Article 1

More than ever before, hospitals in the United States are being challenged to provide high-quality patient care with limited resources. These challenges are generating renewed interest in efficiency initiatives, especially length of stay reduction. A variety of resource limitations currently confront hospitals. One of the most serious of these is the nursing shortage. Acute care facilities throughout the nation are experiencing difficulties in delivering care because of the lack of nurses for inpatient and outpatient services. A major source of this problem is demographics. The declining birth rate during the 1970s, combined with new job opportunities, has resulted in a lower number of candidates for the nursing profession. This situation has been exacerbated by the impact of the expanding technology sector on the employment pool.1,2 In recent years, hospital resources have also been limited by constraints on reimbursement. In the public sector, efforts to balance the federal budget have limited the ability of Medicare payments to keep pace with hospital expenses. In a number of