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Banning shifts longer than 12 hours and increasing
training and continuing education opportunities for
nurses were among the highlights in a key nurse work
environment study released Nov. 4 by the Institute of
Medicine. An IOM panel recommended "substantial
changes" in nursing work environments to foster
improved working conditions and patient safety.
"No one or two actions by themselves can keep
patients safe," said Donald Steinwachs, chair of
the committee that wrote the report, and chair of the
department of health policy and management of the Bloomberg
School of Public Health at Johns Hopkins University
in Baltimore.
"Rather, creating work environments that reduce
errors and increase patient safety will require fundamental
changes in how nurses work, how they are deployed and
how the very culture of the organization understands
and acts on safety," Steinwachs said.
The report, "Keeping Patients Safe: Transforming
the Work Environment of Nurses," concentrated on
changes in four areas: management, workforce deployment,
work design and organizational culture. The report follows
on recommendations from IOM's 2000 report that concluded
that as many as 98,000 patients a year die as a result
of medical errors.
The report was praised by the American Nurses Association
for painting a "clear link" between patient
safety and the nurse workplace.
"ANA has long contended that improved patient
safety and quality of care cannot be achieved without
investing in and valuing nursing," said ANA President
Barbara Blakeney, MS, APRN, ANP. "This study provides
even more evidence that urgent action is needed to improve
nurses' working conditions, and that by doing so, patients
will be protected from preventable errors."
Also backing the report were hospital and nurse executives,
who nonetheless cautioned that many of the changes may
require long-term implementation because of the financial
burdens such measures would have on hospitals.
"This report highlights some important areas that
we've already begun to address," said Pamela Thompson,
MSN, RN, FAAN, CEO of the American Organization of Nurse
Executives. "Today's nurses face an avalanche of
paperwork and red tape that needs to be streamlined.
The report is significant from the aspect that it validates
many of the changes that have been enacted to improve
the work environment for nurses," Thompson said.
Panelists wrote that nurses in some health care facilities
are overburdened by high patient staffing levels, despite
evidence that overburdened staff can lead to an increase
in medication errors.
The report recommended that state regulatory bodies
restrict nurses from working more than 12 hours a day
or more than 60 hours per week.
Nurses also should be more involved in all management
levels of an institution, and executives should solicit
nurse input on issues of work design and implementation.
Health care organizations also should invest in continuing
education and training to alleviate high turnover rates
and deal with the nursing shortage.
"It may be tempting to think that these recommendations
can wait for increases in the supply of nurses, but
evidence on nursing retention indicates just the reverse
is true," Steinwachs said.
"Because the supply of nurses is unfortunately
stretched thin right now, they must be supported by
work processes, work spaces, hours, staffing practices
and a culture that better defends against errors and
readily detects and mitigates errors when they occur.
Nurses will be more likely to stay in health care organizations
that implement the management and work-design practices
recommended in this report," Steinwachs said.
The report also recommended changes in nursing home
staff levels for nurses, including requiring a registered
nurse on premises at all times.
Contact Glen Fest at glenf@nurseweek.com
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