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Factors Predicting Adoption of the Nurses Improving Care of Healthsystem Elders Program

Stimpfel, Amy Witkoski; Gilmartin, Mattia J.

doi: 10.1097/NNR.0000000000000327

Background Registered nurses are often underprepared with the knowledge and skills to care for hospitalized older adult patients. One strategy to bridge this gap is for hospitals to adopt the Nurses Improving Care for Healthsystem Elders (NICHE) program: A nurse-led interdisciplinary organizational intervention to improve care of hospitalized older adults.

Objectives This study aimed to identify the market, organizational and managerial, and sociotechnical factors associated with the adoption of NICHE among U.S. hospitals in order to understand factors that promote and inhibit the adoption of models to improve care for elders and to provide a basis for future studies that evaluate the effects of NICHE participation on patient outcomes.

Methods We used an observational, retrospective design, linking three national administrative data sources, in a secondary analysis. Data included the 2012–2013 American Hospital Association Annual Survey, NICHE database, and the American Nurses Credentialing Center Magnet database. Multivariate logistic regression models were completed at the hospital level (n = 3,506).

Results Statistically significant variables associated with hospital adoption of the NICHE program include using a medical home model, being in a network, having a pain services program, being in an urban location, and having over 100 beds.

Discussion Understanding factors that promote the adoption of organizational interventions like NICHE holds promise for accelerating the use of evidence-based clinical practices to promote health, function, and well-being for older hospitalized adults. Our results provide a foundation for assessing the effects of NICHE participation on patient outcomes by identifying factors that account for membership in NICHE.

Amy Witkoski Stimpfel, PhD, RN, is Assistant Professor, Rory Meyers College of Nursing, New York University, New York.

Mattia J. Gilmartin, PhD, RN, FAAN, is Executive Director, NICHE, Rory Meyers College of Nursing, New York University, New York. At the time the research was completed, Dr. Gilmartin was a Senior Research Scientist at Rory Meyers College of Nursing, New York University.

Accepted for publication August 24, 2018.

This research was supported by the University Research Challenge Fund, New York University.

The University Committee on Activities Involving Human Subjects at New York University reviewed and approved this research as exempt.

The authors have no conflicts of interest to report.

Corresponding author: Amy Witkoski Stimpfel, PhD, RN, Rory Meyers College of Nursing, New York University, 433 1st Avenue, Office 658, New York, NY 10010 (e-mail:

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