Thehealth care environmentin which nursesdeliver care isexperiencing constant change characterized by decreased lengths of stay inacute care settings, increased use of technology,increasing emphasis on computerized patientrecords and care planning options, increasingmarkets dominated by managed care, and anemphasis on outcomes rather than process. These changes dictate that nursing as aprofession ensures that the work of nursing isvisible in this health care environment andincluded in the data used to make health policy