Reducing the shortage in nurse staffing and improving the quality of
nursing-related care by transforming the way care is delivered at the bedside.

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UR INVESTMENTS IN NURSING seek to reduce the nurse staffing shortage and improve the quality of nursing care by transforming the way care is delivered at the patient’s bedside. Our approach to helping hospitals attract and retain nurses stresses improving the hospital work environment.

In the November 2004 issue of Health Affairs, Peter Buerhaus and colleagues at Vanderbilt University’s School of Nursing reported a recent increase in the number of nurses entering the workforce, mostly in hospitals. Despite these improvements in nurse recruitment, the recent influx of nurses does not meet current demand and is not enough to meet expected future demand. Furthermore, too few nurse leaders are engaged in key quality and patient safety organizations, and nursing leaders have little input into decisions about the acquisition and use of hospital technology.

In 2004 we undertook important initiatives aimed at building support for a new kind of hospital that addresses 21st century needs and realities. These initiatives included:

• Transforming Care at the Bedside. The Institute for Healthcare Improvement (IHI) led 13 hospitals participating in the pilot phase of RWJF’s Transforming Care at the Bedside program. IHI observed how small rapid-cycle improvements made a difference in nurses’ workload and improved morale. Some of the improvements instituted in medical-surgical units included conducting multidisciplinary rounds, using noise meters to ensure quiet for both nurses and patients, posting provider pictures in patient rooms, providing nurses with personal digital assistants with drug reference systems, and adding storage space at the bedside for supplies and medications. Participating hospitals reported tangible results benefiting both patients and staff. These innovations have spread beyond these 13 institutions—to nurses, nurse executives and health care leaders seeking to adopt similar improvements at other hospitals.
• Designing the 21st Century Hospital. RWJF also is working to foster a comprehensive approach to improving hospital work environments, as endorsed by the 2003 Institute of Medicine report, Keeping Patients Safe: Transforming the Work Environment of Nurses. Our activities in 2004 included documenting and disseminating information about the need for maximizing staff/patient safety and satisfaction through improvements in the physical structure, design and allocation of space and “corporate culture” of hospitals. A June 2004 conference sponsored by RWJF featured a new Foundation-funded analysis of more than 600 rigorous studies that document how improved physical settings can make hospitals better and safer places to work, as well as more conducive to healing.

Additionally, the Foundation convened national nursing leaders to discuss priorities; launched a policy brief series, Charting Nursing’s Future, for key stakeholders; and supported a National Quality Forum initiative to identify evidence-based measures that link patient outcomes to the care that nurses deliver.