Gilliland M
G & S Healthcare Consultants, Allen, TX, USA.
Nurs Econ. 1997 Nov-Dec;15(6):320-2.
As the number of positions decreases, the workload becomes more stressful for nurses left to pick up the slack. Mistakes are made, patient complaints increase as tensions rise, and the quality of nursing care decreases. The use of contingency staffing and overtime may increase as the workforce is reduced. Lack of job security forces acceptance of overtime, leaving less time for family life which may lead to resentment. The success of an organization is linked to employees' willingness to perform and use their skills. With deteriorating attitudes, employees will not perform at maximum effectiveness. Services do not meet established standards or customer expectations and are reflected in negative customer feedback and decreasing revenues. "There are no quick fixes. Tossing out last month's 'cure' to usher in this month's idea is a big waste of time" (Austin, 1994, p. 19). The impact from layoffs has long-lasting effects on employees, their families, and the community. Support for those displaced, and for those retained, provides a release for pent-up emotions and allows employees to get on with the work at hand. Workforce reductions will continue with the decrease in funding and the decline in patient census, but it is imperative that the quality of care be maintained. Registered nurses cannot be replaced at the bedside by UAP who do not have the specialized knowledge and skills required to provide safe and effective care (Thomas, 1995). Efforts to cut costs should be directed toward decreasing waste and eliminating redundant work, not at decreasing the number of RNs. The RN must remain the primary caregiver at the bedside to maintain quality care. Changes that remove the RN from the bedside will influence the quality of care that patients receive in the future. Increased demands and fewer, less-experienced staff result in less time for patient care. One negative patient outcome can be much more costly, directly and indirectly, than the salaries of several staff nurses.
随着岗位数量的减少，留下来收拾残局的护士工作量压力越来越大。错误频出，随着紧张局势加剧，患者投诉增多，护理质量下降。随着劳动力减少，应急人员配置和加班的情况可能会增加。缺乏工作保障迫使员工接受加班，留给家庭生活的时间减少，这可能会导致怨恨情绪。一个组织的成功与员工执行任务和运用技能的意愿息息相关。随着态度恶化，员工将无法发挥出最大效能。服务无法达到既定标准或客户期望，这体现在负面的客户反馈和收入下降上。“没有快速解决的办法。抛弃上个月的‘解决方案’来推行本月的想法，纯粹是浪费时间”（奥斯汀，1994年，第19页）。裁员对员工、他们的家庭以及社区都会产生长期影响。对被裁员工和留任员工的支持，能够释放积压的情绪，让员工继续手头的工作。随着资金减少和患者人数下降，劳动力削减仍将继续，但必须保持护理质量。床边的注册护士无法被没有提供安全有效护理所需专业知识和技能的非专业辅助人员取代（托马斯，1995年）。削减成本的努力应致力于减少浪费和消除冗余工作，而不是减少注册护士的数量。注册护士必须始终是床边的主要护理人员，以维持高质量护理。将注册护士从床边工作中移除的变革，将影响患者未来接受的护理质量。需求增加，而员工数量减少且经验不足，导致用于患者护理的时间减少。一次负面的患者结果所造成的直接和间接成本，可能比几名护士的薪水高得多。
