Ten Years After Keeping Patients Safe: Have Nurses' Work Environments Been Transformed?

Issue 22 of the Charting Nursing's Future series examines progress made in the 10 years since the Institute of Medicine issued "Keeping Patients Safe: Transforming the Work Environment of Nurses."

A decade has passed since the Institute of Medicine (IOM) published Keeping Patients Safe: Transforming the Work Environment of Nurses. The report revealed that, “the typical work environment of nurses is characterized by many serious threats to patient safety.” To counter these threats and reduce health care errors in hospitals and other settings where nurses care for patients, the 2004 report recommended fundamental transformation in the work environment of nurses—that is, changes to how the workforce is deployed, to how work processes are designed, and to the leadership, management, and culture of health care organizations.  

Despite notable achievements in improving health care quality since that time, patients remain at risk of serious harm. A 2010 report prepared by the U.S. Department of Health and Human Services (HHS) found that 27 percent of hospitalized Medicare beneficiaries were harmed in some way by the care they received during hospitalization (see table, below). Physician review of these harmful events determined that 44 percent were “clearly” or “likely” preventable. Their cost to the federal government: an estimated $324 million in October 2008 alone.                       

This brief revisits some of the IOM report’s recommendations for averting such harm, highlights both progress and persistent gaps in transforming nurses’ work environments, and showcases research, policies, and tools with the potential to advance this transformation.      

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