The Strengthening Hospital Nursing Program

Changing Organizations to Improve Patient Care

The Strengthening Hospital Nursing program described in this chapter was planned in the mid-1980s and has unfolded in some unexpected ways over the past 10 years. The impetus for the program during its planning phase was clear and simple: to help hospitals address the problems caused by shortages of nurses in the 1980s. However, the co-funders of the program—the Robert Wood Johnson Foundation and the Pew Charitable Trusts—quickly widened the scope of this expensive and highly visible program. It became, over time, a focal point for increasing the role of nursing and transforming the basic approach to patient care within hospitals.

In the 1990s, as the program was unfolding, it faced two substantial environmental obstacles: first, the nursing shortage that had motivated the program evaporated, leading to serious questions about the purpose of the program; and second, the spread of managed care and ever-increasing financial pressures facing hospitals became more dominant forces in shaping approaches to patient care than the approaches offered by this program.

It is difficult to assess the success or failure of this program definitively because it addressed ambitious, difficult-to-measure goals and because so much change was taking place in the nation's hospitals. There have been constant concerns within the Foundation, however, that the goals of the projects selected were too broad and that the theory that nursing could lead fundamental changes in overall hospital structure is not viable.

Partly because of these concerns, the Robert Wood Johnson Foundation and the Pew Charitable Trusts asked Thomas Rundall, David Starkweather, and Barbara Norrish from the University of California, Berkeley's School of Public Health, to take an outside look at the program. In this chapter of the Anthology, they summarize the results of their evaluation and present an in-depth report on three of the 20 Strengthening Hospital Nursing sites. The authors conclude that even though the program was overtaken by changes in the health care field and may not have accomplished what it was supposed to, it still led to many positive results in the sites where it was undertaken.