Sean Clarke
FAAN PhD RN
Ursula Springer Professor in Nursing Leadership
sean.clarke@nyu.edu
1 212 998 5264
Ursula Springer Professor in Nursing Leadership
433 First Ave
New York, NY 10010
United States
Sean Clarke's additional information
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Sean Clarke, RN, PhD, FAAN, is a professor at NYU Rory Meyers College of Nursing. His research focuses on quality and safety issues in acute care hospitals, workforce issues, occupational safety of nurses, and the influences of economic and political factors on healthcare 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 co-authored over 100 peer-reviewed articles and 30 book chapters. Clarke has been a principal investigator on projects supported by the National Institute of Nursing Research, the Centers for Disease Control and Prevention, 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, he also supervises PhD and postdoctoral research trainees and maintains a program of research with colleagues from a number of countries.
Clarke has been a member of a variety of panels and boards related to health research and healthcare quality. He has had extensive involvement in peer review of research articles and grants and served on editorial boards of a number of scientific and professional journals in nursing and health services research. 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.
Prior to joining the faculty at NYU Meyers, he was a professor and associate dean in the Undergraduate Program at the Connell School of Nursing, Boston College, from 2014–2018. He was also on faculty at the University of Pennsylvania School of Nursing for seven 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. He also co-directed 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 two decades in Canada, the United States, and internationally.
Clarke completed his basic clinical and research training in nursing at McGill University, in Montreal, Canada, and pursued a nurse practitioner education and a postdoctoral research fellowship at the University of Pennsylvania. He holds BA and BS degrees from the University of Ottawa and Carleton University, in his hometown of Ottawa, Canada.
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PhD, McGill University School of NursingMS, McGill University School of NursingBA, Carleton UniversityBS, University of Ottawa
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Nursing workforceAdult healthNursing administrationHealth Policy
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Faculty Honors 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)Junior Faculty Research Award, Biobehavioral and Health Sciences Division School of Nursing, University of Pennsylvania (2006)Fellow, American Academy of Nursing (2006)Class of 1965 25th Reunion Term Chair, University of Pennsylvania School of Nursing [for enduring contributions to undergraduate education] (2006)American Academy of Nursing Media Award for coverage of Aiken, Clarke et al., JAMA, October 23/30, 2002 (2003)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. Health Affairs, 2001 (2002)Induction into Sigma Theta Tau, Xi Chapter (1999) -
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Publications
Toward a Stronger Post-Pandemic Nursing Workforce
Buerhaus, P., Fraher, E., Frogner, B., Buntin, M., O’reilly-Jacob, M., & Clarke, S. (2023). New England Journal of Medicine, 389(3), 200-202. 10.1056/NEJMp2303652Educators’ Perceptions of the Development of Clinical Judgment of Direct-Entry Students and Experienced RNs Enrolled in NP Programs
AbstractLavoie, P., & Clarke, S. P. (2022). Journal of Nursing Regulation, 12(4), 4-15. 10.1016/S2155-8256(22)00011-4AbstractBackground: Nurse practitioner (NP) education was originally reserved for experienced nurses, but it has gradually opened to nurses with little to no clinical experience at the registered nurse (RN) level as well as to non-nurses. The existence of multiple paths to NP training and practice raises questions about the role of generalist RN experience in learning clinical decision-making and other aspects of the NP role. Purpose: To describe educators’ perceptions of the role of prior nursing experience in the development of clinical judgment during NP graduate education. Methods: In this qualitative descriptive study, 27 NP faculty from four universities participated in individual interviews. Transcripts were analyzed using a thematic approach. Results: According to participants, previous nursing experience—or any relevant experience—can either be helpful or detrimental in the development of NP students’ clinical judgment. Three themes were generated: variations in students’ baseline knowledge and skills, different frames of reference to grasp new content and skills, and challenges related to professional identity. In addition, participants described factors that they believe can affect the impact of different types of experience. Conclusion: Students with and without prior nursing experience face distinct challenges in learning NP-level clinical decision-making and judgment, but they reach similar end-of-program competence. Educators are confronted with contradictions between generally held wisdom, their professional socialization, and first-hand observations regarding the role of experience (inside and outside nursing) in preparing students to become NPs.Evaluating Policy
Clarke, S. P., & Logan, P. (2022). In Nurses Making Policy: Structures, Processes, and Outcomes (1–, pp. 357-390). Springer Publishing Company. 10.1891/9780826166463.0012The nurse workforce
AbstractClarke, S. P. (2021). In Nurses Contributions to Quality Health Outcomes (1–, pp. 39-60). Springer International Publishing. 10.1007/978-3-030-69063-2_3AbstractThe nurse workforce-the nurses available to provide care to a group of patients or a population and the characteristics of these nurses-provides a critical context for the Quality Health Outcomes Model (QHOM). This chapter begins with a brief consideration of workforce issues within the QHOM. Two forces at the heart of workforce analysis (supply and demand) and how these forces play out in various arenas for nursing practice are discussed. This chapter does not focus on managers' decisions regarding coverage of patient care responsibilities by nursing staff and nursing personnel qualifications, which fall within the realm of staffing (see Chaps. 4 and 13). Instead, it will focus on the size and composition of the body of nurses providing care, the forces that influence this body of nurses, and how workforce parameters act as an element of context for staffing, practice environments, and nursing care delivery. The chapter concludes with discussions of ongoing and emerging trends likely to influence the nurse workforce, especially in relation to healthcare quality and safety considerations.Nurses' experience of handoffs on four Canadian medical and surgical units: A shared accountability for knowing and safeguarding the patient
AbstractLavoie, P., Clausen, C., Purden, M., Emed, J., Frunchak, V., & Clarke, S. P. (2021). Journal of Advanced Nursing, 77(10), 4156-4169. 10.1111/jan.14997AbstractAims: To explore nurses' experience and describe how they manage various contextual factors affecting the nurse-to-nurse handoff at change of shift. Design: Qualitative descriptive study. Methods: A convenience sample of 51 nurses from four medical and surgical care units at a university-affiliated hospital in Montreal, Canada, participated in one of the 19 focus group interviews from November 2017 to January 2018. Data were analysed through a continuous and iterative process of thematic analysis. Results: Analysis of the data generated a core theme of ‘sharing accountability for knowing and safeguarding the patient’ that is achieved through actions related to nurses' role in the exchange. Specifically, the outgoing nurse takes actions to ensure continuity of care when letting go, and the incoming nurse takes actions to provide seamless care when taking over. In both roles, nurses navigate each handoff juncture by mutually adjusting, ensuring attentiveness, managing judgements, keeping on track, and venting and debriefing. Handoff is also shaped by contextual conditions related to handoff norms and practices, the nursing environment, individual nurse attributes and patient characteristics. Conclusions: This study generated a conceptualization of nurses' roles and experience that details the relationship among the elements and conditions that shape nurse-to-nurse handoffs. Impact: Nursing handoff involves the communication of patient information and relational behaviours that support the exchange. Although many factors are known to influence handoffs, little was known about nurses' experience of dealing with these at the point of care. This study contributed a comprehensive conceptualization of nursing handoff that could be useful in identifying areas for quality improvement and guiding future educational efforts.Top priorities for the next decade of nursing health services research
AbstractCohen, C. C., Barnes, H., Buerhaus, P. I., Martsolf, G. R., Clarke, S. P., Donelan, K., & Tubbs-Cooley, H. L. (2021). Nursing Outlook, 69(3), 265-275. 10.1016/j.outlook.2020.12.004AbstractBackground: The U.S. health care system faces increasing pressures for reform. The importance of nurses in addressing health care delivery challenges cannot be overstated. Purpose: To present a Nursing Health Services Research (NHSR) agenda for the 2020s. Method: A meeting of an interdisciplinary group of 38 health services researchers to discuss five key challenges facing health care delivery (behavioral health, primary care, maternal/neonatal outcomes, the aging population, health care spending) and identify the most pressing and feasible research questions for NHSR in the coming decade. Findings: Guided by a list of inputs affecting health care delivery (health information technology, workforce, delivery systems, payment, social determinants of health), meeting participants identified 5 to 6 research questions for each challenge. Also, eight cross-cutting themes illuminating the opportunities and barriers facing NHSR emerged. Discussion: The Agenda can act as a foundation for new NHSR – which is more important than ever – in the 2020s.Nurses’ judgments of patient risk of deterioration at change-of-shift handoff: Agreement between nurses and comparison with early warning scores
AbstractLavoie, P., Clarke, S. P., Clausen, C., Purden, M., Emed, J., Mailhot, T., Fontaine, G., & Frunchak, V. (2020). Heart and Lung, 49(4), 420-425. 10.1016/j.hrtlng.2020.02.037AbstractBackground: Nurses begin forming judgments regarding patients’ clinical stability during change-of-shift handoffs. Objectives: To examine the agreement between incoming and outgoing nurses’ judgments of deterioration risk following handoff and compare these judgments to commonly used early warning scores (MEWS, NEWS, ViEWS). Methods: Following handoffs on three medical/surgical units, nurses completed the Patient Acuity Rating. Nurse ratings were compared with computed early warning scores based on clinical data. In follow-up interviews, nurses were invited to describe their experiences of using the rating scale. Results: Sixty-two nurses carried out 444 handoffs for 158 patients. While the agreement between incoming and outgoing nurses was fair, correlations with early warning scores were low. Nurses struggled with predicting risk and used their impressions of differential risk across all the patients to whom they had been assigned to arrive at their ratings. Conclusion: Nurses shared information that influenced their clinical judgments at handoff; not all of these cues may necessarily be captured in early warning scores.Nursing handoffs and clinical judgments regarding patient risk of deterioration: A mixed-methods study
AbstractLavoie, P., Clarke, S. P., Clausen, C., Purden, M., Emed, J., Cosencova, L., & Frunchak, V. (2020). Journal of Clinical Nursing, 29(19), 3790-3801. 10.1111/jocn.15409AbstractAims and objectives: To explore how change-of-shift handoffs relate to nurses' clinical judgments regarding patient risk of deterioration. Background: The transfer of responsibility for patients' care comes with an exchange of information about their condition during change-of-shift handoff. However, it is unclear how this exchange affects nurses' clinical judgments regarding patient risk of deterioration. Design: A sequential explanatory mixed-methods study reported according to the STROBE and COREQ guidelines. Methods: Over four months, 62 nurses from one surgical and two medical units at a single Canadian hospital recorded their handoffs at change of shift. After each handoff, the two nurses involved each rated the patient's risk of experiencing cardiac arrest or being transferred to an intensive care unit in the next 24 hr separately. The information shared in handoffs was subjected to content analysis; code frequencies were contrasted per nurses' ratings of patient risk to identify characteristics of information that facilitated or hindered nurses' agreement. Results: Out of 444 recorded handoffs, there were 125 in which at least one nurse judged that a patient was at risk of deterioration; nurses agreed in 32 cases (25.6%) and disagreed in 93 (74.4%). These handoffs generally included information on abnormal vital signs, breathing problems, chest pain, alteration of mental status or neurological symptoms. However, the quantity and seriousness of clinical cues, recent transfers from intensive care units, pain without a clear cause, signs of delirium and nurses' knowledge of patient were found to affect nurses' agreement. Conclusions: Nurses exchanged more information regarding known indicators of deterioration in handoffs when they judged that patients were at risk. Disagreements most often involved incoming nurses rating patient risk as higher. Relevance to clinical practice: This study suggests a need to sensitise nurses to the impact of certain cues at report on their colleagues' subsequent clinical judgments. Low levels of agreement between nurses underscore the importance of exchanging impressions regarding the likely evolution of a patient's situation to promote continuity of care.Association of State-Level Restrictions in Nurse Practitioner Scope of Practice With the Quality of Primary Care Provided to Medicare Beneficiaries
AbstractPerloff, J., Clarke, S., DesRoches, C. M., O’Reilly-Jacob, M., & Buerhaus, P. (2019). Medical Care Research and Review, 76(5), 597-626. 10.1177/1077558717732402AbstractContext: 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.Debriefing approaches for high-fidelity simulations and outcomes related to clinical judgment in baccalaureate nursing students
AbstractLavoie, P., Pepin, J., Cossette, S., & Clarke, S. P. (2019). Collegian, 26(5), 514-521. 10.1016/j.colegn.2019.01.001AbstractSimulation 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.