Patient Safety

As health care has advanced through the years, many roles have changed which includes those of risk management and patient safety. Once thought to be one in the same,but they have distinct and obvious differences that set each apart from the other. Risk management is defined very broadly by the United States Inspector General of the Department of Health and Human Services as "any activities,process, or policy to reduce liability exposure"(https://oig.hhs.gov/oei/reports/oei-01-03-00050.pdf).This is much different from the definition of patient safety as found in the book Advances in Patient Safety: New Directions and Alternative Approaches as "Patient safety is a discipline in the health care sector that applies safety science methods

Nursing to patient ratio can have a direct impact on patient safety. Studies have been done that show that these ratios impact patient outcomes and mortality rates when nurses are understaffed and are given a larger patient load than they can handle safely. Nursing education level has also shown to play a role in patient outcomes. Whether they are an unexperienced nurse or the patients are at a higher acuity and require more time for care, these larger ratios can be detrimental to the nursing quality of care that can be provided. These larger nurse to patient ratios can also play a part in nurse burnout leading to medical errors, negative patient outcomes, and higher health care costs in the future.

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

The purpose of this paper is to discuss how safety in the nursing profession affects the nursing education, nursing practice, and nursing research. Safety in the nursing profession means to minimize the risk of harm to patients and providers through both system effectiveness and individual performances (QSEN, 2014). Patient safety is a very important aspect in the profession of nursing. It is the nurse’s job to keep up to date with their patients and to make sure that protocol is being followed at all times. To maintain this strategy, the nurse must show proper knowledge of a nurse, skills of a nurse, and also a professional attitude.

Significance: Because nursing is the largest health care profession and nurses provide most of the patient care, and as an acute nurse, I can relate to how unsafe nurse staffing/low nurse-to-patient ratios can have negative impact on patient satisfaction and outcome, can lead to medical and/or medication errors and nurse burnout. It can also bring about anxiety and frustration, which can also clouds the nurses’ critical thinking. Most patients might not know the work load on a particular nurse and can assume that her nurse is just not efficient. Doctors also can become very impatient with their nurses because orders are not being followed through that can delay treatments to their patients. There is also delays in attending to call lights resulting in very unhappy patients who needed help.

Extensive research has shown that there is a correlation between staffing and patient ratio and patient outcomes. Better outcomes particularly are shown with lower patient to nurse ratio. However staffing issues remain an ongoing concern which greatly impacts the safety of the nurse and their patients, and also impacts cost of healthcare. Evidence shows that adequate staffing causes reduction in mortality, nurse burnout and job satisfaction, and reduction in medical errors.

There is a strong relationship between higher nursing ratios and quality of patient care. Safety of the patient is at the forefront of this debate. Higher ratios can be associated with fewer patients, creating an increase of patient hours for the registered nurse. Longer time spent with each patient can translate into fewer potential or real problems being overlooked due to not enough time spent assessing the patient. “74% of California staff nurses thought the quality of care had improved as a result of the

Patient safety and quality of care are vital outcomes in the healthcare system. As professionals dealing with human lives, we consider these topics as core to our practice. In 2005, the Quality and Safety Education (QSEN) project was created in response to the challenges recognized in preparing nurses with the knowledge, skills, and attitude (KSAs) essential in providing safe and high-quality care to every patient (QSEN, 2012). This QSEN collaboration was the product of the strategies developed by the Institute of Medicine (IOM) report Crossing the Quality Chasm in 2001 and Health Professions Education: A Bridge to Quality in 2003 (Armstrong, G. & Barton, J., 2014). There were six competencies identified in the QSEN curriculum that includes patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and safety. In this paper, the QSEN competency, evidence-based practice will be discussed in relation to achieving quality and safety to the nursing process.

Nurses find themselves in the middle of a complex health care system between the financial side and patient safety. A professional nurse’s goal is to provide safe, quality, patient care. However, nurses often fail to meet this goal due to the variability in patient acuity, the unpredictable workload of nurses, and institutional budget constraints (ANA, 2014). According to the American Nurses Association (2014) research shows that lower staffing levels of registered nurses correlate with poor patient outcomes, as well as negative nurse outcomes, such as physical injury and ‘burnout.’

Working with the available staff increases the nurses’ workload and the risk for patients’ negative outcomes. Heavy nursing workload adversely affects patient safety and negatively affects nursing job satisfaction (Carayon & Gurses, 2008, p. 1). Furthermore, a study on the hospital nurse shortage and the California legislation about minimum hospital patient-to-nurse ratios concluded that the nurse staffing levels affect patients’ outcomes detrimentally; for each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-to-rescue. In addition, this study concluded that 23% of the nurses were associated with burnout and a 15% increase in job dissatisfaction (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002, p.

It is a great opportunity to have this experience and to relate it with what we were being taught at school. There are a lot of connections in this project regarding patient safety. My safety project is a qualitative analysis of the difference between an allergy and sensitivity. The question still lies on how could the hospital staff manage allergy better?

However, data over the last decade reveals that it is not to the advantage of the nurse or the patient to continue in this fashion. This is an important issue, since patient outcomes and quality improvement are at the crux of every issue in health care. Increased medication errors, falls, inadequate discharge preparation and instructions and consequent early readmissions are all undesirable events in health care facilities and can affect reimbursement as well as hospital ratings. Risks to nurses are prevalent as well, including needlesticks, musculoskeletal injuries, and physical as well as psychological fatigue. Eventually this results in increased nurse burnout, lower retention rates by hospitals, and increasing shortages which perpetuates the overtime cycle.

How many patients can a nurse effectively care for at the same time? The complexity of that question has caused it to be quite difficult to answer. In the hospital setting today, managers are found being forced to create guidelines for staffing based on numbers instead of needs. These new staffing models are established based on nurse to patient ratios. Therefore, patient census is the primary determining element for justification of available health care providers per shift (Artz, 2005). Acuity of patients and experience of providers are no longer factors that are being considered, and these nurse to patient ratios do not always provide a safe environment. Research has shown that these ineffective nurse to patient ratios are contributing to inadequate patient care (Sochalski, 2004). A new approach for nursing staffing needs to be put enacted for the furtherance of quality of care, patient safety, nurse satisfaction and the overall healthcare environment.

Errors pervade in our lives whether it is our home, in our workplace, or in our society. The effects of healthcare errors have impacted all our lives either directly or indirectly. Patient safety and quality care are at the core of healthcare system which strongly depends upon nurses. “To achieve goals in patient safety and quality, thereby improve healthcare, nurses must assume the leadership role. Nurses need to ensure that they and other healthcare providers center healthcare on patients and their families. Even though the quality and safety of healthcare is heavily influenced by the complex nature

One of the many goals of the nursing profession is to provide high-quality, safe patient care. There are many responsibilities that come with a nursing career and when the nurse to patient ratio increases, there is a possibility that it may hinder the safe care that patients deserve, and this may result in negative patient outcomes and level of satisfaction. Staffing is one of the many issues that healthcare facilities face. In many facilities, there never seems to be enough nurses per shift to provide high quality, thorough patient care which often leads to burnt out staff, and frustrated patients and families. This review discusses the findings of quantitative studies and one systematic review that involves patient outcomes in relation to nurse staffing.