Investing in the nursing workforce to improve quality of care: the reinvention imperative.

In a recent issue of the Harvard Business Review,Miles D. White posits that leaders keep their organizations relevant and high-performing by heeding the “reinvention imperative” (White, 2013). He delineates two elements of reinvention: separating important and enduring trends from the shortlived and ultimately irrelevant, and deciding to take short-term “hits” (declines) in performance in order to lay the groundwork for long-term gains. White’s article has special resonance given the recurring trend in health care to redesign the workforce so as to achieve efficiencies and reduce costs. In relation to the nursing workforce, cost-cutting has historically involved eliminating nursing positions, leaving vacated nursing positions unfilled, and replacing registered nurses with practical nurses or unregulated health-care providers. Yet more than two decades of research has laid out the relationships between patient outcomes and the nursing workforce (Shekelle, 2013). The findings consistently show a correlation between more RN staff and better work environments (e.g., lower turnover and absenteeism rates) as well as better patient outcomes (e.g., lower mortality and morbidity rates and higher patient satisfaction rates). This downsizing of nursing has sometimes been justified using the allegedly economically based argument that cheaper care is better care. This argument is flawed, however, because it has been established that “quality care” is almost always the most “cost effective” when the fundamental purposes of health-care organizations are taken into account. The recurring trend to dismantle nursing services and nursing leadership as a cost-reduction strategy is disturbing at a time when the “smart talk” is about evidence-based practice, decisions, and policies. Further, as care becomes more complex it requires an educated RN workforce to meet the many challenges, including a growing elderly population, advances in science and technology, migration of primary care out of CJNR 2013, Vol. 45 No 4, 69 –71