Nursing Staff in Hospitals and Nursing Homes Is It Adequate? (1996) / Chapter Skim
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However, the changes in payment systems, combined with scientific and technological advances, have permitted shifts from the traditional inpatient care settings to ambulatory, community, home, and nursing home care.) Inpatient use of hospitals, length of hospital stay, inpatient days, and the number of beds staffed have all declined.
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,2 and nurse assistants (NA) and other ancillary nursing personnel.3 They are also downsizing staff to accommodate the reduced volume of inpatient care and to remain economically viable.
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In response the study committee explored: · levels of quality of care in hospitals and nursing homes today; · the relationship of quality of care (or quality of nursing care, to be more precise) and patient outcomes to nurse staffing levels and mix of different types of nursing personnel; · the current supply and demand for nurses, including both American- and foreign-trained nurses, and the current and expected levels of workforce participation in that professional group; · existing ratios of nursing personnel to other measures of demand for health care, such as numbers of patients (in hospitals)
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FINDINGS AND CONCLUSIONS Nursing Personnel in a Time of Change To determine the adequacy of nursing personnel in hospitals and nursing homes, the committee first assessed the overall supply of nursing personnel in the context of the shifting demand for their services and the factors affecting that demand. More than 3 million health care personnel work in nursing services.
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Nursing services are central to the provision of hospital care. Nursing care n hospitals takes on added importance today because the increase in acuity of patients requires intensive nursing care.
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Changing Roles and Responsibilities of Nursing Personnel The challenge today is for care givers and patients to think about the continuum of care needed rather than simply the event of hospitalization. Foremost among these changes is to help RNs and other health care givers to learn how to plan for patient care before the patient is admitted to the hospital, as well as for care needed after discharge from the hospital.
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Furthermore, no accepted mechanism exists either to measure competency or to certify in some fashion that ancillary nursing personnel have attained at least a basic or rudimentary mastery of needed skills. The committee is greatly concerned about these lacks and the potential for adverse impact on patient care.
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In the committee's view, the harmful and demoralizing effects of these changes on the nursing staff can be mitigated, if not forestalled altogether, with more recognition on the part of the hospital industry that involvement of nursing personnel from the outset in the redesign efforts is critical. Rapid changes in the health care delivery system and the resultant unstable situation fuel the concern among the nursing community that large decreases in RN staffing in hospitals are both occurring and leading to decrements in patient care and to threats to the health and well-being of nursing personnel.
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There is, however, a serious paucity of recent research on the definitive effects of structural measures, such as specific staffing ratios, on the quality of patient care in terms of
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Despite this type of information on organizational and related factors, the committee was unable to isolate a number-of-RNs effect. The committee concludes, therefore, that high priority should be given to obtaining empirical evidence that permits one to draw conclusions about the relationships of quality of inpatient care and staffing levels and mix.
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Some broader issues of changes in nursing services, such as the enhanced responsibilities of advanced practice nurses and the use of ancillary nursing personnel and their competency, cut across the straightforward issue of the rela
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Staffing and Quality of Care in Nursing Homes The nursing home market is being stressed by an increasing demand for services combined with a constrained growth rate. To gain insights on issues surrounding the relationship of staffing patterns of nursing personnel to quality of resident care, the committee examined statutory requirements and information gathered during site visits and public testimony; it also reviewed an extensive body of research literature and empirical evidence on the relationships between staffing patterns and quality.
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to improve the MDS and to require all facilities to computerize MDS data and provide them to state and federal agencies, thus providing a mechanism for a national database. The research literature generally agrees on the strong relationship among resident characteristics, nurse staffing time requirements, and nursing costs in nursing homes.
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The committee concludes that the training received by NAs should be enriched and that research is needed on the relationship of NA and LPN staff levels and training to quality of care. The changing focus of services and the increasingly complex nature of the care provided in nursing facilities create new demands for skill, judgment, supervision, and the management of nursing services, Most directors of nursing (DON)
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Recent statistics and other information suggest that these institutions are becoming increasingly hazardous places to work, exposing workers to a wide range of risks. The committee reviewed the literature on work-related injuries, in particular back injuries and needlestick puncture wounds, that affect nursing personnel in hospitals and nursing homes.
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the level and staffing patterns of nursing personnel to promote quality of care in hospitals; (2) the level and skill mix of nursing personnel in nursing homes to promote quality of care in these facilities; and (3)
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