Question

Your 600-bed medical center is a Magnet facility and was one of the first healthcare delivery systems in the nation to attain Magnet recognition. Maintaining Magnet recognition is a goal for the organization that requires planning and resources. You recently joined a committee that is responsible for overseeing the process to apply for Magnet recognition.

1. How can aggregate data collected from this facility be used to demonstrate the value of nursing (e.g., a correlation between nurse credentials and patient outcomes)?

b. Analyze how data obtained from all Magnet facilities in the United States can be used to influence national healthcare policy relative to the following issue:

• The value of nursing care
• Allocation of resources for specific populations
• Funding for further education for nurses

Answer 1

1, The importance of nurse staffing to the delivery of high-quality patient care was a principal finding in the landmark report of the Institute of Medicine’s (IOM) Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes: “Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes”¹ (p. 92). Nurse staffing is a crucial health policy issue on which there is a great deal of consensus on an abstract level (that nurses are an important component of the health care delivery system and that nurse staffing has impacts on safety), much less agreement on exactly what research data have and have not established, and active disagreement about the appropriate policy directions to protect public safety.

The purpose of this chapter is to summarize and discuss the state of the science examining the impact of nurse staffing in hospitals and other health care organizations on patient care quality, as well as safety-focused outcomes. To address some of the inconsistencies and limitations in existing studies, design issues and limitations of current methods and measures will be presented. The chapter concludes with a discussion of implications for future research, the management of patient care and public policy.

The most recent initiative in standardizing staffing and outcomes measures for quality improvement and research purposes was undertaken by the National Quality Forum (NQF). The mission of the NQF is to improve American health care through consensus-based standards for quality measurement and public reporting related to whether health care services are safe, timely, beneficial, patient centered, equitable, and efficient. To advance standardization of nurse-sensitive quality measures and respond to authoritative recommendations from multiple IOM and Federal reports,^{9, 15, 22} the NQF convened an expert panel and established a rigorous consensus process to generate the Nation’s first panel of nursing-sensitive measures for public reporting. The aim of the expert panel was to explicate and endorse national voluntary consensus standards as a framework for measuring nursing-sensitive care and to inform related research. Potential nursing-sensitive performance measures were subjected to a rigorous and systematic vetting under the terms of the NQF Consensus Development Process, which included a thorough examination of evidence substantiating each measure’s sensitivity to nursing factors, alignment with existing requirements being made of providers, and validation/recommendations of advisory bodies to Federal agencies.

2.

the concept of value of nursing care.

BACKGROUND:

Value-based health care delivery and reimbursement models are focused on value as a product of quality and cost. Nursing care provides tangible and intangible contributions to patient and organizational outcomes. The nursing profession must be able to proactively and effectively communicate the value of nursing care.

DESIGN:

Concept analysis.

DATA SOURCES:

Thirty-five separate sources were chosen from database searches of CINAHL Complete and ABI/INFORM Complete. Key terms utilized for the search were "nursing value" OR "nursing care value" OR "value of nursing".

METHODS:

Caron and Bowers' (2000) dimensional analysis method was used as a guide for the project.

RESULTS:

Dimensions identified from this concept analysis included: (a) economic, (b) relational, and (c) societal.

CONCLUSION:

Direct care nurses experience the relational and societal dimensions of the value of nursing care. Patients and/or families experience the relational dimension of value in nursing care. Health care administrators, third-party payers, and nurse researchers interpret value from the economic dimension. Future nursing research should better quantify the economic value of nursing care. Qualitative research which focuses on how patients and families experience the value of nursing care would also contribute to further refinement of this concept.

b. There has been much discussion of resource allocation in medical systems, in the United States and elsewhere. In large part, the discussion is driven by rising costs and the resulting budget pressures felt by publicly funded systems and by both public and private components of mixed health systems. In some publicly funded systems, resource allocation is a pressing issue because resources expended on one disease or person cannot be spent on another disease or person. Some of the same concern arises in mixed medical systems with multiple funding sources.

Although much has been written on resource allocation issues in medicine, there has been less discussion about how resource allocation affects public health. Federal, state, and local public health budgets in the United States constrain investments in health at those levels. In this regard, they are more like some foreign medical systems than the more fragmented and mixed public-private medical system of the United States. In the context of budget cuts domestically and in many countries responding to an economic downturn, how to invest (and allocate) public health resources is a pressing issue.

Most investments in public health aim to reduce population health risks, but some risks are greater than others, and resource allocation decisions must respond to risks. Sometimes resource allocation decisions focus on the immediate payoff of reducing risks from a specific disease, whereas other resource allocation decisions affect the infrastructure needed to respond to health risks over time. In addition, resource allocation decisions may determine who faces risks—the distribution of risks matters, not just the aggregate impact. Resource allocation in public health thus focuses on deciding what risks to reduce—which depends in part on their seriousness as population factors and who faces them—and how to reduce risks.