Nursing

New national reports provide insight into improving patient safety

Nurse Leader Weekly, July 25, 2003

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To enhance patient safety, hospitals should work to increase nurse staffing levels and reduce interruptions, according to two recent national reports that address staffing in the work environment. The reports offer hospital executives specific recommendations to improve patient safety.

The Agency for Healthcare Research and Quality (AHRQ) evidence report, The Effect of Health Care Working Conditions on Patient Safety, is based on a review of 115 existing studies in both healthcare and non-healthcare settings. Researchers classified working conditions into five categories: work force staffing, workflow design, personal/social factors, physical environment, and organizational factors.

Study findings indicate the following:

  • Systems to reduce distractions and interruptions will lower the occurence of medical errors
  • Crafting strategies to raise staffing levels of licensed and unlicensed nurses in acute care hospitals and nursing homes will help to improve patient outcomes
  • Administrators can decrease medication errors and in some cases hospital re-admissions by improving information exchange, transfer of responsibility, and hand-offs

Twenty-one hospitals and 61 individuals participated in an American Organization of Nurse Executives (AONE) survey that led to the report, Insights from a Key Informant Survey on Nursing Work Environment Improvement and Innovation. Survey participants shared experiences, best practices, and lessons for enhancing the nursing work environment.

The study focuses on six key organizational success factors: leadership development and effectiveness, empowered collaborative decision-making, work design and service delivery innovation, values-driven organizational culture, recognition and reward systems, and professional growth and accountability.

Results indicate that successful initiatives for improving the work environment include the following:

  • Patient care delivery and work design. Bayfront Medical Center, for example, reassessed traditional nursing roles on its progressive cardiac unit for cardiac patients. Executives pilot tested alternative staffing patterns, using a unique model that expanded the role of patient care technicians. These technicians participated in an incentive program for skill development training.
  • Preparing for Magnet facility designation. At St. Luke's Medical Center, preparation for Magnet designation led to changes in nursing roles, elimination of several non-nursing duties, and better administrative support and decision-making responsibilities on the unit level.
  • Shared governance and collaborative decision-making. Jewish Hospital has used nursing-led multidisciplinary work groups to allow nurses to give input into designing new applications of information technology.
  • Strategic planning and performance measurement. One Main Line Health hospital outlines strategies for six key dimensions of professional nursing practice and patient care: leadership, culture, recruitment and retention, professional growth, collaboration, and care delivery.

    • To access the reports, go to http://www.ahrq.gov/clinic/epcsums/worksum.htm (AHRQ) and http://www.hospitalconnect.com/aone/keyissues/hwe_excellence.html.



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