Quality in health care requires access, appropriate and acceptable treatment plans, responsible patient follow through, a workforce of sufficient numbers and qualification and agreement on health care quality indicators. The purpose of this article is to describe APN workforce and dose effects on quality, reflected in patient outcomes and health care costs with current quality indicators. Stakeholders measure "quality indicators" differently. Nursing practices are often absent in databases and systems of reimbursement. Research overwhelmingly indicates equal outcomes for physician and APN care plus value-added APN effects on use of preventive services, adjustment to illness, stress management, treatment compliance, satisfaction, and reduced emergency room visits and rehospitalizations. APN dose has an important positive effect on patient outcomes and healthcare costs. Research is needed on the level of APN dose, staff mix and use of AM, and balance of physician and APN dose in different stages of patient health, illness, and recovery to achieve quality outcomes.
