TABLE 3-3 Types of Work Units in Which Hospital-Employed RNs Spend More Than Half of Their Direct Patient Care Time

Type of Work Unit

Percent of RNs Employed

General/specialty bed unit


Intensive care unit (ICU)


Operating room




Emergency department


Step-down/transition from ICU


Outpatient department


Post-anesthesia recovery room


Other area


No specific area


Not known





SOURCE: Spratley et al. (2000).

Fewer hospitals, fewer inpatient beds, and fewer (but more acutely ill) inpatients In the last two decades, hospitals have been under tremendous pressure to remain financially solvent in the face of a widely acknowledged oversupply of hospital beds, cost-containment measures resulting in changes in reimbursement from public and private payors, and demands for greater accountability for the quality of the care they provide. Between 1980 and 2000, the number of hospitals in the United States declined by 17 percent, the number of hospital beds by 28 percent, the number of hospital admissions by 10 percent, and the average length of patients’ hospital stays from 7.6 to 5.8 days (American Hospital Association, 2002).7 Over about the same period, outpatient visits increased by more than 150 percent. By 1999, outpatient surgery constituted 50 percent of all hospital-based surgery—an increase from 16 percent in 1980 (American Hospital Association and The Lewin Group, 2001). As a result of this downsizing and technological advances in care, patients admitted to the hospital today are more acutely ill than was the case in the previous decade (Medicare Payment Advisory Commission, 2001).


In 1999 and 2000, hospital days of care increased. It is not yet known whether this increase signals the beginning of a predicted increase in hospital utilization accompanying the aging of the U.S. population or is just a temporary phenomenon (American Hospital Association and The Lewin Group, 2001).

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