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Physicians and hospital executives often do not associate nurses with patient safety and early detection of complications.
ABSTRACT: National surveys of registered nurses, physicians, and hospital executives document considerable concern about the U.S. nurse shortage. Substantial proportions of respondents perceived negative impacts on care processes, hospital capacity, nursing practice, and the Institute of Medicine's six aims for improving health care systems. There were also many areas of divergent opinion within and among these groups, including the impact of the shortage on safety and early detection of patient complications. These divergences in perceptions could be important barriers to resolving the current nurse shortage and improving the quality and safety of patient care. [Health Affairs 26, no. 3 (2007): 853-862; 10.1377/hlthaff.26.3.853]
THE DELIVERY OF CARE FOR HOSPITALIZED PATIENTS IS Complex and requires coordinated efforts by many health professionals. Physicians, ad' vanced-practice nurses, registered nurses (RNs), and other allied health professionals each provide individualized health care services. Hospital administrators-namely, chief executive officers (CEOs) and chief nursing officers (CNOs)-develop strategic plans; build, manage, and continually improve facilities and systems of care; and oversee resource allocations. Patterns of problem recognition, communication, teamwork, and problem solving within and among these groups contribute to a hospital's capacity to operate efficiently and manage difficult and changing stressors.
An insufficient supply of essential personnel, such as RNs, is a critical stressor for hospitals. Many hospitals are struggling with a nurse shortage that began in 1998. The shortage resulted from, a combination of factors, including rising demand, little growth in RN wages, demographic changes in the RN workforce that decreased the supply of working RNs, and a stressful hospital workplace environment.1 A growing body of research, based primarily on state and hospital administrative data, has established a relationship between inadequate hospital nurse staffing and increased risk of adverse patient outcomes, including mortality.2 Prolonged shortages also might reduce the quantity of patient care, increase operating and labor costs, and decrease the efficiency and eEectiveness of care provided. Looking ahead, recently published projections indicate large, demographically driven shortages developing in the next decade.3
Highly visible Institute of Medicine (IOM) reports have emphasized the importance of teamwork in improving efficiency and quality in hospitals.4 Given differences in education and the nature of work done by different providers...