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Hospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care. Nursing-sensitive outcomes are one indicator of quality of care and may be defined as “variable patient or family caregiver state, condition, or perception responsive to nursing intervention.”6 Some adverse patient outcomes potentially sensitive to nursing care are urinary tract infections (UTIs), pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality.a Most research has focused on adverse rather than positive patient outcomes for the simple reason that adverse outcomes are much more likely to be documented in the medical record.

The nurse workforce consists of licensed nurses—registered nurses (RNs) and licensed practical nurses (LPNs)—and nurses’ aides (NAs). Both RNs and LPNs are licensed by the State in which they are employed. RNs assess patient needs, develop patient care plans, and administer medications and treatments; LPNs carry out specified nursing duties under the direction of RNs. Nurses’ aides typically carry out nonspecialized duties and personal care activities. RNs, LPNs, and nurses’ aides all provide direct patient care.

RNs have obtained their education through three different routes: 3-year diploma programs, 2-year associate degree programs, and 4- year baccalaureate degree programs. Almost a third of all RNs have a baccalaureate degree, and 7.6 percent of hospital nurses have advanced practice credentials (either a master’s or doctoral degree). LPNs receive 12-18-month training programs that emphasize technical nursing tasks. Nurses’ aides are not licensed but many acquire certified nurse aide or nursing assistant (CNA) status after proving they have certain skills related to the requirements of particular positions.

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