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Discussions of hospital quality, efficiency, and nursing care often taken place independent of one another. Activities to assure the adequacy and performance of hospital nursing, improve quality, and achieve effective control of hospital costs need to be harmonized. Nurses are critical to the delivery of high-quality, efficient care. Lessons from Magnet program hospitals and hospitals implementing front-line staff-driven performance improvement programs such as Transforming Care at the Bedside illustrate how nurses and staff, supported by leadership, can be actively involved in improving both the quality and the efficiency of hospital care. 1 Improving the quality of America's hospitals has become a highly visible public and private enterprise, as payers, accreditors, and private organizations attempt to set standards and encourage their achievement.At the same time, there has been ongoing concern about controlling hospital costs, which have experienced real growth of approximately 2 percent per year despite decades of efforts at hospital payment reform and utilization control.2 Efforts by hospitals to control labor costs have had major effects on nurses-the largest component of hospital labor. Lower rates of entry into the nurse workforce

Nurses are the largest group of health care professionals providing direct patient care in hospitals, and the quality of care for hospital patients is strongly linked to the performance of nursing staff, according to an Institute of Medicine report. This paper describes the Robert Wood Johnson Foundation's (RWJF's) work in nursing, which focuses on improving the hospital work environment to attract and retain high-quality nursing staff, with the ultimate goal of improving patient care and outcomes in hospitals. Other organizations' efforts to address the nurse shortage are also explored. [Health Affairs 25, no. 1 (2006): 268-274] T h e r o b e rt wo o d j o h n s o n Foundation (RWJF) is dedicated to improving the health and health care of all Americans. Central to this mission is transforming the way care is delivered at the bedside to reduce the shortage in nurse staffing and improve the quality of nursing care. 1 Nurses are the linchpins in providing highquality patient care in hospitals. To attract high-quality staff, enable them to do their best work, and keep them as long-term employees, improvements must be made in the organization of work and use of information technology (IT); physical design and allocation of space; and hospital leadership and culture. Working with various partners, the RWJF expects to build support for a new kind of hospital that reflects the needs and realities of the twenty-first century: a hospital where patient safety is assured, quality of care is paramount, efficiencies are maximized, and staff are satisfied with and actively supported in their jobs.Although this initiative begins with the nursing profession, the results from these efforts are expected to affect all health care workers in hospitals and the millions of patients whom they serve. A 'Perfect Storm' For Nurses And PatientsThroughout the past few decades, U.S. hospitals have faced cyclical shortages of nurses; in 2000 an estimated 126,000 hospital nursing positions were unfilled. 2 The percentage of nurses working in hospitals dropped from 59 percent in 2000 to a little more than 56 percent in 2004. 3 The current nurse shortage is driven by a broad set of factors related to recruitment and retention-among them, fewer workers, an aging workforce, and unsatisfying work environments-that have contributed to a different kind of shortage that is more com-2 6 8 J a n u a r y / F e b r u a r y 2 0 0 6 G r a n t W a t c h

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As the demand for health care consistently rises and many individuals, even within developed countries, lack access to primary care services, a better understanding of how primary care is defined, the main causes of the primary care shortage both within the United States and across the globe, and key solutions to these issues are paramount. Upon review of the US and international primary care literature, the authors first briefly discuss the fluidity of how primary care is defined and how it is applied in nations with differing levels of health care infrastructure. The main causes of the deficit both domestically and globally are then examined. Finally, upon careful review of the research produced within the past seven years, this article suggests strategies that maximize the primary care workforce: the effective use of technology, task shifting, interprofessional teams, and more consistent primary care data to build workforce strategies.

Three decades ago, a renaissance helped create the foundations of primary care as we know it today. In recent years, however, new challenges have confronted primary care. We believe that the current challenges can be overcome and may, in fact, present an opportunity for a new renaissance of primary care to address the needs of our population. In this paper, we suggest seven core principles and a set of actions that will support a renaissance in, and a positive future for, primary care. The seven principles are 1) Health care must be organized to serve the needs of patients; 2) the goal of primary care systems should be the delivery of the highest-quality care as documented by measurable outcomes; 3) information and information systems are the backbone of the primary care process; 4) current health care systems must be reconstructed; 5) the health care financing system must support excellent primary care practice; 6) primary care education must be revitalized, with an emphasis on new delivery models and training in sites that deliver excellent primary care; and 7) the value of primary care practice must be continually improved, documented, and communicated. At the start of the 21st century, a vital, patient-centered primary care system has much to offer a rapidly changing population with increasingly diverse needs and expectations. If we keep the needs of persons and patients clearly in sight and design systems to meet those needs, primary care will thrive and our patients will be well served.

OBJECTIVE To examine factors that influence nurses' perceptions of organizational compassion and their engagement with the organization. BACKGROUND Despite agreement about the importance of compassionate healthcare, it is difficult for employees to consistently act compassionately when organizational leaders, managers, and systems of care fail to support compassion as a value. METHODS The study used a cross-sectional design, and quantitative and qualitative data were collected through an online survey of nurses. RESULTS Higher individual compassion and team compassion were associated with higher perceived organizational compassion, and higher organizational compassion was associated with greater engagement with the hospital. In contrast, high turnover rates and inadequate staffing were associated with lower perceived organizational compassion and lower engagement with one's organization. CONCLUSIONS Adequate staffing, resource allocation, and practices that contribute to the sense that one is a supported member of a caring team focused on addressing patients' needs build the capacity for compassion within an organization.