Unsafe work environments of nurses effect the qualtiy of care given to patients. The NDNQI developed indicators to assist in measuring the quality of nursing care. Among this indicators are nursing turnover, job satisfaction, and staff mix. These specific indicators can pose a threat to patient safety. Working long hours and mutiple shifts in a row increase the chance of errors and negative patient outcomes. Due to the nursing shortage, nurses are working shifts in excess of 12 hours. "Prolonged periods of wakefulness (17 hours without sleep) can produce performance decrements equilvalent to a blood alcohol concentration of 0.05 percent (Dawson and Reid, 1997; Lamond and Dawson, 1998)" (Page, 2004). I found this to be very interesting. There have been many times that I have worked longer than 12 hours and could hardly stay awake driving home. This was not only due to the number of hours but also to physical and mental demands of the job.
Staffing mix also poses a threat to patient safety. Inadequate licensed staff reduces the time the nurse spends with each patient. Job satisfaction is related to the working environment. Working in an unsafe environment causes a decrease in job satisfaction which in turns causes an increase in turnover rate. It is a domino effect. What types of working environments have you experienced?
Subscribe to:
Post Comments (Atom)
Many times I have worked longer than 12 hours, it is a daily occurrence with 12 hour shifts. I can remember countless times that I drove home not really knowing how I got there, just one auto-pilot. I do not want to be on auto-pilot during patient care, and things have to change to increase the quality of patient care in a workplace environment of staff dissatisfaction, high turnover, and long working hours. I think the solution is a commitment to the culture of the workplace. A positive culture where management is accessible, open, and supportive of staff is essential. A culture where education is valued, autonomy is granted, and a family-like atmosphere is cultivated will help with these issues. The fact that there is a shortage in nursing will not change soon, so those healthcare facilities who are committed to keeping quality staff must change their culture and environment so that nurses and other providers will stay and patient care is at its highest standard.
ReplyDeleteI, too, have worked extremely long hours and wondered how I got home the next morning! I work with physicians who occasionally work a 60-hour weekend and I question the rationale behind allowing this to occur. Long hours and sleep deprivation will never add up to quality patient care. We must all work together to put safeguards in place to prevent this when possible.
ReplyDeleteTrue confession-I am not a nurse(!)-so my response should be considered from that perspective. I agree with all of the previous posters regarding the dangers of all clinicians-nurses included-working excessive hours. I do believe that this practice is more a function of government regulation and payer requirements than it is the local healthcare provider environment but what else would you expect to hear from a hospital management type?!?
ReplyDeleteMy only fear is that as we work to create safer, more patient-oriented clinical settings that in some instances (states)we are using mandatory nurse-patient staffing ratios as a primary solution. Some nurse organizations are favoring this approach. I think that this approach is a significant blow to the nursing profession. Every nurse will tell you, for example, that a 1:6 ratio on a med-surg unit is entirely different when "Mary and Sue are the nurses rather than Mary and Jane." Mandatory ratios perpetuate the idea that patient care is assembly-line in nature and diminishes the differences in individual professional nurses' knowledge base, critical thinking skills and expertise.
I do believe that many current national quality and patient care initiatives are advancing the cause of safer, more reasonable workplaces through substantiated outcomes data-states where mandatory ratios have been implemented are simply not getting the improved outcomes that were foretold. Since Florence Nightingale, it has always been about who the nurse is and not simply what number she/he occupies in the staffing matrix.
This comment was sent to me via email by Debbie Faulk on February 7, 2009.
ReplyDelete"I blogged this but it would not post???"
"It has been many years since I worked in a clinical area but I will tell you I use to work 16 hours many days. I would be so tired that I could hardly put one foot in front of another. There was no way I was safe. Isn't it strange or ironic that patients can die in large numbers and politicians still ignore that we have a shortage and this shortage is contributing to errors. What kind of catastrophic event will need to occur to get their attention. I just sent an email to Jeff Sessions asking for support to keep 600 million in fund for nurse training."
Debbie Faulk
Submitted by Lisa Sims
According to USA Today,travel nurses cost hospitals at least 20% more than a nurse employee even when benefits are factored in (Bradley, 2005). Why do you suppose this is?
ReplyDeleteVery good blog. thanks Lisa for providing a forum for healthcare professionals of various disciplines to express opinions and share ideas.
ReplyDeleteMy sense is that it is often not the hospital or other organization that is driving the long hours, overtime, etc. Increasingly healthcare professionals are wanting the hours and, quite frankly, even gaming the schedule in order to work more hours in an effort to dea with tougher economic times. Nursing and other clinical leaders must be more diligent in determining whether nurses working more shifts etc are posing any safety issues. This must be done through data collection and analysis not just through anecdote.