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An exciting time in health care to assume editor's role. (From the Editor).

It is with great joy and enthusiasm that I assume the role of Editor of Nephrology Nursing Journal, especially in such a dynamic and opportune time for nursing and health care! In the last 6 months:

* The American Hospital Association Commission on Workforce for Hospitals and Health Systems released its report "In Our Hands: How Hospital Leaders Can Build a Thriving Workforce,"

* The Nurse Reinvestment Act was passed by both Houses of Congress and signed by the President (though not yet funded);

* The HIPAA regulations were published;

* The Department of Health and Human Services released its RN supply and demand projections through 2020;

* The Joint Commission on Health Care Organizations released a white paper "Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis;" and

* Numerous states initiated special commissions or task forces to address the nursing shortage.

Research on Nursing Care

All the while, the research evidence has continued to mount that the quality and quantity of nurses as well as the organization of patient care delivery clearly impact patient care. As far back as 1986, Knaus, Draper, Wagner, and Zimmerman showed a correlation between collaboration among nurses and physicians in the ICU and a lower incidence of patient morbidity and mortality. Since then, studies have shown conclusively that interdisciplinary interaction and communication, increased RN hours of care, increased RN staffing mix, how nursing is organized and led, and support of nursing care by hospital administration all affect patient care outcomes.

A recent Department of Health & Human Services study showed strong and consistent relationships between both levels and mix of RN staffing and negative patient outcomes such as UTIs, upper GI bleeding, pneumonia, LOS, shock, and failure to rescue. A study by Clarke et al. revealed that the likelihood of needlestick injuries and near-misses to nurses are increased 50% to 200% in hospitals with poor organizational climates and high workloads.

Magnet hospitals. Numerous studies have also shown that Magnet hospitals have increased patient safety, a higher quality of care, and superior nurse retention rates. This has led to a significant increase recently in the number of hospitals seeking to attain Magnet status. The Magnet Nursing Services Recognition Program for Excellence in Nursing Service was established in 1993 and recognizes:

* excellence in the management philosophy and practices of nursing services,

* adherence to standards for improving the quality of patient care,

* leadership of the chief nurse executive in supporting professional practice and continued competence of nursing personnel, and

* attention to the cultural and ethnic diversity of patients and their significant others as well as the care providers in the system. In addition, Magnet status indicates excellence in nursing services, development of a professional milieu, and growth and development of nursing staff.

The Challenge for Nephrology Nurses

The challenge for nephrology nurses is to learn from this body of research and apply the findings to our practice settings--then we must conduct research of our own to develop an evidence-based nephrology nursing delivery of care model. How many RNs and at what level of expertise ensure that safe, quality patient care will be provided in nephrology settings? What kinds of systems, processes, and support personnel allow us to make the best use of our limited number of nephrology nurses and at the same time enhance the ability of nephrology nurses to practice their profession in the most efficient and effective manner? What is the difference in patient outcomes and nurse satisfaction and retention when nephrology nursing care is led by nurses? What nursing competencies really make a difference in patient care outcomes and how do we ensure those competencies are consistently present?

As the new editor of the Nephrology Nursing Journal, I invite all of you to share the answers you find with our readers. Please email me anytime with your ideas at
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Author:Ulrich, Beth
Publication:Nephrology Nursing Journal
Date:Oct 1, 2002
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