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Current federal and state legislation for mandated nurse staffing falls short of the ideal plan. Hospital nurse-staffing ratios are inadequate to maintain patient safety and quality nursing care. Mandating fixed nurse-to-patient ratios does not accommodate changes in patients' needs, evolving technology, and experience of nursing staff and will be immediately obsolete. Ideal measurement of nurse staffing incorporates nurse skill level and patient acuity. The Pennsylvania State Nurses Association supports legislation to establish patient acuity-based nurse staffing.

One of the vital components to the assurance of quality nursing care is a comprehensive orientation program. The concept of a competency achievement program facilitates the development of independent practice and judgment skills on the part of today's home healthcare nurse. The authors discuss one agency's program to meet the needs of newly employed registered nurses.

Present day fiscal pressures dictate the need for balancing nursing costs and quality concerns. This article presents logical and organized methodologies for interrelating quality compliance, patient volume, and nursing resource consumption and determining the costs associated with the delivery of quality nursing care. These methodologies provide the chief nursing officer a means for evaluating the impact of fiscal constraints on quality compliance and for judging any effectiveness/efficiency trade-offs.

The strategic management of a nursing organization in a changing health care market creates pressure on nursing administrators and on their organizations. The effective management of organizational stress potentiates quality nursing care and reduces the costs related to stress and burnout. This article describes a two-tiered program designed to manage organizational stress. The first component focuses on educating nursing leadership about the nature and impact of organizational stress and how to minimize it. The second component is the instrument used to measure the perceived effectiveness of our interventions.