in patient care quality and safety that are critical to the success of America’s health care system, today and tomorrow” (Joint Commission, 2010). While quality measures have historically focused on conditions or diseases, many of the quality measures used over the past few years address how well nurses are able to do their jobs (Kurtzman and Buerhaus, 2008).

In 2004, the National Quality Forum (NQF) endorsed the first set of nationally standardized performance measures, the National Voluntary Consensus Standards for Nursing-Sensitive Care, initially designed to assess the quality of care provided by nurses who work in hospitals (National Quality Forum, 2004). The NQF measures include prevalence of pressure ulcers and falls; nursing-centered interventions, such as smoking cessation counseling; and system-centered measures, such as voluntary turnover and nursing care hours per patient day. These measures have helped nurses and the organizations where they work identify targets for improvements in care delivery.

Another important vehicle for tracking and improving quality is the National Database of Nursing Quality Indicators, the nation’s largest nursing registry. This database, which meets the new reporting requirement by the Centers for Medicare and Medicaid Services for nursing-sensitive care, is supported by the American Nurses Association.2 More than 25 percent of hospitals participate in the database, which documents more than 21 measures of hospital performance linked to the availability and quality of nursing services in acute care settings. Participating facilities are able to obtain unit-level comparative data, including patient and staffing outcomes, to use for quality improvement purposes. Comparison data are publicly reported, which provides an incentive to improve the quality of care on a continuous basis. This database is now maintained at the University of Kansas School of Nursing and is available to researchers interested in improving health care quality.

Nurses and Access

Evidence suggests that access to quality care can be greatly expanded by increasing the use of RNs and APRNs in primary, chronic, and transitional care (Bodenheimer et al., 2005; Craven and Ober, 2009; Naylor et al., 2004; Rendell, 2007). For example, nurses serving in special roles created to increase access to care, such as care coordinators and primary care clinicians, have led to significant reductions in hospitalization and rehospitalization rates for elderly patients (Kane et al., 2003; Naylor et al., 2004). It stands to reason that one way to improve access to patient-centered care would be to allow nurses to make more care decisions at the point of care. Yet in many cases, outdated regulations, biases, and policies prevent nurses, particularly APRNs, from practicing to the full extent



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