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Nursing Staff

Staffing and Quality of Care in Hospitals

Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes. Twenty-four hour nursing care is one of the distinctive hallmarks of inpatient care in hospitals. Historically, hospitals have been at the core of the U.S. health care system, and nursing services are central to the provision of hospital care. They have also functioned as the traditional place of work for nursing personnel and especially for registered nurses (RN). Nursing personnel comprise the largest proportion of patient care givers in a hospital. Nursing care in hospitals takes on added importance today because increase in acuity of patients requires intensive nursing care.

Preparing for the move from ICU to a general ward

At the same time, the aggregate quantity of RNs is at a high level, creating uncertainties about job security. Much health care is moving to ambulatory settings, the community, and the home through home health services. The nursing profession also has concerns about the training needs to accommodate these shifts in work settings. With respect to the hospital setting, a rapidly changing health care environment, continuing pressures to contain costs, and the rising levels of severity of illness and comorbidity of inpatients all make it imperative for hospitals to explore innovative ways to redesign delivery of care without compromising quality.

Evolving Roles in Advanced Practice Nursing

The committee takes note of the growing trend toward complexity of illness and sophisticated care management of patients in an illness episode that includes the event of hospitalization but is not limited to it. The care planning and managing begins before the patient is admitted to the hospital and continues beyond the hospitalization to discharge planning and management of care needed after discharge from the hospital. Leading and managing the organizational transformations described above require talents or training that not all RNs now have. For the evolving hospital, the committee believes that it will be imperative for these management and leadership skills to be fostered through various educational programs. The committee believes that more advanced, or more broadly trained, RNs will be needed in the future. Such training is essentially like that now provided for RNs who receive certification as, for example, advanced practice nurses (i.e., clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists).

Clinical nurse specialists can be found in every specialty area of nursing. In each of these areas clinical nurse specialists function as practitioners, educators, case managers, consultants, researchers, and administrators; in the mental health arena, they may also serve as psychotherapists. They play a critical role in the ongoing clinical management of caseloads of patients. Nurse practitioners manage patients with acute and chronic conditions. They frequently have responsibility for managing patients with illness such as diabetes or hypertension. They also are responsible for the ongoing primary care of a group of healthy individuals.

Relationship Of Nursing Staff To Quality Of Patient Care

The issues surrounding the relationship of staffing levels and staffing patterns of nursing personnel and outcomes have taken on added importance since the committee was established. Hospitals are restructuring and redesigning the organization and delivery of patient care, and the committee heard many reports of reduction of nursing staff and its adverse effects on quality of care. Very little current data are available describing the quality of care in hospitals, and assessing if it has been affected in any way by changes in the system of delivery of care in the hospitals.