Differences Between Nursing Homes and Care Homes | Balcombe Care
Group Homes are exactly what they sound like – residential homes for group living. residents receive nursing care and have access to an on-call nurse at all times. It is the most flexible of our programs to meet the needs of the consumer. This means that they can provide care for people with more complex needs and those who need regular nursing interventions. All care homes have to specify exactly what level of care they can provide and demonstrate how they can meet each resident's Residential Care · Nursing Care · Dementia Care · Respite Care. Here are some of the most popular housing options for adults with special needs. he may not have the opportunity to meet a lot of other people if he is Group homes come in many varieties and can be paid for in many ways, live in a skilled nursing facility if it is impossible to provide that care at home.
There is divided opinion about whether this type of schooling is beneficial for children. A case for residential special schooling has been advanced in the article: Orphaned, abandoned or high risk young people may live in small self-contained units established as home environments, for example within residential child care communities. Young people in this care are, if removed from home involuntarily, subject to government departmental evaluations that include progressions within health, education, social presentations, family networks and others.
Recent trends have favored placement of children in foster care rather than residential settings, partially for financial reasons, but a survey found that a majority of out-of-home children surveyed preferred residential or group homes over foster care.
Conditions and disabilities such as AutismDown syndromeepilepsy and cerebral palsy to name a few may require that children receive residential professional care.
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- Residential care
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Specialized residential can be provided for children with conditions such as anorexiabulimiaschizophreniaaddictionor children who are practicing self-harm. Foster care[ edit ] Children, including children with special needs, may be cared for in a licensed foster care home. Special training or special facilities may be required to foster a child who is medically fragile - for example, a child who has a serious medical condition or is dependent on medical technology such as oxygen support.
A person or couple who are able to take care of their daily needs may choose to live in a retirement apartment complex " independent living " where they function autonomously. They may choose to fix their own meals or have meals provided, or some combination of both. Medication Management Nearly one-third of older home health care patients have a potential medication problem or are taking a drug considered inappropriate for older people.
The majority of older home health care patients routinely take more than five prescription drugs, and many patients deviate from their prescribed medication regime. All three studies used a controlled experimental design, with random assignment of patients to one or two treatment groups and a control group of usual care. The populations studied were elderly Medicare patients receiving home health care, ranging from 41 to patients. Table 1 Summary of Evidence Related to Medication Management The interventions tested were patient education delivered by telephone or videophone with nurse followup, education tailored to individual patients, and medication review and collaboration among providers e.
Specific outcomes included identifying unnecessary and duplicate medication, improving the use of specific categories of medication such as cardiovascular or psychotropic drugs, and identifying the extent of use of nonsteroidal anti-inflammatory drugs NSAIDs. The effectiveness of the interventions was measured by improved medication management and adherence to drug protocols. Adherence was estimated objectively from medication refill history and medication event monitoring, and subjectively from patient self-report scores on pre- and postintervention questionnaires testing knowledge, understanding of disease, and adherence.
Evidence from these studies suggests that all of the interventions tested were at least somewhat effective. Medication use improved for patients receiving the intervention, while control groups had a significant decline in adherence to drug protocols. The interventions were most effective in preventing therapeutic duplication and improving the use of cardiovascular medications, less effective for patients taking psychotropic medication or NSAIDs. Generally, as knowledge scores improved, adherence improved.
When more than one intervention was tested, there was generally no difference between the two intervention groups. Evidence-Based Practice Implications Nurses must be vigilant for the possibility of medication errors in the home health care setting, recognizing the associated risk factors.
Technology provides many opportunities to improve communication with patients, to provide patients with accurate information, to educate them about their medications, and to monitor medication regimes. Paying close attention to at-risk patients is most effective; therefore, accurate documentation and review of medications during each patient encounter is important.
The evidence suggests that frequent medication reviews and collaboration with other members of the health care team, especially pharmacists, will help to prevent adverse events associated with poor medication management. Research Implications More effective methods are needed to improve medication use in the home health care population. Research should continue to expand the knowledge of factors that contribute to medication errors in home health care and determine what interventions are the most effective in improving medication management in the home.
Fall Prevention Emergent care for injury caused by falls or accidents at home is one of the most frequently occurring adverse events reported for patients receiving skilled home health care services. One in five of these fall incidents requires medical attention.
Although there is strong evidence of effective fall-prevention interventions for the general over population, 202324 knowledge of fall prevention in home health care is limited. Research studies specific to home health care are predominantly retrospective, descriptive, correlational designs in single agencies, using matched control or randomized control groups to explore patient characteristics and other factors contributing to patient falls.
All three interventions were quality-improvement programs in single agencies. The findings suggest that risk factor screening and intervention using a valid and reliable instrument and physical therapy aimed at improvement in gait and balance may reduce injury and emergent care for falls.
Unfortunately, there is no evidence that the number of falls incurred by the home health care population can be reduced. It may be that improved provider assessments increased the number of falls reported and documented. Summary of Evidence Related to Fall Prevention Evidence-Based Practice Implications Home health care providers need to know the risk factors for falls and demonstrate effective assessment and interventions for fall and injury prevention.
Falls are generally the result of a complex set of intrinsic patient and extrinsic environmental factors. Use of a fall-prevention program, standardized tools, and an interdisciplinary approach may be effective for reducing fall-related injuries. Research Implications There are several limitations in the current evidence on falls in home health care.
Most of the research is descriptive, and there are no randomized controlled studies. Findings from small, single-agency quality-improvement projects cannot be generalized. It is not known if predictors for falls in home health care patients are the same as those for other community dwellers over age Research is needed to expand the knowledge of factors that contribute to falls in this population and to develop effective interventions.
Research is also needed to explore factors to prevent injury from falls, as it is likely that the incidence of falls in this population cannot be completely eliminated. Unplanned Hospital Admissions A primary goal of home health care is to discharge the patient to self or family care and avoid subsequent hospitalizations.
Unplanned admission to the hospital is an undesirable outcome of home health care that causes problems for patients, caregivers, providers, and payers.
Unplanned hospital admissions are associated with complications, morbidity, patient and family stress, and increased costs. The national rate of unplanned hospital admissions for home health care patients has gradually increased from 27 percent in to 28 percent in32 and it is the only publicly reported home health care patient outcome that has never improved at the national level. The Briggs National Quality Improvement and Hospitalization Reduction Study 33 convened a panel of experts to identity best practice strategies that agencies should implement to prevent unplanned hospitalizations.
These recommendations were not empirically tested, however. Only eight studies have tested the effectiveness of interventions to prevent unplanned hospital admissions for home health care patients.
Five of these studies employed a randomized controlled trial design, and three used a nonrandomized control or comparison group design. The tested interventions consisted primarily of increasing the intensity of care provided through a disease management program, a team management home-based primary care program, a multidisciplinary specialty team intervention, advanced practice nurse APN transitional care, telehealth services, and intensive rehabilitative care prior to hospital discharge.
Additionally, four of the studies reported lower mean costs or charges for the intervention groups related to lower hospital costs, 4042—44 and one study 45 reported higher costs for the intervention group based on the costs of the team-managed primary care intervention.
In these studies, patients with congestive heart failure CHF had fewer unplanned hospital admissions and longer survival times prior to first admission 39—42 if they received APNtransitional care, team-managed home-based primary care, or a multidisciplinary specialty team intervention.
Results from one nonrandomized controlled study suggest that patients with chronic obstructive pulmonary disease COPD who received APN transitional care also experienced fewer unplanned hospital admissions. Findings are summarized in Table 3. Summary of Evidence Related to Unplanned Hospital Admission Evidence-Based Practice Implications Evidence suggests that specialized, coordinated, interdisciplinary care has a positive impact on unplanned hospital admissions in select home health care populations.
Agencies can identify patient characteristics associated with hospitalization unique to their patient population. High-risk patients may require specialized interventions beyond the traditional scope of home health care services. Targeted interventions using process-of-care analysis and data available from the Outcome and Assessment Information Set OASISwithin the framework of OBQI, may result in fewer unplanned hospital admissions for home health care patients.
They play a critical role in the ongoing clinical management of caseloads of patients. Nurse practitioners manage patients with acute and chronic conditions. They frequently have responsibility for managing patients with illness such as diabetes or hypertension. They also are responsible for the ongoing primary care of a group of healthy individuals. The value of such clinical nurse specialists, in terms of both patient care and economic factors have been studied over the past 20 to 25 years.
In particular, a number of randomized clinical trials have been conducted. One set of studies was directed at testing the effectiveness of programs conducted by clinical nurse specialists in caring for hospitalized elderly patients, especially in comprehensive discharge planning. Outcomes such as length of stay, number of, or length of time before rehospitalization, and costs, as well as functional status, were all better among those patients whose care was coordinated and implemented by clinical nurse specialists.
In a follow-up to this study Kennedy and colleagues found that for the same control and experimental groups the experimental treatment group's average length of stay was reduced by 2 days, and the length of time before hospital readmission increased by 11 days. A pilot study by Naylor had similar results. She found that there was a significant difference between the two groups in frequency of hospital readmissions.
Later, in a randomized clinical trial, Naylor and colleagues found that from initial discharge to 6 weeks after discharge, patients in the intervention group managed by clinical nurse specialists had fewer number of hospital readmissions, fewer total days of rehospitalization, lower readmission charges, and lower charges for health care after discharge. Functional status was the focus of a study by Wanich and colleagues These researchers found that in their clinical trial patients in the intervention group those whose care was coordinated by the clinical nurse specialist were more likely to improve in functional status than those who did not who did not receive such care.
These same patients were less likely to deteriorate on measures of functional status during their hospital stay. These outcomes may also help to reduce length of hospital stay and decrease costs, although cost was not measured as an outcome in this study. Oncology clinical nurse specialists have also been shown to improve patient outcomes. McCorkle and colleaguesfor example, conducted a randomized clinical trial of lung cancer patients. The study demonstrated that lung cancer patients receiving care from specialized oncology clinical nurse specialists experienced less distress, less dependence, fewer rehospitalizations, and shorter lengths of stay than did patients cared for without intervention from these advanced trained personnel.
According to Russell the cost of care for patients undergoing a modified radical mastectomy who were followed by an oncology clinical nurse specialist was significantly lower than for those not so followed.
Their average length of stay was 3. Another set of studies involved low birthweight infants and families who received care and consultation from clinical nurse specialists. Outcomes such as length of stay were better and costs were lower among study participants who were in the group using such specialist nurses Brooten et al.
The ability of clinical nurse specialists to function in a number of different roles and their ability to work independently to solve problems and be patient advocates as well as integral members of a health care team have been cited as a reason for improved outcomes and cost savings that they help to bring about.
Nurses in this role are an important part of the total patient care picture across settings and as such are essential to improved patient outcomes. Although the discussion to this point has drawn on the use of advanced practice nurses in discharge planning and working with patients in the home after hospitalization, the place of such personnel in the entire continuum of care for which hospitals are responsible needs to be understood.
For one thing, all but the smallest hospitals operate outpatient clinics of various sorts including those that deal with non-urgent problems of patients who present to emergency departments.
Moreover, as the U. With this trend, plus the growing phenomenon of delegation and substitution of responsibilities from physicians to nurses i. Based on this type of information, combined with what was learned from testimony, site visits, and the professional expertise and experience of its members, the committee concludes that high-quality, cost-effective care for certain types of patients, particularly those with complicated or serious clinical conditions, will be fostered by the use of such advanced nurse specialists.
The committee believes that increased use of advanced practice nurses would improve the cost-effectiveness of our health care systems and facilities.Avery Healthcare Care Homes
That is to say, changing the mix of nursing personnel involved in caring for patients with increasingly complex management problems may yield both improved outcomes and lower costs. The committee recommends that hospitals expand the use of registered nurses with advanced practice preparation and skills to provide clinical leadership and cost-effective patient care, particularly for patients with complex management problems.
Advanced practice nurses are typically classified in at least one of four ways, and their educational training and duties differ accordingly. Clinical nurse specialists typically are master's degree-trained RNs; some may also have PhDs.
Their clinical specialties can include oncology, neonatology and, or, pediatrics, mental health, adult health, women's health, geriatrics, and AIDS. They commonly work in clinical settings and provide primary care; case management services; psychotherapy; and a variety of organizational, administrative, and leadership services as well.
Nurse practitioners are usually prepared at the master's degree level and also certified in a specialty area of practice, such as pediatrics, family practice, or primary care. Their usual responsibilities include managing clinical care; they conduct physical examinations, track medical histories, make diagnoses, treat minor illnesses and injuries, and perform an array of counseling and educational tasks. Nurse practitioners may also, in some circumstances, order and interpret diagnosis tests and prescribe medications.
Certified nurse midwives are RNs who have graduated from a nurse midwifery program accredited by the American College of Nurse-Midwives ACNM and are certified as a nurse-midwife by the ACNM; some may have taken a master's program offered by a school of nursing or a school of public health.
They provide prenatal and gynecological care, deliver babies in a variety of settings hospitals, birthing centers, or homesand render postpartum care. Finally, certified RN anesthetists have a bachelor of science in nursing and 2 to 3 years of additional education and training in anesthesiology, often at the master's level. They, too, have a rigorous certification process, managed through programs approved by the American Association of Nurse Anesthetists.
Particularly in rural areas, these nurse specialists may administer the majority of anesthesia or anesthetics in health care settings today. Clearly, well-trained advanced practice nurses can function in a number of different roles. They can work independently to solve patient care problems, serve as patient advocates, and be integral members of a health care team. Advanced practice nurses can improve the cost-effectiveness of health care systems and facilities because changing the mix of personnel involved in caring for patients with complex management problems may yield better outcomes, lower costs, or both.
The committee concludes that the way should be clearer for such personnel to be used in both inpatient and outpatient settings and for them to be able to take up leadership positions and act independently.
One obstacle, however, to accomplishing the changes advocated in this section lies in the differing ways in which states recognize advanced practice nurses, chiefly in terms of the breadth of independent authority e. Some state boards of nursing have not yet recognized the expanded responsibilities that such personnel can and should discharge.
To address this problem, the committee believes that all states should recognize nurses in advanced practice in their nurse-practice acts and delineate the qualifications and scope of practice of these nurses.
Ancillary Nursing Personnel Today, almost all hospitals in the United States use some kind of ancillary nursing personnel. As stated in Chapter 4this group of personnel includes nurses aides or assistants NAsome of whom may be certified, as well as a variety of other ancillary personnel.
By definition, they have less formal education and training than RNs or LPNs; on average, when hired they may also have less exposure to, and time or experience in, the inpatient setting. Their education, however, does not stop after the basic training. Many serve for several years and learn from physicians, RNs, and LPNs to perform tasks that once were not done by NAs and to be responsible for specific aspects of clinical care.
However, the transformation of the hospital care delivery system is clearly going to involve these types of personnel at least in the near future.
Explaining the difference between a care home and a nursing home
The use of NAs and other ancillary nursing personnel to assist RNs with patient care is reported to have increased in recent years. In most instances, NAs and other ancillary nursing personnel are used in simple bedside care or as unit assistants e. In other cases, tasks performed by these types of personnel may overlap with those of other support units, such as dietary, housekeeping, or transportation services.
Krapohl and Larson describe the evolution of nursing delivery systems in hospitals, from team nursing with all the variations such as clinical, nonclinical, and integrated nursing models to primary nursing models. The various "patient-focused" team models that some hospitals are implementing incorporate less skilled nursing personnel to varying extent; the models themselves vary according to the specific needs of different hospitals or hospital systems.
The authors also reviewed the literature regarding the use and evaluation of ancillary nursing personnel in hospitals and found no strong evidence to confirm that these nursing personnel improve or reduce quality or increase or decrease nurse or patient satisfaction.
A review of studies of primary nursing also do not conclusively show the superiority of primary nursing models over various team nursing models. They conclude, basically, that although nursing care has been provided in hospitals since the hospital's beginning, no single delivery system has emerged as ideal. The authors also note the methodological and design weaknesses of the studies reviewed.
Patient Safety and Quality in Home Health Care - Patient Safety and Quality - NCBI Bookshelf
Nevertheless, some informal information about these new team approaches is encouraging. The committee learned, for instance, about variations of the "partners-in-practice" program pioneered in the s, which linked NAs and other ancillary nursing personnel with an RN Manthey, At the site visit in Oregon, committee members and staff were able to observe and interact with care teams in which RNs assumed a very close working relationship with the other care partners.
Nursing personnel at all levels worked together at all times; thus, RNs were able to assess the knowledge and clinical capabilities of each member of the team and, where necessary, step in to supervise, and then teach, the less-well-prepared nursing personnel.
Other hospitals have implemented similar systems, according to information made available to the committee. The underlying message of the literature review and the observational information gathered by the committee is that, in the hospital sector, issues of training and competency of non-RN staff remain critical. No national standards exist for minimum training or certification of ancillary nursing personnel employed by hospitals unlike, as discussed in Chapter 6for NAs in the nursing home sector ; thus, they vary widely in educational attainments and in their training for simple nursing or quasi-nursing tasks.
Furthermore, no accepted mechanism exists either to measure competency or to certify in some fashion that ancillary nursing personnel have attained at least a basic or rudimentary mastery of needed skills.
Hospitals vary widely in the levels of training they provide to these personnel.
Care homes for older people, adults with disabilities and children - NHS
Barter and colleagues found that 99 percent of the hospitals in California reported less than hours of on-the-job training for newly hired ancillary nursing personnel.
Only 20 percent of the hospitals required a high school diploma. The majority of hospitals 59 percent provided less than 20 hours of classroom instruction and 88 percent provided 40 hours or less of instruction time.
RNs and their supporting organizations have expressed much concern that NAs and other ancillary nursing personnel are being given various nursing-related tasks in hospitals in the absence of competency requirements.
The committee is greatly concerned about this lack and the potential for adverse impact on patient care. The committee recommends that hospitals have documented evidence that ancillary nursing personnel are competent and that such personnel are tested and certified by an appropriate entity for this competence.
The committee further recommends that the training for ancillary nursing personnel working in hospitals be structured and enriched by including training of the following types: The committee believes that hospitals should take the lead in ensuring the competence of, and provision of appropriate training to, all direct care personnel employed by them, including ancillary nursing personnel.
The committee does not believe that the first course of action should be enforcement by law or regulation at the federal, state, or municipal level. It does caution however, that if real quality-of-care problems were to emerge in hospitals that could be related to negligence by hospitals in ensuring competence, then the public might be expected to clamor for the enactment and enforcement of more stringent, external, regulation.
Such rules would then protect the public from problems that hospitals themselves should have guarded against. Hospitals are in a better position than nursing homes to assure the competence of NAs because NAs are not the predominant care givers in hospitals that they are in nursing homes.
Hospital NAs are more likely to work in teams with other care givers and to have more direct supervision from the RN, who is more immediately available than is usually the case in nursing homes. Finally, culturally sensitive care will become increasingly important in the years ahead.
As noted in Chapter 2the population, and therefore the patient population, is not only aging but also is becoming more racially and ethnically diverse. Thus, increasingly, care givers and care receivers may come from different cultural backgrounds. The imperative for cultural sensitivity is obvious. Involving Personnel in Planning for Change The changes briefly described above are appealing conceptually, and time will tell if they are effective and practical as the hospital sector reinvents itself.
In the short term, however, these shifts in the way hospitals do business, and the way they organize to conduct their business, are causing notable disruptions and misgivings among the nursing staff. From the frequency and intensity of the commentaries that the committee heard during this study, RNs are concerned about both the employment ramifications and more importantly the professional implications of the organizational changes that are occurring; they believe that these changes may lead to undesirable and unanticipated effects on quality of care.
In response to pressures to contain costs and improve quality of care, which may or may not be related to the downward trend in inpatient hospital use, hospitals are restructuring services, units, and activities.
As stated above, redesign efforts often involve the integration and coordination of work across departmental lines, which may also lead to elimination of positions, layoffs, redefinition of positions, and realignment of supervisory lines.
Restructuring of inpatient services in hospitals, accompanied by a changing mix of nursing personnel, is an inevitable consequence of the demands by society, through the payers of care, to control the costs of health services. Downsizing of the patient care workforce in inpatient hospital settings will continue, at least in the near future. Nursing personnel will not be immune from such downsizing. Overall, the sense of disquiet about the future, especially among RNs, was palpable, in part because of the unpredictability of the effects of these changes and in part because of the seeming lack of input and control that many nurses felt about the changes being made.
The committee heard from nurses who had lost their positions in hospitals about management decisions for downsizing that had been made without any staff involvement—a phenomenon that adds to the feelings of threat and uncertainty for many hospital-based RNs. At the same time, the committee had the benefit of learning about other hospitals where management involved staff in substantial ways in reaching solutions about how the necessary staff restructuring ought to take place.
At one of its public hearings, for instance, the committee heard from witnesses about the beneficial results of using free federal mediating services. On site visits, committee members visited some hospitals where change had been successfully implemented through well-conceived planning and implementation processes that involved both nursing administrators and staff nurses. In the committee's view, the harmful and demoralizing effects of these changes on the nursing staff can be mitigated, if not forestalled altogether, with more recognition on the part of the hospital industry that involvement of nursing personnel from the outset in the redesign efforts is critical.
The committee recommends that hospital leaders involve nursing personnel RNs, LPNs, and NAs who are directly affected by organizational redesign and staffing reconfiguration in the process of planning and implementing such changes.
The committee found impressive the testimonies and descriptions of these collaborative "redesign" efforts that involved all levels of nursing personnel in the restructuring process as illustrated above.
The rationale for inclusion of nursing personnel in hospital restructuring efforts relates to several factors: It is not simply to make the affected nursing staff feel better. Change is likely to fail if a top-down approach is imposed on hospital nursing staff.
Furthermore, the health care sector is moving rapidly to adopt principles of continuous quality improvement and total quality management as means for addressing issues in quality of care, for advancing the state of the art of quality measurement and management, and for promoting continuous progress in health care processes and patient outcomes.
These newer quality assurance and improvement techniques rely heavily on input from multiple segments of a health organization's personnel and departments; that is, they do not deal with quality issues that relate to only a single department, in part because most problems in health institutions and facilities are systemic rather than traceable to single events, people, or units.
Logic alone would dictate, therefore, that as an organization wishes to reinvent its structure and systems, it ought to adopt these same principles of involving individuals from across the departmental and personnel spectrum. Tracking the Effects of Change Although available national statistics on hospital employment do not show reductions in levels of nursing staff at the national level, the media frequently report on staff layoffs in hospitals.
Anecdotal information abounds, and ad hoc inquiries are conducted by unions, nurse associations, magazines of their membership and subscribersand other organizations. Unfortunately, the very low response rates of many of these inquiries and the deficiencies in the design of surveys and of questions do not permit consumers or policymakers to derive objective measures of the links between staffing patterns and processes and outcomes of care, and to draw valid conclusions.
As a consequence of declining trends in inpatient hospital use, some hospitals have been reducing the number of operating beds and reducing nursing positions by attrition or layoffs. Other hospitals are closing, and some are converting beds to long-term care and other services. These types of downsizing and consequent restructuring efforts necessarily affect employment of nursing personnel and will continue as long as hospitals face low-use patterns.
This turbulence in the health care delivery system and the resultant unstable situation fuel the concern that large decreases in RN staffing in hospitals are both occurring and leading to decrements in patient care and to threats to the health and well-being of nursing personnel.
As stated earlier, throughout the period of the committee's study changes were occurring in hospitals in the use of RNs and in the ratio of RNs to other nursing personnel in the organization of the delivery of patient care. Many of them intimated that such changes potentially will diminish the quality of care provided but the committee was unable to find evidence of a decline in the quality of hospital care because of any changes in staffing. Lacking reliable measures and data, no one is in a position to draw valid conclusions.
The amount of testimony provided, however, and the depth of concern cited, was sufficient to lead the committee to believe that this is an area that requires on-going monitoring and research in order to ensure that the responsibility for providing safe, effective, quality, and cost effective care is fulfilled within the health care system.
The committee finds that lack of reliable and valid data on the magnitude and distribution of temporary or permanent unemployment, reassignments of existing nursing staff, and similar changes in the structure of nursing employment opportunities greatly hampers efforts at understanding the problem and planning for the future. Answers are needed to numerous questions, such as: What happens to nursing staff after they are laid off? Are they employed in another hospital or reemployed at the same hospital?
Do they move to outpatient, community, or long-term care settings? Do they return to school for retraining or for more advanced nurse training? Do they leave nursing altogether for another occupation? Information on RN employment patterns is necessary. Research is needed on whether career paths of RNs will change markedly over the next 5 to 10 years.
These changes can have implications for career choices, curriculum design, structure of occupational ladders, and perhaps, quality of care. Among the many questions that warrant attention are the implications of restructuring for career choices, the structure of occupational ladders, and both entry and midcareer curriculum design.
The committee recommends that hospital management monitor and evaluate the effects of changes in organizational redesign and reconfiguration of nursing personnel on patient outcomes, on patient satisfaction, and on nursing personnel themselves. Throughout its deliberations the committee focused largely on RNs not only because they form the largest proportion of nursing personnel in this country and because their professional associations are the most well organized, but also because of the paucity of comparably detailed data on NAs and LPNs.
For that reason, hospitals should not concentrate their monitoring and evaluation solely on the relationships between RN staffing and quality of care or on work-related illness and injury.
Rather, hospitals should focus their monitoring and evaluation efforts of the restructuring and redesign of staffing on the entire spectrum of their nursing personnel.