NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

Support for this project was provided by the National Institute for Nursing Research through an interagency agreement with the Bureau of Health Professions of the Health Resources and Services Administration, U.S. Department of Health and Human Services. The views presented are those of the Institute of Medicine Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes and are not necessarily those of the funding organization.

Library of Congress Cataloging-in-Publication Data

Nursing staff in hospitals and nursing homes : is it adequate? / Gooloo S. Wunderlich, Frank A. Sloan, and Carolyne K. Davis, editors.

p. cm.

“Division of Health Care Services, Institute of Medicine.”

Includes bibliographical references and index.

1. Nurses—Supply and Demand—United States. 2. Nurses’ aides—Supply and demand—United States. 3. Hospital care—United States. 4. Nursing home care—United States. I. Wunderlich, Gooloo S. II. Sloan, Frank A. III. Davis, Carolyne K.

[DNLM: 1. Nursing Staff—supply & distribution. 2. Nursing Staff, Hospital. 3. Nursing Homes. WY 125 N9748 1996]

RT86.73.N886 1996

331.12′91362173′0973—dc20

DNLM/DLC 96-117

for Library of Congress CIP

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.