Hospital Administration
In view of increasing attention to costs, hospital policy has resulted in reorganized nurse staffing, including few er RNs and the replacement of professional nurses with unlicensed assistive personnel. Hospital ad ministrators ex pected that this strategy would re duce hospital expenditures (Kunen, 1996; Norrish & Rundall, 2001). However, the evidence evaluated here suggests that reducing RNs may significantly de crease quality of care and in crease hospital costs and LOS. Decisions about nurse staffing levels should be based on sound evidence to en sure that appropriate numbers of skilled nursing staff are available to achieve safety standards and optimum patient outcomes.