title: Licensed nursing staff reductions and substitutions in Pennsylvania hospitals, 1991-1997.
abstract: Nurses report a decline in RN/patient and skill mix in the 1990s while quantitative studies fail to confirm this. This study examines aggregate hospital nursing staff in Pennsylvania from 1991-1997, focusing on changes in licensed nursing staff. It finds that licensed nursing staff declined while nursing assistants increased in this period. With adjustment for patient acuity, there was a slight decrease in RN/adjusted patient days of care (APDC), a 23% decrease in LPN/APDC, and a 4% decrease in licensed nurse/APDC. The RN/nurse ratio increased slightly, and licensed nurse/nurse fell slightly. Since RNs often operate in environments which make use of teams of licensed staff, nurses' perceptions of a decline in the RN/patient ratio is a result of the decline in licensed staff/APDC, and of an increase in patient acuity.
authors.affiliation: Health Services Administration Program, College of Health and Public Affairs, University of Central Florida, Alpha Building Tr 534, Orlando, Florida 32816-2205, USA.
authors.forename: L
authors.initials: L
authors.lastname: Unruh
mesh_terms: D002983:Clinical Competence; D006801:Humans; D007318:Inservice Training; D008008:Licensure, Nursing; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D009743:Nursing, Practical; D010414:Pennsylvania; D020415:Personnel Downsizing / Q000706:statistics & numerical data / Q000639:trends*; D010561:Personnel Staffing and Scheduling / Q000592:standards / Q000639:trends*; D000078329:Workforce