Letter to the Editor by Janet M. Reed to “Determinants of Who Does What in Health Care”

Who Does What in Health Care?

October 30, 2014

Response by Janet M. Reed to “Determinants of Who Does What in Health Care” by Ada Jacox, PhD, RN, FAAN (December 30, 1997):

Dear Editor:

I am writing in response to the article “Determinants of Who Does What in Health Care” by Ada Jacox. This article brings up the important topic of the overlap of nursing with other healthcare occupations and how nursing needs to distinguish itself by demonstrating its ability to provide cost effective care. I believe that one of the things that set nursing apart from other health disciplines is the focus not only on actual problems, but also potential problems for patients. Drawing from nurses’ knowledge and expertise of holistic patient care, registered nurses (RNs) are able to analyze potential future problems for their patients and form a plan of intervention to prevent those from happening. What other discipline is like nursing, with a focus on early detection and prevention that can help recreate the future for patients by early intervention?

There are so many intangible, immeasurable nursing outcomes. Who knows how many bowel obstructions have been prevented by nurses who put a bowel management program in place to prevent constipation? Who knows how many pressure ulcers have been prevented by astute nurses who noticed their patient’s Braden score, knew the patient was at risk, and took independent measures to prevent skin breakdown? Who knows how many falls have been prevented, falls which may have led to hip fractures, head injuries, and severe debilities? Who knows how many re-hospitalizations have been prevented by nurses who gave thorough patient education that resulted in lifestyle changes and adherence to medical management?

In today’s society, healthcare organizations want to see tangible, numerical outcomes measured by quantitative tools that can also provide cost-savings information. For nursing, this creates a difficulty because it is difficult to measure things which have not happened. But research has confirmed that higher RN to patient ratios result in decreased patient mortality (AHRQ, 2012; Aiken, Clark, Sloane, Sochalski, Silber, 2002; Needleman et al., 2011; Stanton, 2004). Part of this phenomenon must be attributed to nursing’s focus on eliminating potential “risk for” problems. As the nursing profession seeks to redefine itself and its overall mission, remember the uniqueness of nursing’s ability to recreate the future for individual patients, groups, communities, societies and the world. Just like artists, who envision a masterpiece before they even pick up the paintbrush, nurses must dare to dream big, and intervene on potential health problems before they actualize.

Janet M. Reed, RN MSN
Nursing Faculty
Kent State University at Stark
6000 Frank Ave.N. Canton, OH 44720


Agency for Healthcare Research and Quality (2012). State-mandated nurse staffing levels lead to lower patient mortality and higher nurse satisfaction. Retrieved from http://innovations.ahrq.gov/content.aspx?id=3708&tab=1

Aiken, L.H., Clark, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288 (16), 1987-1993.

Needleman, J., Buerhaus P., Pankratz V., Leibson C., Stevens S., Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-45. doi: 10.1056/NEJMsa1001025

Stanton, M. (2004). Hospital nurse staffing and quality of care. Research in Action: Agency for Healthcare Research and Quality, 14. Retrieved from www.ahrq.gov/research/findings/factsheets/services/nursestaffing/index.html