The past decade has witnessed pronounced changes in the organization of United States hospitals, many the direct result of restructuring and re-engineering initiatives intended to decrease costs and increase productivity. Little is known about how these initiatives have affected clinical care and patient outcomes. Using data from a variety of sources, the authors describe initiatives that hospitals undertook during this period, discuss how nurse staffing changed relative to the case mix of patients receiving care, and examine changes in nursing practice environments from 1986 to 1998.
Linda H. Aiken, PhD, RN, FAAN, FRCN, Claire M. Fagin Leadership Professor of Nursing, Professor of Sociology, Director, Center for Health Outcomes and Policy Research,
Sean P. Clarke, PhD, RN, CS, Postdoctoral Fellow, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia,
Douglas M. Sloane, PhD, Research Scientist and Adjunct Associate Professor, Center for Health Outcomes and Policy Research, University of Pennsylvania, Associate Professor of Sociology, Life Cycle Institute, Catholic University of America, Washington DC.
Supported by a Robert Wood Johnson Foundation Investigator Award in Health Policy Research and grants from the National Institute of Nursing Research, National Institutes of Health.
Adapted and reprinted with permission from the Journal of Health and Human Services Administration, published by the Southern Public Administration Education Foundation Inc., PO Box 632, Randallstown, MD 21113, USA, copyright 2000.