able staffing and turnover data from hospitals and nursing homes. Information on individual hospital and nursing home staffing at the level of individual nursing units and the facility in the aggregate should be disclosed routinely to the public.

  • Federal and state nursing home report cards should include standardized, case-mix–adjusted information on the average hours per patient day of RN, licensed, and nurse assistant care provided to residents and a comparison with federal and state standards.

  • During the next 3 years, public and private sponsors of the new hospital report card to be located on the federal government website should undertake an initiative—in collaboration with experts in acute hospital care, nurse staffing, and consumer information—to develop, test, and implement measures of hospital nurse staffing levels for the public.

The creation of such a system for collecting staffing data from hospitals and nursing homes should remedy the lack of a national database on hospital nurse staffing levels that, as previously cited, (1) reports staffing levels by type of patient care unit; (2) distinguishes direct-care nursing staff from nursing staff in administrative, managerial, educational, or other non–direct patient care positions; and (3) distinguishes inpatient nurses from those delivering outpatient care in hospitals. These problems have thwarted researchers’ and managers’ attempts to better understand the role of nurse staffing in patient care and the more efficient and effective deployment of nursing staff.


The IOM (2001a) report Crossing the Quality Chasm cites the growing complexity of science and technology as one of the four main attributes of the U.S. health system affecting health care quality. This tremendous expansion of clinical knowledge, drugs, medical devices, and technologies continues unabated, and likely provides ongoing benefits to patients. In a study of hospital organizational and structural features associated with patient


This report addresses postemployment knowledge and skill acquisition. Issues pertaining to prelicensure nursing education were outside of the scope of this study. However, recommendations addressing the education of all health professions with respect to improving health care quality are contained in a recent IOM report Health Professions Education: A Bridge to Quality (IOM, 2003).

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