A major effect of today's emphasis on cost-cutting in health care has been reductions in the numbers and mix of registered nurses (RNs). RNs have increased concerns over patient and practitioner safety and patient care quality. The American Nurses Association (ANA) has a major, multi-phase project addressing these concerns, called Nursing's Safety and Quality Intitiative. This initiative encompasses: nursing-sensitive quality indicators, educating staff nurses, researching the impact of skill mix on patient outcomes, political activities, a national database of nursing quality indicators, and liaisons and coalitions. These activities reflects ANA's committment to patient and nurse safety and the quality of patient care.