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Broadening and overlapping job tasks among nurses key to sustaining high-quality patient care, reducing hospital costs

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Contact: Brian Lustig (202) 331-5530 or Nan Gibson (202) 331-5546

Washington, D.C. – Delegating sole responsibility of seemingly routine nursing tasks in hospitals, such as taking vital signs or conducting sterile procedures, decreases the quality of information available for decision making in patient care. Therefore, hospitals need to insure the availability of high quality patient information by overlapping tasks of both nursing assistants and registered nurses, adopting clinical pathways for use in patient care, and promoting skill development for all care providers, according to a new report released by the Economic Policy Institute (EPI).

Hospital reorganization has penetrated all staff levels, but nursing units, which represent, on average, 30% of a hospital’s annual budget, have been the most attractive cost-cutting target. As a result, administrators have sought to redistribute tasks within the nursing units in ways that may seriously impact the quality of patient care.

In Sharing Care: The Changing Nature of Nursing in Hospitals, Gil A. Preuss examines the effect changes in nursing work organization have on the patient care process and the quality of care. Preuss finds that a successful model of work organization in hospitals should include overlapping job responsibilities across care providers to build communication and information quality, broadening the definition of RN jobs, and continuous learning for all employee groups.

Routine tasks once performed by Registered Nurses (RNs) are now being delegated to lower-skilled nursing employees such as Nursing Assistants (NAs). While transferring RN duties down the employee ladder can lower costs, Preuss warns that there are clear limits to this type of reshuffling of job tasks:

  • Broadening nursing assistants’ responsibilities over seemingly routine tasks decreases the quality of information available for decision making on the unit.
  • Compared to units where NAs are responsible for only a few tasks, units with more extensive NA job responsibilities exhibit lower information quality.
  • Lower information quality on nursing units is linked with a higher perceived frequency of medication errors and lower nursing care quality as perceived by patients.

Based on these findings, the author makes four recommendations to hospital administrators that can improve both patient outcomes and hospital performance:

  • Broaden the definition of Registered Nurse (RN) jobs to include routine and managerial tasks. Hospitals must maintain RN responsibility over both routine and managerial tasks so that a high degree of skill is maintained at each level. RN responsibility for routine tasks should be shared with, not delegated to, ancillary personnel;
  • Overlap job responsibilities across care providers to build communication and information quality. By maintaining RN and NA joint responsibility for routine tasks, the quality of information available for decision making would increase and the frequency of medication errors would decrease;
  • Use clinical pathways more extensively. These pathways, which are maps of possible patient treatment and recovery schedules, are important tools to manage patient care among the different staff levels and improve patient care over time; and
  • Create opportunities for continuous employee learning. Promote more formal training, informal skill development, and close interaction with physicians.

Preuss’ report is based on a survey distributed to 3,500 nursing unit employees in 16 Minneapolis/St. Paul area hospitals. The conclusions reached by the author in the report offer one of very few available models hospital administrators can use to guide them through the rapidly evolving health care structure.

A companion to this report, Committing to Care: Labor-Management Cooperation and Hospital Restructuring, examines the role that labor-management relations play both in shaping the work practices adopted by hospital administrators and in determining the financial performance of hospitals.

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Gil Preussis a professor of Labor and Human Resource Policy at the Weatherhead School of Management, Case Western Reserve University. His research focuses on the role of information and skill in shaping work practices and organization outcomes. He received his Ph.D. in 1997 from the Industrial Relations/Human Resources group at the Sloan School of Management, Massachusetts Institute of Technology.

The Economic Policy Institute is a nonprofit, non-partisan economic think tank
based in Washington, D.C. Founded in 1986, EPI seeks to widen the debate about policies to achieve healthy economic growth, prosperity and opportunity in the U.S.

To order copies of Sharing Care and Committing to Care, contact EPI at 1-800-EPI-4844 or order online.