Nursing and health care reform: Implications for curriculum development

The health care system is undergoing profound changes. Cost containment eff orts and restructuring have resulted in cutbacks in registered nurse (RN) p ositions. These changes are often related to the increased market penetrati on by managed care companies. To determine how RN graduates perceive these changes and their impact on the delivery of patient care, Healthcare Enviro nment Surveys were mailed to graduates of the classes of 1986 and 1991. Usi ng the Survey's 5-point Likert Scale, we measured the graduates' satisfacti on with their salary, quality of supervision they received, opportunities f or advancement, recognition for their job, working conditions, the overall job and the changes in their careers over the previous five year period. Ou r study suggests that the changes in the health care system are having an i mpact on how health care is being delivered and the way nurses view their j obs. Respondents reported that insurance companies are exerting increased c ontrol over patient care and perceive that the quality of patient care is d eclining. Increased workloads and an increase in the amount of paperwork we re reported. Participants perceived that there were fewer jobs available an d that job security was decreasing. The percentage of nurses who see job sa tisfaction as remaining the same or increasing are a majority. However, the relatively high percent of nurses who see job satisfaction as declining sh ould provide a note of warning. The major implications of this study are th at the professional nursing curriculum must be modified to include content on communication, organization, legislative/policy skills, and leadership. The nation's health care system is undergoing profound changes. There are n umerous forces at work that are effecting the delivery of care and, consequ ently, the work of health professionals. These forces include significant e fforts at cost containment, restructuring and downsizing of hospitals, and the movement of health care delivery out of acute care centers and into the community. Even though cutbacks in registered nurse (RN) positions appear to have leveled off in sections of the country that have gone through restr ucturing and reengineering of the work place, there still remains a heavy e mphasis on lowering costs by decreasing employee benefits and increasing pr oductivity through the substitution of part-time RNs for full-time RNs and the substitution of unlicensed assistive personnel (UAP) for RNs. These cha nges are often related to the increased market penetration by managed care companies, which are not expected to abate any time soon. It is important to determine what impact these changes are having on the de livery of patient care since there is some evidence to suggest that reducti on in nursing staff below certain levels is related to poor patient outcome s (Fridken et al, 1996). It is also important to assess the effect of syste m changes on the satisfaction level health professionals have in their jobs . This is particularly important since some researchers suggest that job di ssatisfaction, over a period of time, can result in burnout and eventually, turnover (Cameron, Horsburgh, & Armstrong-Stassen, 1994; Cotterman, 1991). Finally, understanding the impact of these health care delivery system cha nges has significant implications for baccalaureate nursing education and t he preparation needed by future nurses to help them adjust to the changed e nvironment.