Is your ED unsafe? Make these changes now
Do you worry about unsafe staffing levels, a shortage of experienced nurses, a lack of trust between administration and staff, long work hours, and systems that don’t promote safety and efficiency? If so, you have new ammunition to call for dramatic changes in your ED.
A 2004 report from the Washington, DC-based Institute of Medicine, Keeping Patients Safe: Transforming the Work Environment of Nurses gives specific recommendations to avoid adverse outcomes.
"Emergency nurses have been talking for years about the issues in this report and will feel supported by these recommendations that are designed to improve the workplace," says Linda F. Yee, RN, MSN, CEN, former chair of the Emergency Nurses Association (ENA) patient safety workgroup.
The report cites compelling research that links nursing conditions with patient safety. "It is hard to argue with the evidence found in these studies," she says.
Here are key recommendations:
- Empower direct care nursing staff to determine staffing levels, regulate the unit work flow, and develop methods to allow for variability in patient volume and acuity. "EDs should incorporate systems such as ENA’s Guidelines for Emergency Department Nurse Staffing’ to ensure appropriate staffing levels," says Yee. (See resources box, below left, for more information.)
- Require budgetary allowances equal to a defined percentage of nursing payroll to support education and skill development for nurses and assistive personnel. "EDs must have resources to provide routine, ongoing patient safety education for staff which includes special training in error detection, analysis, and reduction," says Yee.
- Change your ED from a punitive environment to one that encourages reporting of errors, both actual and near misses. "EDs should institute rewards and incentives for error reduction," she advises. "Staff must feel safe in reporting errors so systems can be designed to prevent errors from recurring."
Source/resources
For more information about nursing conditions and patient safety in the ED, contact:
• Linda F. Yee, RN, MSN, CEN. E-mail: [email protected].
A paper copy of the Institutes of Medicine report, "Keeping Patients Safe" costs $44.95 plus $4.50 shipping charge. To order, contact: The National Academies Press, 500 Fifth St. N.W., Lockbox 285, Washington, DC 20055. Telephone: (888) 624-8373 or (202) 334-3313. Fax: (202) 334-2451. E-mail: [email protected]. Web: www.nap.edu.
To order the Emergency Nurses Association’s Guidelines for Emergency Department Nurse Staffing, go to www.ena.org. Click on "Marketplace" and "The ENA Staffing Best Practices Tool and Guidelines." The cost is $500 for nonmembers or $100 for members.
Do you worry about unsafe staffing levels, a shortage of experienced nurses, a lack of trust between administration and staff, long work hours, and systems that dont promote safety and efficiency? If so, you have new ammunition to call for dramatic changes in your ED.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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