Nursing and health care reform: implications for curriculum development

Area of Science:

• Healthcare Management
• Nursing Education
• Health Services Research

Background:

• The healthcare system is experiencing significant transformations driven by cost containment, restructuring, and managed care.
• These changes include cutbacks in registered nurse (RN) positions and increased use of unlicensed assistive personnel (UAP).
• System changes may affect patient care quality and healthcare professional job satisfaction, potentially leading to burnout and turnover.

Purpose of the Study:

• To assess registered nurse (RN) graduates' perceptions of healthcare system changes.
• To determine the impact of these changes on patient care delivery.
• To evaluate the effect of system changes on RN job satisfaction.

Main Methods:

• A survey was distributed to registered nurse (RN) graduates from the classes of 1986 and 1991.
• A 5-point Likert Scale was used to measure satisfaction with salary, supervision, advancement, recognition, working conditions, and overall job.
• Respondents reported on career changes over the preceding five years.

Main Results:

• Respondents indicated increased insurance company control over patient care.
• Perceptions of declining patient care quality, increased workloads, and more paperwork were reported.
• Fewer job opportunities and decreased job security were perceived by participants.
• While a majority reported stable or increasing job satisfaction, a significant percentage noted a decline.

Conclusions:

• Healthcare system changes are impacting patient care delivery and nurses' job perceptions.
• Nursing curricula require modification to include essential skills like communication, organization, legislative/policy, and leadership.
• Addressing declining job satisfaction and perceived quality issues is crucial for the nursing profession and patient outcomes.