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| What's
clear from the IOM report is that changing nurses'
work environment and putting patient safety first
is not for the faint of heart. Band-Aids won't do. |
Nurses, who more than any single group are responsible
for patient safety, have a new care plan in mind. It's
a multipoint document written in their own hand through
the Institute of Medicine to change the nursing work
environment and focus on patient safety.
Reaction since its unveiling in November has been unequivocally
positive, from the RNs instrumental in creating "Keeping
Patients Safe: Transforming the Work Environment of
Nurses," to the chief nursing officer of a large
health network, a patient safety guru and others.
"We now have the research from the 1990s, which
shows without a doubt that inadequate staffing, and
that often is a problem of a poor work environment,
does in fact affect patient safety," said Ada Sue
Hinshaw, Ph.D., RN, dean of the University of Michigan
School of Nursing and vice chair of the IOM committee.
What's clear from the report is that changing nurses'
work environment and putting patient safety first is
not for the faint of heart. Band-Aids won't do.
The IOM estimates that as many as 98,000 hospital patients
die each year, not from injury or disease, but rather
as a result of their care. Untold numbers survive adverse
events, such as medication errors, with serious health
effects: long-term disability and severe pain.
Such a toll doesn't rest solely on nurses' shoulders,
but they and their assistants account for 54 percent
of all health care providers.
"When people are hospitalized, in a nursing home,
having a baby or learning to manage a chronic condition
in their own homes-at some of their most vulnerable
moments-nurses are the health care providers they are
most likely to encounter, spend the greatest amount
of time with and … depend on for their recovery,"
the IOM said.
It's against this backdrop that the Agency for Healthcare
Research and Quality, a part of the U.S. Department
of Health and Human Services, asked the independent
IOM to look at nurses' work environment and how it must
change to better protect patients.
The institute marshaled a committee of 18, eight of
whom were RNs.
The panel concluded that hospital restructuring and
redesign initiatives during about 20 years have "damaged
trust between nursing staff and management … infrequently
have involved nurses in decision-making pertaining to
the redesign of their work, and have not employed practices
that encourage the uptake and dissemination of knowledge
throughout the organization."
The report calls for systemic changes in:
- Leadership and management, to strike a balance between
cost-effective care and patient safety, "emphasizing
safety to the same extent as productivity and financial
goals." It's incumbent on leadership to foster
trust between nurses and management, create the culture
of a "learning organization" and involve
workers in decision-making and work flow.
- Workforce deployment, to update decade-old staff-patient
ratios in long-term care facilities, hospital intensive
care units and elsewhere. California has taken the
lead with its first-in-the-nation minimums for RN
staffing across the breadth of hospitals, not just
in trauma, coronary and other specialty units. Under
workforce deployment, the committee stressed a commitment
to orientation, mentoring, precepting and other education,
among other things.
- Work design, to limit nurses' hours to 12 per shift
in any 24-hour period and 60 per week. The committee
looked at fatigue and remedies in the transportation
industries and the military.
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