At the request of Congress, the IOM committee studied relationships among staffing levels, the mix of different types of nursing personnel, and the quality of patient care in hospitals and nursing homes, as well as the incidence of work-related injuries and stress among nursing staff. Workforce adequacy must be defined both in terms of numbers of RNs and the mix of their knowledge and skills, the IOM panel concluded. In particular, AACN commends the IOM panel for urging that increasing numbers of registered nurses with advanced practice skills be utilized in outpatient and inpatient settings to meet the demand for RNs with management, leadership, and supervisory abilities. Anecdotal information from nurses in many hospitals indicates that basic procedures such as dispensing medication, inserting catheters, changing surgical dressings, monitoring blood sugar levels, and maintaining patients' charts at times are being performed by assistants with only a few weeks or less of training. AACN agrees that more systematic data on such practices and on reassignments of existing nursing staff are vitally needed to understand the scope of the problem and its impact on the quality of patient care.
Nursing is ultimately accountable for the quality of care it provides.
As such, RNs not only should supervise all nursing personnel, but also define the appropriate educational preparation for all individuals delivering nursing care. Indeed, this supervision must be carried over into nursing homes, as well, where the intensive level of nursing assistants' direct care responsibilities and the minimal training for resident care required of them make professional oversight and close supervision by registered nurses critical, particularly given the increased acuity of today's residents, the IOM report urges. Anything less is substandard care that compromises the welfare and safety of patients. All rights reserved.