Q Did unit restructuring go out with the '90s?

A A variety of new and old pressures continue to strain the hospital industry: reimbursement woes, workforce availability, hospital disaster response, patient safety technology, and new government regulations concerning privacy. To meet these unrelenting demands, many nurse executives will once again need to restructure units and design new work processes. Restructuring at the patient care level involves safeguarding precious resources, namely nursing time and expertise. Nurse leaders planning to restructure will reevaluate and realign practice expectations and care processes.

Since the late '90s, the literature regarding nurses' contributions to professional practice and clinical outcomes has grown substantially, confirming that RNs provide an important surveillance system for quality patient care. While a single best approach for unit reconfiguration doesn't exist, the design process should involve discrete decisions about unit staffing and professional practice.

As workforce issues intensify, restructuring gets more challenging. Yet, the contribution that nursing makes to outcomes appears more evident than ever before. New approaches for supporting nurse staffing and professional nursing practice will prove key to achieving positive outcomes for staff and patients.