Hospitals and nursing homes are responding to changes in the health care system by modifying staffing levels and the mix of nursing personnel. But do these changes endanger the quality of patient care? Do nursing staff suffer increased rates of injury, illness, or stress because of changing workplace demands? These questions are addressed in Nursing Staff in Hospitals and Nursing Homes, a thorough and authoritative look at today's health care system that also takes a long-term view of staffing needs for nursing as the nation moves into the next century. The committee draws fundamental conclusions about the evolving role of nurses in hospitals and nursing homes and presents recommendations about staffing decisions, nursing training, measurement of quality, reimbursement, and other areas. The volume also discusses work-related injuries, violence toward and abuse of nursing staffs, and stress among nursing personnel--and examines whether these problems are related to staffing levels. Included is a readable overview of the underlying trends in health care that have given rise to urgent questions about nurse staffing: population changes, budget pressures, and the introduction of new technologies. Nursing Staff in Hospitals and Nursing Homes provides a straightforward examination of complex and sensitive issues surround the role and value of nursing on our health care system.

Contents

• COMMITTEE ON THE ADEQUACY OF NURSE STAFFING IN HOSPITALS AND NURSING HOMES
• Division of Health Care Services
• Acknowledgments
• Part I. Review And Recommendations
  • Summary
    • Findings And Conclusions
    • Recommendations
  • 1. Introduction
    • Immediate Origins Of The Institute Of Medicine Study
    • Committee Charge
    • Definitions
    • Study Approach
    • Underlying Assumptions And Values
    • Organization Of The Report
  • 2. Implications of Population Change
    • Introduction
    • Growth Of The Population
    • Diversity Of The Population
    • Health Status And Disabling Conditions
    • Conclusion
  • 3. Evolving Health Care Scene
    • Overview
    • Private Insurance And Public Payers For Health Care
    • Managed Care
    • Ownership Structure
    • Hospitals
    • Nursing Homes
    • Implications For Nursing Services
  • 4. Nursing Personnel in a Time of Change
    • Supply Of Nursing Personnel
    • Changing Demand For Nursing Personnel
    • Is The Supply Adequate For The Demands Of The Next Century?
    • Summary
  • 5. Staffing and Quality of Care in Hospitals
    • Restructuring In The Hospitals
    • Measuring Quality Of Care In Hospitals
    • Relationship Of Nursing Staff To Quality Of Patient Care
    • Legislative And Regulatory Requirements
    • Summary
  • 6. Staffing and Quality of Care in Nursing Homes
    • Measurement Of Quality
    • Status Of Quality Of Care In Nursing Facilities
    • Has Quality Of Care Improved Since Obra 87?
    • Relationships Among Nursing Staff, Management, And Quality Of Care
    • Effects Of Reimbursement And Other Factors On Nursing Staff
    • Residents, Families, Volunteers, And Ombudsmen
    • Conclusion
  • 7. Staffing and Work-Related Injuries and Stress
    • Overview
    • Incidence Of Work-Related Injuries And Illness
    • Violence, Abuse, And Conflict
    • Work-Related Stress
    • Summary
  • 8. Epilogue
  • Appendixes
    • Appendix A Presentations Made to the Committee
    • Appendix B Liaison Panel
    • Appendix C Separate Statement and Responses
    • Appendix D Acronyms
  • References
  • Biographical Sketches of Committee Members
• Part II. Resources For The Study
  • Overview
  • 1. Study Activities
    • Written And Oral Testimony Submitted To The Committee
    • Site Visits Conducted By The Committee
    • EXHIBIT 1.1 Request by the Committee on the Adequacy of Nurse Staffing for written testimony
  • 2. Statistical Resources
  • 3. Commissioned Papers
    • Quality of Care, Organizational Variables, and Nurse Staffing
    • Professional Nursing Education—Today and Tomorrow
    • Nursing Staff and Quality of Care in Nursing Homes
    • Quality of Care and Nursing Staff in Nursing Homes
    • Nursing Facility Quality, Staffing, and Economic Issues
    • Nursing Injury, Stress, and Nursing Care

Support for this project was provided by the National Institute for Nursing Research through an interagency agreement with the Bureau of Health Professions of the Health Resources and Services Administration, U.S. Department of Health and Human Services. The views presented are those of the Institute of Medicine Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes and are not necessarily those of the funding organization.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.