146 unit 2 | Working Within the Organization
skilled nursing care. The number of aging baby
boomers will significantly increase the demands
on the health-care systems and increase the
needs for RNs.
■Increased demand for nurses.As health care
moves to a variety of community settings, only
the most acute patients remain in the hospital.
The transfer of less acute patients to nursing
homes and community settings creates addition-
al job opportunities. Research supporting
improved patient outcomes when patient care is
provided by RNs as opposed to unlicensed per-
sonnel will also increase demand for RNs.
■Aging nursing workforce.In 2000, fewer than
one in three RNs was younger than 40 years of
age. The percentage of nurses age 40–49 years is
currently more than 35%.
In March 2004 the average age of the RN popula-
tion was 46.8 years of age, up from 45.2 in 2000.
The RN population under the age of 30 dropped
from 9% of the nursing population in 2000 to 8%
in 2004 (AACN, 2008).
■Job dissatisfaction.Staffing levels, heavy
workloads, increased use of overtime, lack of
sufficient support staff, and salary discrepancies
between nurses and other health-care profes-
sionals have contributed to growing dissatisfac-
tion and lower retention of nurses. Many
facilities are now using workplace issues and
incentives as a retention strategy.
■Reduction in and shortage of nursing faculty.As
retirements for faculty continue, the shortage
of faculty continues to affect the number of
students admitted to nursing programs. In
2007 nursing programs reported more than
750 open nursing faculty positions (AACN,
2008). In addition, nursing programs turned
away over 40,000 qualified nursing applicants,
in part, due to the shortage of nursing faculty
(AACN, 2008).
■The need to control spiraling health-care costs,
along with the issues of supply and demand for
nursing services will continue. According to the
ANA, more than 40% of nurses graduate initially
from associate-degree nursing programs. You,
personally, will be affected by trends in health-
care delivery, but you can also be a major voice
in decision making (Nelson, 2002). As in the
past, cost control and demand for nursing
services will most likely involve changing nurse
staffing, the model of care, and professional
nursing practice (Ritter-Teitel, 2002).Safety in the U.S. Health-Care
SystemPatient safety is the prevention of harm caused by
errors. The IOM defines errors as “the failure of a
planned action to be completed as intended (e.g.,
error of execution) or the use of a wrong plan to
achieve an aim (e.g., error of planning) (IOM,
2000, p. 57). It is important to note that errors are
unintentional and that not all errors lead to an
adverse event causing harm or death.Types of Errors
To Err is Human(2000) relied on the work of
Leape et al. (1993) to categorize types of errors
(Box 10-7). After categorizing types of errors,
Leape and colleagues found that 70% of all errors
were preventable.
Human errors can occur for many reasons.Skill-
based errorscan be slips or lapses when the actions
taken by the provider were not what was intended
(Duke University Medical Center, 2005). An
example of rule-based error is an experienced nurse
administering the wrong medication by picking up
the wrong syringe.box 10-7
Types of Errors (IOM, 2000, p. 36)
Diagnostic
Error or delay in diagnosis
Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Treatment
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatment or in responding to an abnor-
mal test
Inappropriate (not indicated) care
Preventive
Failure to provide prophylactic treatment
Inadequate monitoring or follow-up of treatment
Other
Failure of communication
Equipment failure
Other system failure
Leape, Lucian; Lawthers, Ann G.; Brennan, Troyen A., et al. Preventing medical
injury. Qual Rev Bull. 19(5):144–149, 1993.