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J Public Health Policy. 2001;22(3):286-310.

Licensed nursing staff reductions and substitutions in Pennsylvania hospitals, 1991-1997.

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Health Services Administration Program, College of Health and Public Affairs, University of Central Florida, Alpha Building Tr 534, Orlando, Florida 32816-2205, USA.


Nurses report a decline in RN/patient and skill mix in the 1990s while quantitative studies fail to confirm this. This study examines aggregate hospital nursing staff in Pennsylvania from 1991-1997, focusing on changes in licensed nursing staff. It finds that licensed nursing staff declined while nursing assistants increased in this period. With adjustment for patient acuity, there was a slight decrease in RN/adjusted patient days of care (APDC), a 23% decrease in LPN/APDC, and a 4% decrease in licensed nurse/APDC. The RN/nurse ratio increased slightly, and licensed nurse/nurse fell slightly. Since RNs often operate in environments which make use of teams of licensed staff, nurses' perceptions of a decline in the RN/patient ratio is a result of the decline in licensed staff/APDC, and of an increase in patient acuity.

[Indexed for MEDLINE]

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