Sean Clarke

Faculty

Sean Clarke Headshot

Sean Clarke

FAAN PhD RN

Ursula Springer Professor in Nursing Leadership
Executive Vice Dean

1 212 998 5264

433 First Ave
New York, NY 10010
United States

Sean Clarke, RN, PhD, FAAN, is the executive vice dean and 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.

PhD - McGill University School of Nursing
MS - McGill University School of Nursing
BA - Carleton University
BS - University of Ottawa

Nursing workforce
Adult health
Nursing administration
Health Policy

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)

Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model

Poghosyan, L., Boyd, D. R., & Clarke, S. P. (2016). Nursing Outlook, 64(2), 146-155. 10.1016/j.outlook.2015.11.015
Abstract
Abstract
Background: Nurse practitioners (NPs), if utilized to their optimal potential, could play a key role in meeting the growing demand for primary care. Purpose: The purpose of this study was to propose a comprehensive model for maximizing NP contributions to primary care which includes the factors affecting NP care and patient outcomes and explains their interrelated impact. Method: We synthesized the results of the published literature to develop a model, which emphasizes NP scope of practice regulations, institutional policies, NP practice environment, and NP workforce outcomes as determinants of NP care and patient outcomes. Discussion: Our model provides a framework to help explain how variations in scope of practice regulations at the state-level and institutional policies within organizations directly and indirectly influence the practice environment of NPs, NP workforce outcomes, and patient care and outcomes. Conclusion: Aligning policy change, organizational innovations, and future research are critical to NP optimal utilization and patient care and outcomes.

A protocol to assess the impact of adding nursing support workers to ward staffing

Duffield, C., Roche, M., Twigg, D., Williams, A., & Clarke, S. (2016). Journal of Advanced Nursing, 72(9), 2218-2225. 10.1111/jan.12965
Abstract
Abstract
Aim: To assess the impact of adding nursing support workers to ward staffing. Background: Nurses' capacity to provide safe care is compromised by increased workloads and nursing shortages. Use of unregulated workers is an alternative to increasing the number of regulated nurses. The impact of adding nursing support workers on patient, nurse and system outcomes has not been systematically evaluated. Design: A mixed longitudinal and cross-sectional design using administrative data sets and prospective data from a sample of wards. Methods: Payroll data will identify wards on which unregulated staff work. To assess the impact on nursing-sensitive outcomes, retrospective analysis of morbidity and mortality data of all patients admitted to Western Australia hospitals for over 24 hours across 4 years will be undertaken. For the cross-sectional study, a sample of 20 pairs of matched wards will be selected: 10 with unregulated workers added and 10 where they have not. From this sample the impact on patients will be assessed using the Patient Evaluation of Emotional Care during Hospitalisation survey. The impact on nurses will be assessed by a nurse survey used extensively which includes variables such as job satisfaction and intention to leave. The impact on system outcomes will be explored using work sampling of staff activities and the Practice Environment Scale. Interviews will determine nurses' experience of working with nursing support workers. Discussion: The study aims to provide evidence about the impact of adding nursing support workers to ward staffing for patients, staff and the work environment.

Rationing of nursing care interventions and its association with nurse-reported outcomes in the neonatal intensive care unit: A cross-sectional survey

Rochefort, C. M., Rathwell, B. A., & Clarke, S. P. (2016). BMC Nursing, 15(1). 10.1186/s12912-016-0169-z
Abstract
Abstract
Background: Evidence internationally suggests that staffing constraints and non-supportive work environments result in the rationing of nursing interventions (that is, limiting or omitting interventions for particular patients), which in turn may influence patient outcomes. In the neonatal intensive care unit (NICU), preliminary studies have found that discharge preparation and infant comfort care are among the most frequently rationed nursing interventions. However, it is unknown if the rationing of discharge preparation is related to lower perceptions of parent and infant readiness for NICU discharge, and if reports of increased rationing of infant comfort care are related to lower levels of perceived neonatal pain control. The purpose of this study was to assess these relationships. Methods: In late 2014, a cross-sectional survey was mailed to 285 Registered Nurses (RNs) working in one of 7 NICUs in the province of Quebec (Canada). The survey contained validated measures of care rationing, parent and infant readiness for discharge, and pain control, as well as items measuring RNs' characteristics. Multivariate regression was used to examine the association between care rationing, readiness for discharge and pain control, while adjusting for RNs' characteristics and clustering within NICUs. Results: Overall, 125 RNs completed the survey; a 44.0 % response rate. Among the respondents, 28.0 and 40.0 % reported rationing discharge preparation and infant comfort care "often" or "very often", respectively. Additionally, 15.2 % of respondents felt parents and infants were underprepared for NICU discharge, and 54.4 % felt that pain was not well managed on their unit. In multivariate analyses, the rationing of discharge preparation was negatively related to RNs' perceptions of parent and infant readiness for discharge, while reports of rationing of parental support and teaching and infant comfort care were associated with less favourable perceptions of neonatal pain control. Conclusions: The rationing of nursing interventions appears to influence parent and infant readiness for discharge, as well as pain control in NICUs. Future investigations, in neonatal nursing care as well as in other nursing specialties, should address objectively measured patient outcomes (such as objective pain assessments and post-discharge outcomes assessed through administrative data).

Risk Factors and Best Practices for the Prevention of Post-Cardiac Surgery Surgical Site Infections in a Tertiary Care Centre

Logan, S., Quinn, D., Brault, D., Vandal, V., Pare, B., & Clarke, S. (2016). Canadian Journal of Cardiovascular Nursing = Journal Canadien En Soins Infirmiers Cardio-Vasculaires, 26(4), 19-26.
Abstract
Abstract
BACKGROUND: Post-cardiac surgery surgical site infections (SSIs) pose devastating consequences in terms of morbidity and mortality to patients.OBJECTIVE: To examine current risk factors and best practice perioperative care for prevention of SSI following cardiac surgery through the lens of the demographic/clinical characteristics of patients who developed post-cardiac surgery SSIs at a major tertiary care institution, and to identify where documentation is lacking and could be improved to better serve clinical practice.METHODS: A literature review on post-cardiac surgery SSI prevention and risk factors was performed. These risk factors were examined through a retrospective chart review of the population of patients who developed SSIs during the study period.RESULTS: The study population was characterized by a high prevalence of riskfactors including age, diabetes, obesity, operative time, blood glucose control, surgical re-exploration, blood transfusions, and emergency context, as well as differences from best practice guidelines such as preoperative showering. Compared to other populations in the literature, several ofthese risk factors were more prevalent at the study site than in the other comparable populations.CONCLUSION: The patient population had a relatively high prevalence of riskfactors, and the care received by these patients varied in some ways from best practices. Using best practice guidelines, known risk factors, and the data specific to the institution can provide insightsfor analysis and practice improvement efforts in the form of identifying at-risk patients, improving adherence to best practice guidelines, targeting areas to focus care efforts, and improving clincal documentation.

Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: A qualitative evidence-synthesis

Jordan, J., Rose, L., Dainty, K. N., Noyes, J., Clarke, S., & Blackwood, B. (2015). Cochrane Database of Systematic Reviews, 2015(7). 10.1002/14651858.CD009851.pub2
Abstract
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To enhance and extend the recent Cochrane effectiveness review of protocolized weaning (Blackwood 2010) by synthesizing evidence from qualitative research to identify contextual factors that impact on the use of ventilator weaning protocols for critically ill adults and children. The research questions we will address are as follows. 1. Which contextual factors may have contributed to the heterogeneity in effect sizes of the randomized controlled trials included in the Blackwood (2010) review on protocolized weaning? (enhancing the review). 2. Which contextual factors (facilitators and barriers) may have an impact on the effective use of protocols for weaning critically ill adults and children from mechanical ventilation? (extending the review).

Influences on and Outcomes of Enacted Scope of Nursing Practice: A New Model

Déry, J., D’Amour, D., Blais, R., & Clarke, S. P. (2015). Advances in Nursing Science, 38(2), 136-143. 10.1097/ANS.0000000000000071
Abstract
Abstract
Enacted scope of practice is a major issue for nursing administrators, given the potentially negative effect on accessibility, continuity, safety and quality of care, job satisfaction, and organizational costs of nurses working at reduced scope. Optimal deployment of nurses to a fuller enacted scope of nursing practice holds much promise for addressing all of these larger challenges. In this sense, new model of the Enacted Scope of Nursing Practice presented in this article provides a number of directions for interventions that could improve health system functioning.

Pain and anxiety in rural acute coronary syndrome patients awaiting diagnostic cardiac catheterization

O’Keefe-McCarthy, S., McGillion, M., Clarke, S. P., & McFetridge-Durdle, J. (2015). Journal of Cardiovascular Nursing, 30(6), 546-557. 10.1097/JCN.0000000000000203
Abstract
Abstract
Context: In rural areas of Canada, people with acute coronary syndromes (ACS) can wait up to 32 hours for transfer for diagnostic cardiac catheterization (CATH). While awaiting CATH, it is critical that pain and anxiety management be optimal to preserve myocardial muscle and minimize the risk of further deterioration. Objectives: The aim of this study was to examine the relationship between clinical management, cardiac pain intensity, and state anxiety for rural ACS patients awaiting diagnostic CATH. Methods: In a prospective, descriptive-correlational repeated-measures design involving 121 ACS rural patients, we examined the associations of analgesic and nitroglycerin administration with cardiac pain intensity (numeric rating scale) and state anxiety (Spielberger State Anxiety Inventory) and also nurses' pain knowledge and attitudes (Toronto Pain Management InventoryYACS Version and Knowledge and Attitudes Survey Regarding Pain) using linear mixed models. Results: The mean age of patients was 67.6 T 13, 50% were men, and 60% had unstable angina and the remainder had non-ST-elevated myocardial infarction. During follow-up, cardiac pain intensity scores remained in the mild range from 1.1 T 2.2 to 2.4 T 2.7. State anxiety ranged from 44.0 T 7.2 to 46.2 T 6.6. Cumulative analgesic dose was associated with a reduction in cardiac pain by 1.0 points (numeric rating scale, 0Y10) (t108 = j2.5; SE, j0.25; confidence interval, j0.45 to j0.06; P = .013). Analgesic administration was not associated with state anxiety. Over the course of follow-up, ACS patients reported consistently high anxiety scores. Conclusions: Whereas cardiac pain declines in most patients in the early hours after admission, many patients experience a persistent anxious state up to 8 hours later, which suggest that development and testing of protocols for anxiety reduction may be needed. More urgently, the development and examination of a treatment intervention, early on in the ACS trajectory, are warranted that targets pain and anxiety for those for whom immediate angioplasty is not possible and who continue to experience cardiac pain and persistent high levels of anxiety. Moreover, a larger prognostic study is required to determine whether high levels of anxiety in rural ACS patients are predictive of major adverse cardiac events.

Patient safety research

Clarke, S. P., & Schubert, M. (2015). In Routledge International Handbook of Advanced Quantitative Methods in Nursing Research: Methodological challenges (1–, pp. 381-396). Taylor and Francis Inc.

Patients in the radiology department may be at an increased risk of developing critical instability

Ott, L. K., Pinsky, M. R., Hoffman, L. A., Clarke, S. P., Clark, S., Ren, D., & Hravnak, M. (2015). Journal of Radiology Nursing, 34(1), 29-34. 10.1016/j.jradnu.2014.11.003
Abstract
Abstract
The purpose of this study was to calculate the event rate for inpatients in the radiology department (RD) developing instability leading to calls for medical emergency team (MET) assistance (MET-RD) compared with general ward (MET-W) patients. A retrospective comparison was done of MET-RD and MET-W calls in 2009 in a US tertiary hospital with a well-established MET system. MET-RD and MET-W event rates represented as MET calls/hr/1,000 admissions, adjusted for length of stay (LOS); rates also calculated for RD modalities. There were 31,320 hospital ward admissions that had 1,230 MET-Ws, and among 149,569 radiology admissions there were 56 MET-RDs. When adjusted for LOS, the MET-RD event rate was two times higher than the MET-W rate (0.48 vs. 0.24 events/hr/1,000 admissions). Event rates differed by procedure: computed tomography (CT) had 38% of MET-RDs (event rate, 0.89), and magnetic resonance imaging (MRI) accounted for 27% of MET-RDs (event rate, 1.56). Nuclear medicine had 1% of RD admissions, but these patients accounted for 5% of MET-RD (event rate, 1.53). Interventional radiology (IR) had 6% of RD admissions but 16% of MET-RD admissions (event rate, 0.61). Although general X-ray comprised 63% of RD admissions, only 11% of MET-RD involved their care (event rate, 0.09). In conclusion, the overall MET-RD event rate was twice the MET-W event rate; CT, MRI, and IR rates were 3.7 to 6.5 times higher than on wards. RD patients are at increased risk for an MET call compared with ward patients when the time at risk is considered. Increased surveillance of RD patients is warranted.

Content validity of the Toronto Pain Management Inventory-Acute Coronary Syndrome Version.

O’Keefe-McCarthy, S., McGillion, M., Nelson, S., Clarke, S., McFetridge-Durdle, J., & Watt-Watson, J. (2014). Canadian Journal of Cardiovascular Nursing = Journal Canadien En Soins Infirmiers Cardio-Vasculaires, 24(2), 11-18.
Abstract
Abstract
Cardiac pain and/or discomfort arising from acute coronary syndromes (ACS) can often be severe and anxiety-provoking. Cardiac pain, a symptom of impaired myocardial perfusion, if left untreated, may lead to further myocardial hypoxia, which can potentiate myocardial damage. Evidence suggests that once ACS patients are stabilized, their pain may not be adequately assessed. Lack of knowledge and problematic beliefs about pain may contribute to this problem. To date, no standardized tools are available to examine nurses' specific knowledge and beliefs about ACS pain that could inform future educational initiatives. To examine the content validity of the Toronto Pain Management Inventory-ACS Version (TPMI-ACS), a 24-item tool designed to assess nurses' knowledge and beliefs about ACS pain assessment and management. Eight clinical and scientific experts rated the relevance of each item using a four-point scale. A content validity index was computed for each item (I-CVI), as well as the total scale, expressed as the mean item CVI (S-CVI/AVE). Items with an I-CVI > or = 0.7 were retained, items with an I-CVI ranging from 0.5-0.7 were revised and clarified, and items with an I-CVI < or = 0.5 were discarded. I-CVIs ranged from 0.5-1.0 and the S-CVI/AVE was 0.90, reflecting high inter-rater agreement across items. The least relevant item was eliminated. Preliminary content validity was established on the TPMI-ACS version. All items retained in the TPMI-ACS version met requirements for content validity. Further evaluation of the psychometric properties of the TPMI-ACS is needed to establish criterion and construct validity, as well as reliability indicators.