These activities can serve as foundations for the necessary research that will follow. As ANA continued its work on Nursing's Quality Indicators for Acute Care Settings, it became clear that while we recommend surveying patients and nurses for satisfaction, we are not able to identify with precision the instruments or the criteria which could be used. This, we believe, will be essential in order to standardize what is being evaluated and how the evaluation is done, and to facilitate comparison of findings. Therefore, ANA strongly recommends that research be funded that seeks to identify the essential elements which evaluate satisfaction levels of staff nurses and patients. In addition, research needs to be undertaken that identifies the essential elements in patient classification instruments used to determine staffing and skill mix.
Nursing is a cognitive discipline first, and a practice discipline second.
Practice is the application of a large reservoir of knowledge with well developed critical thinking abilities provided by registered nurses. The reservoir of nursing knowledge has indicators of educational levels, certification status, experience base of the nurse and record of seeking and obtaining continuing education, all of which must be examined to determine their relationship to the impact of registered nurse care on patient outcomes. In addition, ANA believes that the end result of analysis and comparison of the nurse sensitive structure and outcomes data will yield answers to the appropriate number and mix of nursing staff to maintain and improve the quality of patient care. There are substantive sources in the health service research literature exploring these variables. These organizational variables critically affect nursing staffing and the ability of the registered nurse to provide quality patient care.