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Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

Index

A

Abuse and violence

in hospitals, 178-179

in nursing homes, 179-183, 375-377

toward patients, 170, 180-183, 185-186, 375-376, 377

toward staff, 15-16, 170, 177-183, 187-188, 376-377, 512-514

Access to care, 36, 353

in nursing homes, 59, 164, 377-378, 476-477

Acquisitions, 53, 64

Activities of daily living (ADL), 39, 40, 131, 378

Acuity, see Case-mix acuity

Acute care, see Hospitals

Admissions to hospitals, 53, 54, 55, 279-280, 292

Advanced practice nurses (APN), 17, 97-100, 248, 342

barriers to practice, 7, 100, 325, 348, 353

education, 90, 336, 340, 342, 347, 348, 349

see Clinical nurse specialists;

Geriatric and gerontological nursing;

Nurse practitioners

Adverse incidents, 319-320

Age, of nurses, 72-74, 340, 350-351,

see also Elderly population

Agency for Health Care Policy Research (AHCPR), 17, 122, 352

AIDS

in nursing home case mix, 379

special care units, 58, 120

staff attitudes toward patients, 510-512

see HIV transmission

Almshouses, 362

Alzheimer's disease and other dementia, 39, 363-364, 366

special care units (SCU) for, 65, 184-185, 380

staff problems with, 179-180, 184, 389

Ambulatory care, 51, 55-56, 70, 81

American Board of Nursing Specialities, 342, 349

American Indians, 373-374

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

American Nurses Association (ANA), 10-11, 122, 123, 124, 309, 381

Ancillary personnel, see Nurse assistants (NA) and ancillary nursing personnel

Antipsychotic drugs, 131, 135, 139, 363, 381

Asian and Pacific Islander population, 34, 35, 374

Assault, 178, 513-514

Assisted living services, 39, 40, 65, 131, 365-366, 368, 378

Assistive lifting devices, 18, 174, 175, 177, 506, 507

Associate degree (AD) programs, 74, 75, 76, 83, 300-301, 302, 335-342 passim, 350

Autonomy and control, 88, 91, 117, 120, 315-316

B

Baccalaureate programs, 74-75, 76, 87, 300-301, 302, 334-342 passim, 349, 351

Background checks, 18, 181, 182

Back injuries and pain, 173-175, 505-509

Barriers to practice, 7, 100, 325, 348, 353

Black population, 34, 35, 38

in nursing homes, 78, 373

Blood and body fluids handling, 511-512

Board and care facilities, 63, 364-365

Boren Amendment, 61, 479

Bureau of Health Professions, Division of Nursing, 106, 122

Burnout, 183, 184, 185-186, 347, 388-389, 519-521, 523, 524

C

Career development and mobility, 106, 340, 345, 354

Care planning, 96, 316

in nursing homes, 131, 134, 146

Care teams, 1-2, 89, 95, 96, 101, 322-323, 352, 363-364

Case management, 6, 89, 95, 96-97, 321, 434

Case-mix acuity, 261

hospitals, 54-55, 79, 84-85, 93

nursing homes, 58, 129, 131-132, 147, 363, 366, 378-379, 434-435

Case-mix reimbursement, 61-62, 368, 400-401

under Medicaid, 163-165, 479-480, 482-484

Certificate of Need (CON) program, 43, 61, 476

Certification, see Licensing and certification

Chronic conditions, 38-39, 40, 58

Clinical nurse specialists, 97-99, 249, 342

Closures, of hospitals, 52, 53

Collaboration, see Care teams

Community college programs, 77, 87-88, 335, 340, 350

Community-oriented care, 89-90, 261, 345, 351-352, 354

Competencies

in graduate programs, 342, 351-352

of nurse assistants (NA), 17, 70, 102-103

Complication rates, 318-319

Computer skills, 345, 352

Conditions of Participation, 11, 125

Conflict resolution, 183

Continuing education (CE), 342-343, 353, 434

Continuous quality improvement (CQI), 94-95, 104, 384

Continuum of care, 51, 55-58, 66, 96-97, 343

Cost containment and cost reduction, 19, 27-28, 43-44, 343

through cuts in nursing staff, 85-86, 90, 94, 103, 261-262, 347, 409

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

through hospital restructuring, 1-2, 51, 52, 53, 94

through shifting of care, 55-56, 66

Council on Performance Measurement, 126

Culturally sensitive care, 7, 17, 18, 35-36, 102, 103, 158, 351, 372-373

D

Data bases and data management systems, 347, 352

administrative, 112, 145

nursing home assessments, 135-136, 145

patient records, 112-113, 408-409

Dementia, see Alzheimer's disease and other dementia

Department of Education, 350

Diagnosis-related groups (DRG), 44, 114, 435

Differentiated practice, 69, 90-91, 337, 340-342, 344-345, 349-350

Diploma programs, 74, 75, 76, 83, 300-301, 302, 334, 335, 336, 350, 433

Directors of nursing, 14-15, 18, 83, 141, 158-159, 348, 391, 397

education, 18, 158-159, 391, 397

Discharge planning, 39-40, 97, 98

Discharges from hospitals, 54, 114-115, 282

Diversity, see Racial and ethnic groups

Doctoral degree programs, 335, 336, 337, 338, 339, 341, 342, 348

Downsizing and layoffs, 2, 82, 83, 92, 93, 103, 105-106, 246, 347, 354

E

Education and training, 86, 88-91, 256-257, 271-272, 333-354

of advanced practice nurses (APN), 90, 336, 340, 342, 347, 348, 349

for alternative settings, 89-90

in conflict management, 17, 18, 102, 158, 183

continuing (CE), 342-343, 353, 434

differentiated practice, 90-91, 337, 340-342, 349-350

of directors of nursing, 18, 158-159, 391, 397

in interdisciplinary team care, 89, 352

of licensed practical nurses (LPN), 76-77, 303, 335, 338, 432-433

of nurse assistants (NA), 7, 18, 70, 78, 100-101, 102, 157-158, 181 , 391, 432, 468

in occupational safety, 15, 17, 18, 102, 158, 174, 175, 177, 506

of registered nurses (RN), 69, 73-76, 83, 87-88, 300-302, 335, 338 , 339, 350-351, 433

in research skills, 336, 337, 342, 346, 349, 352-353

teaching and faculties, 345, 349, 351

Elderly population, 2, 20, 31, 32-41

abuse of, 180, 374-375

aged 85 and over, 32, 33, 34, 38, 40, 58, 59, 366

health and disability status, 38-39

home health services use, 63

hospital use, 39-40, 54, 282-283, 292

nursing home demand and use, 38, 39, 40, 41, 58, 59, 366, 378-379

see Geriatric and gerontological nursing

Emergency rooms, stress and violence in, 178, 184, 513-514

Employment in health occupations, 4, 69, 72, 304-305

registered nurses (RN), 71-72, 93, 304-305

Enrollments in nursing programs, 75, 76, 301, 302, 303

Ethnic groups, see Racial and ethnic groups

Evaluation research, 17, 106, 342, 345, 352-353

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

F

Falls, 170, 171

Families, 36-37

role in nursing home care, 131, 165-167, 268, 384-386, 410-411, 413

Fatigue, 169

Fee-for-service (FFS) system, 47, 48, 49

Functional status, 109, 131, 378-379

G

Gender, see Men;

Women

Generic screens, 112-113

Geriatric and gerontological nursing, 321, 350, 379

Graduate degree programs, 335-336, 342, 350,

see also Advanced practice nurses (APN)

Graduations from nursing programs, 73, 75-76, 301, 302, 303, 337, 350

H

Health Care Financing Administration (HCFA), 112, 122

hospital regulation, 125

nursing home regulation, 13, 133, 134-135, 136, 402, 457, 459-460, 462-463

Health maintenance organizations (HMO), 43, 45, 47, 48, 49, 125, 290

Health promotion, 343, 352

Hepatitis transmission, 175, 176, 509

Hispanic population, 34, 35, 38, 374

in nursing homes, 351, 374

HIV transmission, 175, 176, 509, 510

Home health care, 54, 63-64, 70, 365

Home health services, of hospitals, 56, 57, 58, 287

Hospices, 56, 57, 58, 288-289

Hospitals, 22, 51-58, 79-81, 83-85

abuse and violence in, 178-179, 184, 513-514

beds, 54, 55, 79, 284-286, 292

case mix, 54-55, 79, 84-85, 93

closures, 52, 53

continuum of care, 51, 55-58, 96-97

discharge planning, 39-40, 97, 98

home health services offered, 56, 57, 58, 287

hospice services offered, 56, 57, 58, 288-289

injuries among staff, 170, 171, 175, 503

inpatient activity, 1, 53-55, 279-283, 292

licensed practical nurses (LPN) in, 77, 78, 93, 106, 294-297

mergers, 53

nurse assistants (NA) in, 17, 78, 95, 100-103

outpatient care, 55, 56-57, 99, 289, 292

registered nurses (RN) in, 4, 6-7, 44, 45, 79-84, 93, 95, 293-299

regulation of, 11, 102-103, 124-126

restructuring, 1-2, 5-6, 51, 52, 53, 94-106, 113

skilled nursing units, 56, 57-58, 287-288

special care units, 55, 57, 58

staffing levels and mix, 9-12, 44, 45, 68, 70, 79-81, 113, 116-122, 262-263, 294-299

staffing regulations, 11, 125

see Intensive care units (ICU);

Quality of hospital care

I

Income, 38

and Medicaid eligibility, 60, 377-378

Incontinence, 131, 133, 140, 366

Independence, of nursing home residents, 138

Independent practice associations (IPA), 47, 49, 52

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

Indian Health Service (IHS), 373-374

Informatics, 352

Injuries and illness among staff, 15, 169-172, 246, 248, 503-505

back injuries and pain, 173-175, 505-509

needlesticks, 18, 175-177, 505, 509-512

relation to staffing levels, 15, 173-177, 187

research needs, 18, 175

safety training, 15, 17, 18, 102, 158, 174, 175, 177, 506

Inpatient activity, 1, 53-55, 279-283, 292

impacts on hospital staffing, 79, 84, 93

Instrumental activities of daily living (IADL), 40, 378

Insurance, 46-47, 51, 125

Integrated systems, 51-52, 64, 99

Intensive care units (ICU), 55, 79, 93, 286, 515, 516, 522

J

Job satisfaction, 315-316, 323-324, 325, 515-516

among nursing home staff, 159-160

Job security, 86, 92, 345, 354

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

and hospitals, 11, 125-126

subacute care unit standards, 66, 380

K

Kerr-Mills Medical Assistance to the Aged Act, 362

L

Language skills and barriers, 36, 351, 372-373

Layoffs, see Downsizing and layoffs

Legislation, see Nursing Home Reform Act;

Omnibus Budget Reconciliation

Act (OBRA);

Social Security Act;

Tax Equity and Fiscal Responsibility Act (TEFRA)

Length of hospital stay, 53, 54, 55, 280-281, 282-283, 292

Licensed practical nurses (LPN), 69, 72, 73, 76-78, 80, 304-305

education, 76-77, 303, 335, 338, 432-433

in hospitals, 77, 78, 93, 106, 294-297

injuries among, 172

in nursing homes, 18, 70, 77, 78, 143, 144, 149-154, 158, 430-433

Licensing and certification

of advanced practice nurses, 100, 342, 349

of health care providers, 11, 125

of licensed practical nurses (LPN), 69

of nurse assistants, 17, 70, 102, 181-182

of nursing homes, 133, 136, 460

of registered nurses (RN), 69, 71, 337

Life expectancy, 32, 34

Lifting injuries, 15, 18, 171, 174, 175, 177, 505, 507-508

Living arrangements, 36-37

Long-term care, see Assisted living services;

Nursing homes

M

Managed care, 1, 19, 45, 47-49, 52, 96, 261-262, 348

Master's degree programs, 83, 335-336, 337, 338, 339, 341, 351,

see also Advanced practice nurses (APN)

Medicaid, 23, 38, 46, 51, 60, 61-62, 133, 163-165, 353, 362, 377-378, 463, 475-484 passim

case-mix reimbursement, 163-165, 479-480, 482-484

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

and cost containment for nursing homes, 61-62, 385

income and asset eligibility, 60, 377-378

prospective payment system, 61, 62, 163, 479, 480-481

Medicare, 38, 46, 51, 113, 126, 350, 353

home health service coverage, 57

and nursing homes, 46, 60, 62, 133, 362, 363, 377, 484-485

prospective payment system (PPS), 43-44, 62, 79, 114

Men

elderly, 36

in nursing, 72, 345, 351

Mergers and acquisitions, 53, 64

Minimum data set (MDS), 13, 134, 135, 145-146, 383, 415, 460

Minority groups, see Racial and ethnic groups

Mortality rates, 109, 112, 114

in nursing homes, 131, 133

relation to staffing ratios, 9, 112, 117-120, 317-318, 348

Multistate Nursing Home Case-mix and Quality Demonstration Project , 147, 402

N

National Center for Health Statistics, 106, 122

National Institute of Nursing Research (NINR), 17, 106, 122, 336, 352

National League of Nursing (NLN), 334, 348

Needlestick injuries, 18, 175-177, 505, 509-512

Neonatal intensive care units (NICU), 520-521

Nurse anesthetists, 85, 100

Nurse assistants (NA) and ancillary nursing personnel, 2n, 69-70, 72, 73, 78, 304-305, 347-348

abuse and violence involvement, 16, 18, 180-182, 376, 514

competencies, 17, 70, 102-103

conflict management training, 17, 18, 102, 158

and culturally sensitive care, 17, 18, 102, 103, 158, 372-373

in hospitals, 7, 17, 70, 100-103, 294-297

injuries among, 15, 171, 172, 174, 503-504, 505-506

occupational safety training, 15, 17, 18, 102, 158

training, 7, 18, 70, 78, 100-101, 102, 157-158, 181, 391, 432, 468

wages, 156, 160, 370, 371

Nurse midwives, 85, 100

Nurse practitioners, 85, 97, 99-100, 342, 347, 350

Nursing Home Reform Act, 68, 83

Nursing Home Resident Assessment System, 135, 459-460

Nursing homes, 58-66, 362-366, 426-429, 471-473, 477-479

abuse and violence in, 179-183, 374-377

access issues, 59, 164, 377-378, 476-477

alternative services, 40, 42-43, 64-65, 365-366, 472

bed supply and occupancy, 58-59, 472-476

case mix, 58, 129, 131-132, 147, 363, 366, 378-379, 434-435

complex technologies in, 59, 65

conflict management, 183

cultural issues, 372-374, 411, 413-414

directors of nursing in, 14-15, 18, 141, 158-159, 391, 397

injuries among staff, 170, 171, 173-174, 269, 503

and Medicaid, 23, 46, 60, 61-62, 133, 163-165, 362, 377-378, 463, 475-484 passim

and Medicare, 46, 60, 62, 133, 362, 363, 377, 484-485

mergers and acquisitions, 64

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

nurse assistants (NA) in, 13-14, 18, 70, 78, 143, 144, 149-154, 156-158, 160, 252-253, 263-265, 369, 370-371, 381, 399, 432

ownership, 50, 162, 364, 403, 485-489

profits, 486-487, 488

registered nurse (RN) in, 13-14, 83, 141, 142, 143, 144, 148-154, 160, 161, 199-204, 371, 381, 391, 430-432, 462-463

regulation of, 133-136, 141-142, 367-368, 381-382, 457, 459-461

reimbursement mechanisms, 46, 61-62, 162-165, 270-271, 368, 385, 479-485

restructuring, 64-66

salaries, 160-161, 369, 371-372, 466-467

shift to rehabilitative care, 42-43, 64-65, 134, 367, 379, 412-413

special care units (SCU), 65, 379, 380

staff education and training, 83, 411-412, 432-434

staffing levels and mix, 4-5, 12-13, 18, 68, 129, 141-144, 146-158, 167-168, 190-191, 368-370, 393-399, 429-430, 435-436, 437-450, 461 -465, 468-470

staffing needs and demand factors, 13, 22-23, 59, 83, 381, 434-435

staffing regulation, 141-142, 167-168, 253, 369-370, 381-382, 427, 462-463, 470-471, 491-492

staff turnover, 263, 430

subacute care units, 5, 65-66, 366, 379-380

24-hour registered nurse (RN) presence, 18, 83, 141-142, 153-155, 162, 199-204, 369, 381, 403

see Quality of nursing home care

Nursing shortage, 71, 353, 371

educational component, 349

and nursing homes, 141

O

Occupational health, see Injuries and illness among staff;

Stress

Older persons, see Elderly population

Ombudsmen, 167, 250n, 394

Omnibus Budget Reconciliation Act (OBRA), 12, 61, 62, 133-134, 168 , 181-182, 364, 367-368, 381, 383, 457, 459

implementation, 140-141

nursing coverage requirements, 12, 141-142, 383-384, 462-463

waviers, 141-142, 369, 381-382, 382

Oncology clinical nurse specialists, 98

Organizational factors, 17, 118, 121, 122, 308-309, 314

Outcome measures, 23-24, 344, 345, 346

hospitals, 108-109, 111, 123-124, 313-315, 325-328

nursing homes, 130, 131, 383, 456

Outpatient care, 55, 56-57, 99, 289, 292

Overexertion, 170, 171, 174

Ownership of facilities, 50, 247

nursing homes, 50, 162, 364, 403, 485-489

P

Partners-in-practice models, 101-102, 344

Patient-centered care, 94-95, 101

Patient satisfaction, 322-323, 325

with managed care, 48, 49

with nursing homes, 131

and restructuring, 17, 106

Peer Review Organizations (PRO), 113

Perkins Act programs, 350

Personal care activities of daily living (ADL), 40, 378

Population, growth rate, 32-34,

see also Elderly population;

Racial and ethnic groups

Postdoctoral training, 337, 339

Poverty status, 38

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

Preferred provider organizations (PPO), 45, 291

Pressure sores and decubitis, 131, 133, 157

Preventive medicine, 343

Primary care, 97, 342, 343, 344

Process of care indicators, 108, 110-111

for nursing homes, 129, 130, 131, 456-457

Professional practice models, 118, 258, 310-311, 313, 315-316, 324 , 405-407

Profit margins, 50

Prospective payment system (PPS), 60

impacts on staffing, 44, 79

under Medicaid, 61, 62, 163, 479, 480-481

under Medicare, 43-44, 62, 79, 114

Psychiatric clinical nurse specialists, 342, 348

Public health nursing, 90

Q

Quality assurance and quality improvement (QA/QI), 10-11, 104, 107

in nursing home assessment, 135-136, 460

Quality of hospital care, 28, 113-116, 245-250, 265-267

advanced practice nurses role in, 17, 97-100

and ancillary nursing personnel, 17, 100-103

elements of, 107-109, 110-111

legislation and regulation, 11, 102-103, 124-126

measurement of, 8-9, 106-113, 325-328

and organizational restructuring, 5-6, 94-106, 113

performance indicators and standards, 122-124

prospective payment system impacts, 9, 114-115

research needs, 8, 10-11, 17, 106, 116, 121-122, 127

and staffing level and mix, 9-12, 113, 116-122

Quality of nursing home care, 12, 28, 132-146, 250-256, 267-269, 456-457

elements of, 129-131

families' roles in, 131, 165-167, 268, 384-386, 410-411, 413

and geriatric specialists, 18, 155-156, 381-382, 396-398, 414-415, 467-468

and job satisfaction, 386-387, 399

and job stress, 387-390

legislation and regulation, 133-136, 141-142, 367-368, 381-382, 457 , 459-461

management issues, 18, 158-159, 403-405

measurement of, 129-132, 382-385, 407-409, 454-457

and nurse assistants (NA), 18, 156-158, 399

ombudsmen's role in, 167, 394

outcomes-based incentives, 165, 490-491

and ownership, 162, 403, 487-489

and patient mix, 131-132

and reimbursement mechanisms, 15, 385, 400-403, 412, 490-491

research needs, 18, 407-411

resident assessment tools, 135-136

and staffing levels and mix, 12-13, 18, 146-158, 167-168, 190-191, 393-399, 435-436, 437-450, 468-470

and staff training, 390-392, 467-468

and staff turnover, 159-160, 386-387, 394, 399-400

24-hour registered nurse (RN) presence, 18, 141-142, 153-155, 199-204, 381

volunteers and, 166

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

R

Racial and ethnic groups, 34

elderly population, 32, 34-36, 38, 373-374

in nursing, 249, 345, 351

nursing home residents, 374

nursing home staff, 372-373

see American Indians;

Asian and Pacific Islander population;

Black population;

Culturally sensitive care;

Hispanic population;

White population

Record review, 112-113

Registered nurses (RN), 4, 69, 70, 304-305, 350-351

autonomy and control, 88, 117, 120

differentiated practice, 69, 90-91

education, 69, 73-76, 83, 87-88, 300-302, 335, 338, 339, 350-351, 433

in hospitals, 4, 6-7, 44, 45, 79-84, 93, 95, 293-299

injuries among, 172

in nursing homes, 13-14, 83, 141, 142, 143, 144, 148-154, 160, 161 , 199-204, 371, 381, 391, 430-432, 462-463

salaries, 80, 85-86, 160, 161, 337, 369, 371

shifts in service settings, 81-82

supervisory duties, 13-14, 95, 347

see Advanced practice nurses (APN)

Registries, 181-182

Regulation

of hospital operations, 11, 102-103, 124-126

of hospital staffing, 11, 125

of nursing home operations, 133-136, 141-142, 367-368, 381-382, 457 , 459-461

of nursing home staffing, 141-142, 167-168, 253, 369-370, 381-382, 427, 462-463, 470-471, 491-492

Rehabilitative care, 42-43, 64-65, 134, 367, 379, 412-413

Rehospitalization rates, 131, 133

Reimbursement mechanisms, 43-44,

see also Case-mix reimbursement;

Prospective payment system (PPS)

Report cards, 122-124

Research needs, 192

for quality of hospital care, 8, 10-11, 17, 106, 116, 121-122, 127

for quality of nursing home care, 18, 407-411

Resident assessment instrument (RAI), 134, 135-136

Resident assessment protocols (RAP), 134, 135

Resident assistants, 157

Residential facilities, 63, 64

Resource constraints, 107, 129

Resource utilization groups (RUGS), 147, 163, 401, 402-403, 434-435

Respect, of nursing home residents, 138

Restraints, 131, 135, 138-139, 381

Restructuring, 19, 343-345, 347-349

monitoring effects of, 17, 105-106

and staffing patterns, 95-97

staff involvement in, 17, 103-105, 265-267, 348

RUGS, see Resource utilization groups (RUGS)

S

Salaries and compensation

nurse assistants (NA), 156, 160, 370, 371

nursing home staff, 160-161, 369, 371-372, 466-467

registered nurses (RN), 80, 85-86, 160, 161, 337, 369, 371

Satisfaction, see Job satisfaction;

Patient satisfaction

Security measures, 65, 180

Service learning, 346, 348

Suggested Citation:"Index." Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?. Washington, DC: The National Academies Press. doi: 10.17226/5151.
×

Service utilization, 320-322

Sharp objects, 176, 509-510

Shift work, 519-520

Sigma Theta Tau, 334

Social Security Act, 125, 133, 141, 362, 457

Special care units (SCU), 55, 57, 58

for AIDS, 58, 120

for Alzheimer's disease, 65, 184-185, 380

in nursing homes, 65, 379, 380

Specialization, 120

State boards of nursing, 7, 100, 257

State-level associations, 122, 247-249

State regulation, of nursing homes, 142

State surveyors, 133, 135, 140, 367-368, 413, 460, 461

Stress, 169, 183-187, 246, 248, 514-521

and turnover, 185-186, 522-524

Structural measures of care, 108, 110, 118

in nursing homes, 129, 130, 383

Subacute care units, 5, 65-66, 366, 379-380

Substitutions of staff, 85-86, 92, 246, 248, 343, 348, 385

Supply of nursing personnel, 4, 69-78, 87-91, 304-305, 342

Support networks, 187, 389-390

T

Tax Equity and Fiscal Responsibility Act (TEFRA), 43-44

Team care, 1-2, 89, 95, 96, 101, 322-323, 352, 363-364

Telecommunications, 352

Total quality management, 94-95, 104

Tube feedings, 133, 166

Turning patients in bed, 157

Turnover and retention

of directors of nursing, 158

of nursing home staff, 159-160, 263, 386-387, 394, 399-400, 430

relation to stress, 185-186, 522-524

24-hour registered nurse (RN) presence, 18, 83, 141-142, 153-155, 162, 199-204, 369, 381, 403

U

Undergraduate programs, see Associate degree (AD) programs;

Baccalaureate programs

Unemployment in nursing, 72, 73, 78, 105

Unions, 245-248, 251-252

University programs, 340, 345-347, 348-349, 350

Urethral catheterization, 132, 140

V

Ventilator care, 57, 59, 65

Violence, see Abuse and violence

Volunteers, 166, 191

W

Wages, see Salaries and compensation

Waivers

home- and community-based care, 63

nursing home staff requirements, 14, 141-142, 154, 200, 202-203, 369-370, 381-382

Weapons, 178-179, 513-514

White population, 34

elderly, 34, 35, 38, 373

Women

elderly, 36, 38, 375

home health services use, 63

as informal caregivers, 37

in nursing, 72, 156

occupational injuries among, 171, 172

and violence, 178, 375

Workplace hazards, see Injuries and illness among staff;

Stress

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Hospitals and nursing homes are responding to changes in the health care system by modifying staffing levels and the mix of nursing personnel. But do these changes endanger the quality of patient care? Do nursing staff suffer increased rates of injury, illness, or stress because of changing workplace demands? These questions are addressed in Nursing Staff in Hospitals and Nursing Homes, a thorough and authoritative look at today's health care system that also takes a long-term view of staffing needs for nursing as the nation moves into the next century. The committee draws fundamental conclusions about the evolving role of nurses in hospitals and nursing homes and presents recommendations about staffing decisions, nursing training, measurement of quality, reimbursement, and other areas. The volume also discusses work-related injuries, violence toward and abuse of nursing staffs, and stress among nursing personnel--and examines whether these problems are related to staffing levels. Included is a readable overview of the underlying trends in health care that have given rise to urgent questions about nurse staffing: population changes, budget pressures, and the introduction of new technologies. Nursing Staff in Hospitals and Nursing Homes provides a straightforward examination of complex and sensitive issues surround the role and value of nursing on our health care system.

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