The many financial pressures placed on hospitals as well as the drive to use outpatient care whenever possible have resulted in fewer nurses taking care of more severely ill patients during ever shorter hospital stays. What's more, nonprofessional and unlicensed personnel such as nurse's aides are replacing registered nurses (RNs) in patient care roles at many hospitals. These developments are at the root of widely reported concerns that the workload of RNs is increasing, jobs are disappearing, morale is declining, and quality of care is worsening. Concerns about hospital quality of care led California to enact legislation in October 1999 that set mandatory hospital nurse staffing levels.
Despite such concerns about the impact of reductions in staffing levels on the quality of hospital care, there has been little evidence linking changes in the hospital nurse workforce to potentially adverse effects on patient outcomes. This research issue is now being addressed by eight federally funded studies, which are summarized in a recent paper by Peter I. Buerhaus, Ph.D., R.N., F.A.A.N., and Jack Needleman, Ph.D., of Harvard University, whose work is supported by the Agency for Healthcare Research and Quality (HS09958). Once completed, these studies, which include four supported by AHRQ, should provide a richer understanding of which patient outcomes, both good and bad, are in fact sensitive to nursing. This, in turn, will enable hospital administrators to better understand the consequences of restructuring and staffing decisions and how different organizational models of nursing affect outcomes.
For more information, see "Policy implications of research on nurse staffing and quality of patient care," by Drs. Buerhaus and Needleman, in the March 2000 Policy, Politics, and Nursing Practice 1(1), pp. 5-15.