Nursing World | ANA Policy paper: The Acute Care Nurse in Transition

The Acute Care Nurse in Transition

Summary

The American health care system is in the midst of a major transition. Restructuring is changing, among other things, how health care is financed and delivered. At the center of this change is the hospital sector of the health care industry where downsizing, mergers and closures are having serious consequences not only for the quality of patient care, but also the employment stability of registered nurses. As the costs of providing services in acute care settings increase, more and more health care is being channeled into less expensive delivery sites.

Recognizing the possibility of a significant shift in RN employment settings occasioned by health care restructuring, the American Nurses Association (ANA) undertook in the fall of 1995 a study to identify skills registered nurses would need to transition into various non-acute care employment sectors or to remain in acute care. The study, which involved in-depth interviews with nurse executives and employers of registered nurses, produced a list of skills which were considered crucial for RNs. Those skills were then ranked in order of importance and difficulty. In late January 1996, ANA completed the study and circulated it for review and comment to ANA Board members, state nurses associations (SNA), and ANA structural unit chairpersons. The study is currently being prepared for publication and will be available for purchase in late August 1996 from American Nurses Publishing. ANA is planning and conducting additional research to complement the study and is collaborating with the SNAs to develop appropriate strategies to help registered nurses manage today's changing health care environment.

Background and Purpose of Study

In September 1995, ANA, in collaboration with Research in Marketing, Inc., began conducting market research to identify skills that acute care registered nurses would need to transition into non-acute care settings such as home health, long-term care, and health maintenance organizations (HMOs) or to remain in acute care. The main purpose of the study was to assist ANA's research on the issue of demand for RN services in acute care and non-acute care settings and to identify skills registered nurses would need to prepare for possible transition from one employment setting to another. Findings from the study would enable ANA, in collaboration with the SNAs, to develop appropriate interventions to help registered nurses manage the change.

Methodology

The study was conducted in two phases. Phase One consisted of a qualitative in-depth interview with a small number (thirteen) of nurse executives and hospital administrators about job trends and skills which they believe that RNs need in different employment settings. The respondents in this exploratory phase represented four health care sectors: hospitals, home health agencies, nursing homes and HMOs. Phase Two consisted of a quantitative study with a larger sample (185) of respondents, all of whom were nurse executives. The purpose of the quantitative phase was to confirm (or refute) findings from the exploratory phase. As in the qualitative phase, respondents in Phase Two represented the same four sectors of the health care industry.

Principal Findings

Phase One of the study identified nineteen skills that registered nurses need to transition from acute care to home health, nursing homes and HMOs. Respondents also identified seven skills that RNs must acquire or enhance to remain in acute care. Respondents in Phase Two rated the importance of each skill for the RN transitioning from acute care to one of the non-acute care settings and the difficulty involved in learning that skill. ("Importance" was defined as working successfully in the new setting. "Difficulty" was defined as the amount of learning and adjustment required for the new setting.) A combined "Importance-Difficulty" ranking was then calculated. Among the skills that the respondents stressed were independence, flexibility, strong communication and analytical capabilities, and new technical and management skills.

Additional Research

More research needs to be conducted related to the acute care registered nurse in transition. Issues that require further exploration include the critical skills acute care RNs must develop in order to remain in acute care; the potential for sustained RN job growth in non-acute care employment settings, for example, the home health sector; validation of the study's findings at the state level; and, a comparative analysis of the compensation levels of acute care versus non-acute care employment. ANA is working on several fronts to continue this work and will share its research findings with the House of Delegates and the SNAs as they become available.

Conclusion

ANA recognizes and acknowledges the narrow sample of the study and reminds readers of the limitations inherent in a sample of this size. The study is intended more as an exploratory probe than a definitive statement about RN skill requirements and employment trends in today's changing health care environment. If it sparks debate and further research into these complex issues, the study will have served a very useful purpose.

10/9/96

For more information regarding the Policy Series, contact, policy products specialist, at (202) 651-7022. If you have specific questions about this document, please mention No. 96-LAB-01.

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