NurseWeek: Editor's Note

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Editor's Note

Formula for the future
Research about nursing provides RNs with the data to control the profession's destiny
Beth Ulrich, Ed.D., RN, South Central Editor
May 28, 2001

The moves to outcomes management and evidence-based practice are beginning to provide data to discover clinical answers and to support things that many nurses have known intuitively for a long time. At the same time, research on the nursing profession and the quantitative value of the profession often has lagged behind. Such research is important because we belong to a scientific profession that practices in health care businesses.

In the same way that we rely on clinical research to direct our patient care efforts, the people who are in charge of administering our practice sites must rely on data to tell them what they should do. This is especially true as we face a shortage of RNs. Without valid data to support the need for RNs specifically, other solutions will be proposed that replace RNs with other workers.

Nurses who began their practices before the mid-1970s remember when what are today the professions of respiratory care, cardiology, occupational therapy, physical therapy, etc., were then the job of nursing.
It is interesting to note that the specialties that once were part of nursing seem to be all the things that could be charged for as ancillary services while nursing services generally remained part of the daily room rate.

The good news is that several recently released studies quantify what is going on in the nursing profession and what nurses directly affect in terms of care outcomes and cost. While the results of the studies do not always paint a positive picture, the data is important.

The National Sample Survey of Registered Nurses 2000, conducted every four years, shows more RNs, an aging workforce, flat earnings and an almost doubling of NPs and CNSs since 1996. Further, the data reveal that while there is an overall shortage, the shortage varies widely by geographic area with a national average
of 782 employed RNs per 100,000 population, but a range from 544 to 1,675.

A team of researchers at the University of Pennsylvania School of Nursing recently released survey data from the International Hospital and Outcomes Research Consortium, 1998-99, that studied nursing in the United States, Canada, England, Scotland and Germany (Health Affairs, May/June 2001). In every country except Germany, more than one-third of nurses report dissatisfaction and score high on emotional exhaustion and feeling overwhelmed by their work.

In the United States, one-third of the
nurses surveyed younger than age 30 say they plan to leave in the next year.
Although more than 80 percent of American nurses believe that physicians provide high quality care, nurses are clinically competent and physicians and nurses have good working relationships, more than one-third believe that there are not enough RNs to provide high-quality care or even get the work done.

The nurses in this study report performing many non-nursing tasks while having to leave undone important duties such as patient/family teaching and comforting or talking with patients. They also report significant verbal abuse from patients and families.

Another study, "Nurse Staffing and Patient Outcomes in Hospitals" (http://bhpr.hrsa.gov/dn/staffstudy.htm), was conducted for the U.S. Department of Health and Human Services. This nationwide research clearly documents strong, consistent relationships between nurse staffing variables and outcomes.

In medical patients, for example, higher
RN staffing was associated with a 3 percent to 12 percent reduction in urinary tract infections, pneumonia, length of stay, upper gastrointestinal bleeding and shock. Given the overall cost of these outcomes, a reduction of this size can be quantified into multimillion dollar savings (or additional expenditures if higher RN staffing does not occur).

For nurses who provide or have previously provided direct care, none of this research is news. The beauty of nursing is that we often think with our hearts and souls, but that also can be our weakness when we compete for resources with people who must run businesses based on solid financial information.

We have made much progress in the last 10 years in having nurses move into executive management positions so that someone who has been at the bedside now can be in the boardroom. Research efforts like the aforementioned provide all of us with the data to support what we have observed and improve the odds that we, rather than others, can control the destiny of nursing.

What do you think?
Email us at editor@nurseweek.com