Porter-O'Grady(2001'p9)makes the statement that

Sustaining Health in a New Age

Although many of the changes in today 's health care arena in the United States have been beneficial , there continues to be some dissatisfaction with the nation 's health care delivery system . Patients and other consumers are overwhelmed by limited access to care , escalating costs the complexity of the system , and the fragmentation of the care received . Providers are equally overwhelmed by the rise in the acuity and complexity of patient care problems . Health care institutions are pressured by the demands of multiple factors that are

perceived to have mutually exclusive needs . Simultaneously , payers must respond to their constituencies ' demands for quality care at a lower cost , as employers and government agencies react to the escalating portions of their dollars that are spent on health care (Brayfield Rothe , 2001 ,

br 182-195

The provision of outcome-oriented , cost-effective health care is no longer a goal . It is a mandate . To accomplish this mandate , the relationship between the costs of care , the quality and desired outcomes of care , and the processes involved in providing care must be reexamined

The financial aspect of health care has been one of the greatest driving forces in the adoption of the care management model because institutions that have implemented this model have experienced reduced increased patient turnover , and potential increase in revenues . Still the American health care system is said to have become impersonal , cold fragmented , expensive , and impractical . Health care workers , government insurance agencies , and patients are demanding change in today 's health care paradigm (Crosby , 1999 ,

. 28-30

The central mandate of the new paradigm is to do more for less and achieve equal or better patient outcomes . The new public concern for error and patient safety , together with the continuing "quest for quality " creates heightened nursing accountability for the outcomes of patient care , while at the same time the numbers of nurses available to provide that care are decreasing . The 1996 Institute of Medicine (IOM study Nursing Staff in Hospitals and Nursing Homes : Is it Adequate noted the paucity of empirical evidence available to support the anecdotal and other informal information that . quality of care is being adversely affected by hospital restructuring and changes in the staffing patterns of nursing personnel . Even before the IOM released its findings , the American Nurses Association (ANA ) recognized the need to provide a greater amount of evidence-based information . Therefore , ANA initiated a series of activities , which are now referred to collectively as Nursing 's Patient Safety and Quality Initiative . The initiative is a giant step toward public accountability . It is based on the premise that all nurses must become more knowledgeable about the measurement improvement , and benchmarking of clinical costs , as well as quality and outcomes specific to nursing . The underlying goal of the initiative is to support the registered nurse 's ability , opportunity , and value as a provider of quality , safe patient care in continuing and new health care delivery systems (Brayfield Rothe , 2001 ,

. 202-205 . Of critical importance to the...