursing Research (NIH), the Centers for Disease Control and Prevention (CDC), the Robert Wood Johnson Foundation, and the Ontario Ministry of Health and Long-Term Care and has served as a co-investigator on grants totaling over $10 million over the course of his career. In addition to teaching nursing, health policy and research at the baccalaureate through doctoral levels, supervising PhD and postdoctoral research trainees and maintaining a program of research with colleagues from a number of countries, he codirected nursing health services and workforce research groups in Philadelphia and Toronto and has been a consultant to clinicians, leaders and professional associations on issues related to nursing and patient safety for almost 2 decades in Canada, the United States and internationally. Dr. Clarke has been a member of a variety of panels and boards related to health research and health care quality, has had extensive involvement in peer review of research articles and grants, and has served on editorial boards of a number of scientific and professional journals in nursing and health services research.
Clarke holds undergraduate degrees from both the University of Ottawa and Carleton University in his hometown of Ottawa, Canada, completed his basic clinical and research training in nursing at McGill University in Montreal, and pursued nurse practitioner education and a postdoctoral research fellowship at the University of Pennsylvania. He is a Fellow of the American Academy of Nursing, and currently holds affiliate faculty appointments at the Université de Montréal and the University of Hong Kong.
PhD, School of Nursing, McGill UniversityMS, School of Nursing, McGill UniversityBA, Carleton UniversityBS, University of Ottawa
Honors and awards
Creative Teaching Award, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto (2011)Dean’s Award for Undergraduate Teaching, University of Pennsylvania School of Nursing (2007)Class of 1965 25th Reunion Term Chair, University of Pennsylvania School of Nursing [for enduring contributions to undergraduate education] (2006)Fellow, American Academy of Nursing (2006)Junior Faculty Research Award, Biobehavioral and Health Sciences Division School of Nursing, University of Pennsylvania (2006)Article of the Year, Academy Health [Academy for Health Services Research and Health Policy] for Aiken, Clarke et al., JAMA, October 23/30, 2002 (2003)American Academy of Nursing Media Award for coverage of Aiken, Clarke et al., JAMA, October 23/30, 2002 (2003)American Academy of Nursing Media Award for coverage of Aiken, Clarke, et al. Health Affairs, 2001 (2002)Induction into Sigma Theta Tau, Xi Chapter (1999)
Debriefing approaches for high-fidelity simulations and outcomes related to clinical judgment in baccalaureate nursing studentsAbstractSimulation followed by debriefing is increasingly common in clinical nursing education. Yet, limited studies have compared approaches to debriefing—the portion of simulations where participants re-examine and make sense of their experience. In this study, 120 baccalaureate nursing students in Quebec were randomized to receive one of two types of debriefing (self-assessment with Plus-Delta vs. guided reflection using a structured tool with REsPoND) after each of four simulations (a hemorrhage scenario, two sepsis scenarios, and a trauma simulation) during which their situation awareness was measured as a proxy for their clinical judgment. Unexpectedly, situation awareness scores showed little to no consistency across students or simulations and no clear improvements over time were noted, which rendered the comparison of the debriefing approaches across scenarios problematic. However, when comparing the two iterations of the sepsis scenario, students who participated in a reflective debriefing showed greater improvement in their recognition of abnormalities in patient vital signs and level of consciousness than students whose debriefing involved self-assessment.
Adding unregulated nursing support workers to ward staffing: Exploration of a natural experimentAbstractAims and objectives: To explore the impact of an initiative to add unregulated nursing support workers to wards in acute care hospitals. Background: Adding nursing support workers to existing nurse staffing may be one solution to reduce nursing workloads and improve outcomes. However, the effects of this addition on nurse, patient and system outcomes are not well documented. In one state of Australia, a trial deployment of nursing support workers to wards across the public health system provided opportunity for the exploration of their impact in a natural, real-world, environment. Design: Cross-sectional study. Methods: A sample of five wards where nursing support workers had been added matched to a group of five wards where there were no nursing support workers. Data were collected via patient survey (n = 141) and nurse survey (n = 154). Analysis was comparative with regression models constructed for the different ward types. Results: Nursing leadership, staffing and resources, and nurse experience were linked to outcomes on both ward types. Instability was a significant predictor of reduced quality of care and increased turnover intention on wards where support workers were added. Conclusion: Adding nursing support workers to ward staffing did not lead to improvements in patient care. Findings suggest that staffing a nursing ward is a complex activity and that a simple approach to staffing is unlikely to be successful. Future research should explore the process of implementation and the conditions under which this strategy is likely to be successful. Relevance to clinical practice: Ward-level factors are key in making appropriate staffing and skill mix choices to limit instability and to consequently avoid negative patient, staff and system outcomes. Consideration of the ward context, alongside effective delegation processes and integration into the care team are imperative when adding nursing support workers.
Effect of transformational leadership on job satisfaction and patient safety outcomesAbstractBackground: Improving patient safety within health care organizations requires effective leadership at all levels. Purpose: The objective of this study was to investigate the effects of nurse managers’ transformational leadership behaviors on job satisfaction and patient safety outcomes. Methods: A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling. Finding: The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses’ job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events. Conclusion: The findings provide support for managers’ use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses.
Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and PhysiciansAbstractObjective: To examine differences in the quality of care provided by primary care nurse practitioners (PCNPs), primary care physicians (PCMDs), or both clinicians. Data Sources: Medicare part A and part B claims during 2012-2013. Study Design: Retrospective cohort design using standard risk-Adjustment methodologies and propensity score weighting assessing 16 claims-based quality measures grouped into 4 domains of primary care: chronic disease management, preventable hospitalizations, adverse outcomes, and cancer screening. Extraction Methods: Continuously enrolled aged, disabled, and dual eligible beneficiaries who received at least 25% of their primary care services from a random sample of PCMDs, PCNPs, or both clinicians. Principal Findings: Beneficiaries attributed to PCNPs had lower hospital admissions, readmissions, inappropriate emergency department use, and low-value imaging for low back pain. Beneficiaries attributed to PCMDs were more likely than those attributed to PCNPs to receive chronic disease management and cancer screenings. Quality of care for beneficiaries jointly attributed to both clinicians generally scored in the middle of the PCNP and PCMD attributed beneficiaries with the exception of cancer screening. Conclusions: The quality of primary care varies by clinician type, with different strengths for PCNPs and PCMDs. These comparative advantages should be considered when determining how to organize primary care to Medicare beneficiaries.
Scope of Nursing Practice in a Tertiary Pediatric Setting: Associations With Nurse and Job Characteristics and Job SatisfactionAbstractPurpose: While professional nursing, like other health professions, has a recognized educational base and a legal scope of practice that is remarkably consistent across societies, there are important variations even within the same institution or organization in the extent to which professional nurses engage in the full range of activities for which they are qualified. There has been limited study of enacted (actual) scope of nursing practice (ESOP) or of its impacts on nurse job outcomes, such as job satisfaction. The aim of this study is to measure ESOP, as well as its predictors and impact on job satisfaction, in a specialty university-affiliated tertiary referral center in one of the few remaining jurisdictions outside the United States that continue to educate registered nurses at multiple educational levels. Methods: This was a correlational cross-sectional design using structural equation modeling. Self-administered questionnaires were completed by 301 registered nurses holding permanent positions in specific clinical areas for 6 months or longer in a pediatric hospital in the province of Quebec, Canada. Findings: ESOP or actual scope of practice was low—on average, nurses applied the range of skills within their theoretical scopes of practice only occasionally or “less than frequently” in their daily work (3.21 out of a possible 6 points). ESOP was strongly related to decision latitude (β = 0.319; p =.012), role ambiguity (β = 0.297; p =.011), and role overload (β = 0.201; p =.012). The personal characteristics that exerted the greatest direct influence on ESOP were education level (β = 0.128; p =.015) and growth need strength (β = 0.151; p =.008). Results also showed that ESOP exerts a direct positive influence on nurses’ job satisfaction (β = 0.118; p =.006). Structural equation modeling analyses revealed a good fit of the data to the hypothesized conceptual model (χ²/df ratio index = 1.68, root mean square error of approximation = 0.049, confirmatory fit index = 0.985). Conclusions: Specific aspects of nurses’ jobs are closely related to ESOP. ESOP is limited by certain job and personal characteristics and appears to affect nurses’ job satisfaction. Clinical Relevance: Results suggest that ESOP might be improved by adjusting nursing job characteristics and practice environments and that expanding ESOP increases nurse job satisfaction and may improve other health system outcomes as well.
Association of State-Level Restrictions in Nurse Practitioner Scope of Practice With the Quality of Primary Care Provided to Medicare BeneficiariesAbstractContext: State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. Method: This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Findings: Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. Conclusion: State regulations restricting NP SoP do not improve the quality of care.
The BSN entry into practice debate
Get your hands dirty: Improving student clinical experiences
An Integrative Review of the Hands-Free Technique in the ORAbstractSharps injury rates are proportionally higher in perioperative areas than in other practice settings. The hands-free technique (HFT) has been shown to decrease the hazards of sharps injuries when passing sharps during surgery. We reviewed and synthesized research studies regarding compliance with the HFT and factors facilitating its use using a key word search of online databases and a secondary search of references. We reviewed English language studies published since 2001 regarding HFT compliance rates or related factors using the Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. We found 14 articles reporting a wide range of HFT compliance rates (ie, 5% to 84%), which identified that a number of organizational factors and health care workers’ perceptions of infection risks influenced the use of the HFT.
The quality of primary care provided by nurse practitioners to vulnerable Medicare beneficiariesAbstractBackground Studies suggest nurse practitioners are heavily represented among primary care providers for vulnerable Medicare beneficiaries. Purpose The purpose of this study was to compare quality indicators among three groups of vulnerable beneficiaries managed by MDs and nurse practitioners (NPs). Methods The methods include retrospective cohort design examining 2012 and 2013 Medicare claims for three beneficiary groups: (a) initially qualified for the program due to disability, (b) dually eligible for Medicare and Medicaid, and (c) both disabled and dually eligible. Validated quality indicators in four domains were analyzed. Discussion Gaps in outcomes suggest better performance for primary care nurse practitioners (PCNPs) in preventable hospitalizations and adverse outcomes. Outcome gaps suggesting better performance for primary care physicians in chronic disease management were diminished for beneficiaries who were both disabled and dually eligible suggesting improved performance for PCNPs within this subpopulation. Conclusion These findings add new evidence indicating the quality of primary care provided to vulnerable Medicare beneficiaries by PCNPs is generally consistent with clinical guidelines and the less intensive use of costly health care services.