Nursing Staff in Hospitals and Nursing Homes Is It Adequate? (1996) / Chapter Skim
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1 Introduction
1 Introduction
Pages 19-30
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From page 19... ...
Steady pressures for cost containment combined with competition, and the rapid escalation of restructuring and mergers, consolidations, and closures of hospitals, have led to work redesign, reconfiguration of staffing patterns, and downsizing. Market competition in an environment of economic constraints has led to a rapid growth of outpatient services and departments, home- and community-based services, and subacute care units.
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From page 20... ...
Hospitals are responding to the changing health care system by taking several measures, including modifying their staffing levels and their mix of nursing personnel. Individual care givers, professional and trade associations involved with nursing, and unions have expressed concerns that these changes are endangering the quality of patient care and causing nursing staff to suffer increased rates of injury, illness, and stress.
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From page 21... ...
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) or residents (in nursing homes)
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From page 22... ...
This decision was based on the committee's judgment that this approach is the most useful and responsible guide for hospital-based resource planning. Nursing Homes In defining need for nursing home settings, again following the principles laid out in previous IOM reports on the subject (IOM, 1986b, 1989)
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From page 23... ...
It is critical that there be not only enough staff, but that they are properly trained and appropriately supervised in their assigned tasks, and they are motivated to care for the elderly and disabled people." That is to say, adequacy of nurse staffing means enough nursing services to provide high quality of care in hospital and nursing home settings and to ensure a safe environment for patients and staff. Further, adequacy to achieve the nursing tasks implies an understanding of the nature and scope of those tasks and a view of how those tasks can be accomplished.
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From page 24... ...
Needs for nursing services are affected by other variables such as severity of illness and organization of nursing care. Management and leadership, a culture of caring and compassion, a sense of staff teamwork, availability of facilities conducive to human care, experience, education, and support systems all are necessary considerations in assessing whether a staffing pattern for nursing care is adequate to contribute to quality patient care.
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From page 25... ...
It assessed comments from their members, reports and other material from nursing home industry groups and nursing home resident advocate groups, analyses of published and unpublished data from the federal statistical systems, trade and professional associations and special detailed tabulations on trends at national and subnational levels obtained from the American Hospital Association; special small surveys conducted by various groups; and research workshops held on behalf of the study committee. The committee did not collect primary survey data or undertake independent inferential analyses of data.
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From page 26... ...
In the summer of 1994, the committee sent out over 500 announcements to health care givers, industry associations, unions, nurse associations, national and state boards of nursing, nursing home resident advocates, hospital and nursing home associations, and concerned and interested individuals. The committee received more than 100 written statements in response to its request.
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From page 27... ...
UNDERLYING ASSUMPTIONS AND VALUES The present study should be considered a first step toward addressing a major topic of concern in health care policy, namely, the role of nursing services in ensuring the delivery of quality patient care. These issues must be considered in an environment undergoing rapid changes that are themselves influenced by pressures of cost containment and competition.
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From page 28... ...
Most people with acute care needs enter hospitals for short-term medical attention and the attendant nursing care. Quality-oflife considerations (as distinct from quality of patient care)
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From page 29... ...
The next three chapters set the framework and provide the context within which the committee addressed the key issues under study. They briefly describe the changing demographic profile of the nation, and the implication of these changes for the health care system, the changing demand for, and use of, health resources in hospitals and nursing homes, and the implications for the future supply of nursing staff and the type of education and training that will be needed to adequately prepare them to meet the demands of tomorrow's jobs.
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From page 30... ...
30 NURSING STAFF IN HOSPITALS AND NURSING HOMES demanded that the committee stay within the specific mandate of the contract and not try to cover all possible related topics. Although the principal intent of the report is to address the specific concerns of Congress as defined in its mandate, the committee believes that the report will provide guidance to a wider audience responsible for organization, delivery, and financing of health care and for federal health care policy.
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