New Charting Nursing’s Future Brief: Patient Safety Through Workplace Transformation

Mar 19, 2014, 9:45 AM

Ten years ago, a report from the Institute of Medicine (IOM) proposed a transformation of nurses’ workplaces, warning that “The typical work environment of nurses is characterized by many serious threats to patient safety.” The latest issue of the Charting Nursing’s Future policy brief series from the Robert Wood Johnson Foundation (RWJF) focuses on how much has changed in the intervening years, and how much remains to be done.

The new brief identifies a series of initiatives designed by and for nurses that have “spurred the creation of work environments that foster health care quality and patient safety.” Among them:

  • The RWJF-backed Transforming Care at the Bedside (TCAB) initiative, developed in collaboration with the Institute for Healthcare Improvement, which seeks to empower frontline nurses to address quality and safety issues on their units, in contrast with more common, top-down improvement efforts. TCAB is now integrated with Aligning Forces for Quality (AF4Q), RWJF’s signature effort to improve the quality of health care and reduce disparities in targeted communities.

  • Another RWJF-backed project, Quality and Safety Education for Nurses (QSEN), focuses on nursing school faculty, and has helped prepare thousands teaching in graduate and undergraduate programs to integrate quality and safety competencies into nursing school curricula.

  • On the policy side, efforts have been made to further examine and improve the adequacy of nurse staffing. For example, a number of jurisdictions, including California, Illinois, Washington state, and Minnesota, have adopted standards that either require or encourage limits on how many patients a given nurse may be assigned to care for in acute care hospitals. Subsequent research has demonstrated an impact on hospital policies, but evidence of improvements in cost, quality, and safety is mixed so far.

  • A number of institutions, including Vanderbilt University Medical Center in Nashville and The Johns Hopkins Hospital in Baltimore, have taken aim at disruptive behavior and professional discourtesy in the workplace, noting that, given the growing importance of teamwork and collaboration, the consequences of such misbehavior can be “monumental when patients’ lives are at stake.”

The brief concludes with an “emerging blueprint for change” that urges providers, policy-makers, and educators to:

  • monitor nurse staffing and ensure that all health care settings are adequately staffed with appropriately educated, licensed, and certified personnel;

  • create institutional cultures that foster professionalism and curb disruptions;

  • harness nurse leadership at all levels of administration and governance; and

  • educate the current and future workforce to work in teams and communicate better across the health professions.

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This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.