Fewer hospitals are employing more nurses to care for fewer patients, according to a new report. The findings contradict the claims of organized nursing, which has accused hospitals of chopping their nursing staffs to save money at the expense of patient care.
In fact, not only are hospitals employing more nurses, they're employing more workers overall. And that contradicts the bulletins from hospitals and their consultants, which have contended that hospitals are downsizing and restructuring to become more efficient and productive.
Both trends, which rebut conventional wisdom, likely are the result of several factors, including the fact that money is plentiful.
The same report, released earlier this month by the American Hospital Association, revealed that hospital profits jumped nearly 25% in 1996 to a record $21.3 billion (Jan. 12, p. 2).
The report is the AHA's annual Hospital Statistics guide, which is based on financial and utilization data supplied to the association by more than 5,100 acute-care hospitals.
Data in the report show that full-time-equivalent registered nurse positions at acute-care hospitals rose slightly to 895,075 in 1996 from 893,735 in 1995. Over the same period, those hospitals' adjusted average daily patient census dropped to 799,407 from 809,238.
The 1996 figures are based on data from 5,134 hospitals. The 1995 figures are based on data from 5,194 facilities.
The changes resulted in an increase in the registered nurse-to-patient census ratio of 1.12 in 1996 from 1.1 in 1995. In fact, that ratio has been creeping up for at least the past five years, AHA data show. In 1991 the ratio was 1.02.
"That increase just affirms what we've been saying all along," said Marjorie Beyers, executive director of the American Organization of Nurse Executives, a subsidiary of the AHA. "Nurse staffing is driven by patient requirements for care."
Representatives of organized nursing, however, saw things differently.
"Revenues are up, admissions are up, outpatient visits and surgeries are all up, while lengths of stay continue to decline," said Argene Carswell, interim executive director of the American Nurses Association. "Yet RN staffing has remained relatively constant since 1993."
She said these factors should be leading to a larger increase in RN care, especially because the acuity of hospital patients has increased, requiring more intensive care.
Meanwhile, the number of total hospital FTEs is still growing. According to the report, total hospital FTEs rose to 4,276,109 in 1996, up slightly from 4,272,815 in 1995.
And most of that growth is in non-nursing positions. In 1996 registered nurse and licensed practical nurse FTEs represented 39.3% of all hospital FTEs. That's down from 40.6% in 1995.