Future Directions in Primary Care Research

Nurse Staffing

Increasingly, nurse staffing is becoming an issue of concern to both the nursing community and the broader community of providers, patients, and policymakers. For example, an October 2000 meeting on working conditions, jointly sponsored by the National Institute of Occupational Safety and Health and AHRQ, included nurse staffing as an issue on the agenda.

As cost containment efforts over the past 18 years have led to more selective use of hospital services, hospital organizations have sought to reduce financial concerns by changing nursing services.

Because of the financial issues and changes in health care technology, research into the impact of nurse staffing on health outcomes has become of greater importance. Addressing this concern, the Agency has supported research on this topic and has been a cosponsor of a research contract supported by the Health Resources and Services Administration's Division of Nursing, "Nurse Staffing and Quality of Care in Inpatient Units in Acute Care Hospitals."

In response to an IOM report on nurse staffing (Wunderlich, Sloan, & Davis, 1996), AHRQ, the American Nurses Association, and the American Association of Nurse Executives sponsored a meeting held by the American Academy of Nursing (AAN) on "Outcome Measures and Care Delivery Systems." The results of that conference was a research agenda (AHRQ, 1997) published in the November 13, 1996, Federal Register and revised in response to public comment.

A key need to come out of the meeting was that of refining and standardizing conceptual and operational definitions of such factors as nursing staff level and nursing skill mix. An upcoming solicitation for research grants and conferences will support research on the impact of working conditions on the safety and quality of care.