Hospital restructuring and its impact on outcomes: nursing staff regulations are premature.

Objective: Describe restructuring in the organization and delivery of patient care and the effects of nursing structure and processes on selected patient outcomes.

Background: Restructuring has been the dominant cost-reduction strategy in acute care hospitals. Changes occurred without a systematic look at how interventions impacted on the processes and outcomes of care.

Tailoring hospitals for managed care and integrated health systems.

Preparing the hospital for its new role in a capitated, managed care environment requires restructuring and re-engineering. Multiple approaches to achieving cost reductions while improving quality are discussed, with an emphasis on the nursing-led initiatives. An inventory of restructuring and re-engineering strategies from 15 university teaching hospitals is included.

An interview with Margaret D. Sovie. Interview by Connie R. Curran.

Margaret D. Sovie, PhD, RN, FAAN, is associate deputy executive director and chief nursing officer at the Hospital of the University of Pennsylvania, Philadelphia. In this interview, she discusses the pursuit of nursing excellence, the changing health care environment, innovations in documentation, and professional development.

Nurse manager: a key role in clinical outcomes.

As a central partner in the business of the hospital, the nurse manager's focus is on the delivery of high-quality care resulting in desired clinical outcomes at controlled costs. These outcomes require a partnership for patient care. Nurse managers develop and empower staff; forge collaborative and team relationships within nursing and with other disciplines and departments; and help to transform the hospital culture.