The levels of experience and expertise of nursing staff have not been well measured. Experience is typically assessed using a proxy measure—the number of years an individual has been employed in nursing. This measure may capture exposure to opportunities for experience and the gaining of expertise, but as noted above, such exposure is not always a guarantee of expertise. Using years of nursing work as a proxy measure, however, experience has been associated with better patient care. In an analysis of data from two studies (involving 42 inpatient units in one large tertiary-care hospital and 39 patient care units in 11 other hospitals), nursing units whose nurses had more years of experience were found to have lower rates of medication errors and patient falls (Blegen et al., 2001). Likewise, a 1996–1998 analysis of nurses and errors in a Japanese cardiology ward found that nurses with less than 3 years of experience made significantly more rule-based and skill-based errors than those with more than 3 years of experience (Narumi et al., 1999).

Further support for the beneficial effects of years of experience and expertise in providing nursing care to individuals with particular clinical conditions can be inferred from similar studies of physicians. Such studies have revealed better patient outcomes when clinical procedures are carried out by physicians who have performed greater numbers of those procedures and when care of patients with certain clinical conditions, such as AIDS, is rendered by physicians with more experience in treating those conditions. The Agency for Healthcare Research and Quality’s (AHRQ) recent evidence-based report on the effect of health care working conditions on patient safety presents evidence that in a number of types of clinical care, greater experience of health professionals is associated with better patient outcomes (Hickam et al., 2003).

Currently, the experience level of nursing staff is threatened by high turnover rates in all health care delivery settings. Nationally in 2000, an estimated 21 percent of all acute care hospital nurses left the position in which they were practicing. Most hospitals reported turnover rates of 10 to 30 percent, but some experienced even higher rates (The HSM Group, 2002). The turnover rate is even higher in long-term care facilities. A 2001 national survey of the American Health Care Association (AHCA) revealed turnover rates of 78 percent for NAs, 56 percent for staff RNs, 54 percent for LPNs/LVNs, and 43–47 percent for directors of nursing and RNs with administrative duties (AHCA, 2002). If all these nursing personnel left their positions to take new positions in settings offering similar clinical services, the level of expertise of the nursing workforce would not be threatened.3


Although safety would still be threatened by nurses’ unfamiliarity with new HCO structures, policies, and practices.

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