Researchers in the field of health services have known for decades that nurse staffing affects hospital treatment results.
2–4
Nursing care and nurse staffing, on the other hand, were essentially background variables in several of these research and were not the primary focus of investigation.
5
The National Center for Nursing Research, forerunner of the National Institute of Nursing Research, held an invitational conference on patient outcomes research from the perspective of nursing practice effectiveness in the 1990s.
6
Evidence tying the structure of nurse staffing (i.e., hours of care, skill mix) to patient care quality and safety was hoped to grow as methods for quantifying the quality of patient care became more complex.
However, the 1996 IOM study emphasizing the role of nurses and nurse staffing on outcomes noted that there was little evidence at the time that staffing had an influence on acute care hospital patient outcomes and limited evidence of its impact on long-term care outcomes.
1
Since the IOM study in 1996, this corpus of knowledge has grown dramatically.
Over the last decade, hospital reorganization has resulted in intense cost cutting, fueled in part by a shift to managed care payment structures and the growth of market competition among health care delivery companies.
Human resources, a major cost center for hospitals in the past, and in particular nurse staffing, were frequently the target of work redesign and workforce reduction attempts.
Cuts in nurse staff resulted in increased workloads, raising concerns about the sufficiency of hospital staffing levels.
7 and 8
Concurrently, research and policy papers (such the IOM’s To Err is Human9) aroused public and professional concerns about the quality and safety of patient care, which were subsequently fuelled by the popular media.
Reports began surfacing a few years ago detailing a new, unprecedented nurse shortage linked to rising demand for services, as well as drops in both prelicensure nursing education program graduations and licensed nurse workforce participation, both of which have been linked by at least some researchers to deteriorating working conditions in hospitals.
ten, eleven
The impact of nurse staffing on the quality and safety of patient care was a new topic of study within health services research as a result of these converging health care finance, labor market, professional, and public policy concerns.
The need of understanding the staffing-outcomes relationship and providing nurses and health care leaders with information about the implications of providing care under varied nurse staffing situations has intensified as the shortfall is likely to worsen in the future years12.
A review of related material from early 2007 is included in this chapter.
