TABLE 4.4 Percent Change in Nurse Staffing in Community Hospitals, United States, 1994–1995


Percent Change Quarter Ending March 1994–1995

Total FTE personnel


Total FTE nursing personnel






NOTE: FTE = full-time-equivalent.

SOURCE: American Hospital Association, National Hospital Panel Surveys, March Panel, 1994, 1995, preliminary, unpublished data.

numbers of RNs employed as well as the ratio of RNs to patients showed some signs of slowing down (see Table 2.9 in Part II of this report).

However, preliminary unpublished data from AHA's National Hospital Panel Surveys comparing the first quarters of 1994 and 1995 show a substantial percentage increase between 1994 and 1995 in the employment of RNs in hospitals, along with an increase in inpatient admissions (see Table 4.4).

Shift in Service Settings

Although the majority of nurses continue to work in hospitals, major shifts in nursing are taking place as a result of continuing cost pressures, the growth of managed care, and scientific and technological advances. As discussed in Chapter 3, the focus of health care is shifting away from nursing at the hospital bedside to nursing at the patient's side in a continuum of care (see Figure 4.7). The 1992 National Sample Survey of Registered Nurses found a greater number and proportion of RNs working in a variety of settings, notably ambulatory care, than in previous years. The largest increase in the rate of growth between 1988 and 1992 was in the outpatient areas. The rate of growth was about 15 percent for RNs working in community and public health settings. The growth in this service sector is largely due to the growth in home health care. Ambulatory care accounted for an 8 percent increase in the RN workforce. Even within the hospital setting, nurse employment in outpatient departments grew much faster than in inpatient units (Moses, 1994). The increase in employment in outpatient departments of hospitals is not surprising because outpatient admissions show a substantial growth. Despite this increase, however, in absolute terms the largest numbers of RNs by far are still working in inpatient settings of hospitals.

Although opportunities for the employment of RNs in settings other than the

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