Nurses Drive Change in Patient Safety Improvements

“CNA nurses worked for years to achieve the passage of [this law] and have continued to push for the development of these regulations, contributing their expertise at advisory committees and public hearings, and doing everything possible to ensure that healthcare workers get the protections they deserve,” commented Bonnie Castillo, RN, director of health and safety for CNA/National Nurses United (NNU), in a news release issued on the bill’s passage.

With the bill’s passage has come a push for greater change. In January 2017, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) granted NNU’s petition to develop a national standard to prevent workplace violence in healthcare settings. The petition, submitted to OSHA in July 2016, requests a workplace violence prevention standard with an expansive scope, thorough prevention requirements, and robust training. 

“Such regulations are vital to protecting nurses and other healthcare workers, as well as their patients, from the epidemic of workplace violence across the U.S.,” Castillo says.

Seeking greater support in fulfilling their safety mission 

Appropriate staffing is another a critical safety issue on which nurses across the country are demanding attention. 

In her testimony for the need to develop an OSHA standard on workplace violence, NNU co-president Jean Ross, RN, commented, “Throughout nearly every state in America, hospitals do not meet the nurse-to-patient ratios that are necessary for quality patient care and safety. Increasing staffing must be a priority in order to protect against workplace violence.”

Appropriate staffing is an issue that goes far beyond workplace violence, however. “Studies have shown again and again that safe nurse-to-patient staffing ratios save lives,” commented Rhonda Risner, RN, of the Dayton (Ohio) VA Medical Center, in a news release issued on the February 14 reintroduction of the Ohio Patient Protection Act—a bill to set limits on how many patients Ohio nurses can care for at once.

Risner cites, among others, a BMJ study that found with each 10-percentage-point reduction in the proportion of professional nurses, there was an 11% increase in the odds of patient death. The study relied on data collected from 13,077 nurses in 243 hospitals in six countries, and 18,828 patients in 182 of those hospitals. 

The Ohio Patient Protection Act is modeled on a California law that, according to studies, has saved patient lives, improved quality of care in multiple ways, and reduced nurse burnout, keeping the most experienced RNs at the bedside.

Even without the support of such legislation, nurses across the country are insisting healthcare C-suites listen to their concerns on patient safety. As one example, nurses at Berkshire Medical Center (BMC), represented by the Massachusetts Nurses Association (MNA), have rallied to call attention to the hospital’s failure to agree to improved nurse staffing levels that would ensure safe and effective patient care. To address their staffing problem, BMC nurses are seeking to include safe staffing levels within their contract. 

The closure of a nearby regional hospital led to a spike in patients requiring care, according to a news release from the MNA. In spite of nurses’ concerns about unsafe staffing in nearly every unit of the hospital, BMC management in 2015 increased the number of patients that nurses were required to care for at one time in seven hospital units. Between October 2015 and October 2016, nurses filed 280 unsafe staffing forms documenting times when there were not enough nurses to care for the number of patients and/or the serious level of illness or injury of the patients on a unit. That simple act of documentation and calling attention to a problem is a significant way that nurses can take action. 

Leading the charge as the ultimate patient advocate

Today, nurses play a critical role in choreographing strategies to minimize the risk of harm, morbidity, and mortality through the use of quality and safety measures. “Things like checklists or ad hoc tests to address certain types of problems typically will involve nurses. They are in many cases the frontline of care delivery. They know the truth about what’s happening, and they’re able to apply their critical thinking skills to creatively address issues,” McGaffigan says.

To truly be effective, Swick encourages nurses to rely on one another and ensure the entire team is committed to the highest standards of patient safety. “Work with your colleagues and hold each other accountable for following best practices such as intentional hourly rounds, fall precautions, and change-of-shift safety huddles. Use this to create a monitoring plan and develop posters to report the progress your team. I can assure you senior leadership will notice your efforts,” she says.

Given their unique perspective, nurses have strong insight into how they can impact patient safety. And more than ever, they are taking the lead in effecting the change that can drive broad improvements to patient care. 

Megan Headley is a contributing writer at Patient Safety & Quality Healthcare.