Working
conditions require 'substantial changes"
Institute of Medicine report draws clear link between work
culture, patient safety
By Glen Fest
November 18, 2003
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