Staffing, work climate impact patient safety
Needlesticks more likely with reduced staffing
Nurses who work in hospitals with lower staffing and poor morale are more likely to suffer needlestick injuries, according to research that was a highlight at a special conference on working conditions and patient safety.
"We found that the worst staffed nursing units in 20 hospitals and the nursing units with the worst working climate [as measured through surveys] had two to three times increased risk of being stuck by a needle in a 30-day period," says Sean Clarke, RN, PhD, CRNP, CS. Clarke, a postdoctoral fellow at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia, used 1991 data.
The center, led by researcher Linda Aiken, RN, PhD, conducted three different studies in 1991, 1998, and 1999, encompassing data from five countries. The results provided evidence for the concerns raised at the October conference, "Enhancing Working Conditions and Patient Safety: Best Practices."
The conference was sponsored by five federal agencies: the National Institute for Occupational Safety and Health, the Agency for Healthcare Research and Quality, the Occupational Safety and Health Administration (OSHA), the Veterans Health Administration, and the National Institute for Communicable Diseases at the Centers for Disease Control and Prevention.
Patient safety and employee health are interconnected, several speakers contended.
"[The conference] reflects a vision and a wisdom that is emerging in parallel universes that they can’t be parallel, they have to be intertwined," says Mary Foley, RN, MS, president of the American Nurses Association and one of the speakers at the conference. "The worker element was missing in a lot of the studies on the [patient] safety issues, on patient errors. It failed to recognize the human factors," she tells Hospital Employee Health.
In fact, researchers at the University of Pennsyl-vania found that the "human factors" could outweigh other measures designed to reduce injury. Preliminary data show that patient indicators such as medication errors, patient falls, and low satisfaction are associated with health care worker injuries and burnout. Hospitals where nurses perceived they had a good working climate and adequate staffing also had better patient outcomes, he says. "What’s good for workers is good for patients," Clarke tells HEH.
"If we want to make hospitals a safer place we need to work on good policies and procedures, but we also need to look at how many people we’re putting to work and how we’re supporting them," he says.
Interestingly, although the countries studied have different types of medical systems, they all experienced similar issues, Clarke says. The center’s latest study included hospitals in the United States, Canada, Germany, Scotland, and England.
"So far, everything we see suggests that those countries are more alike than different," he says. "Nurses are seeing the same situations in terms of quality in their hospitals. Nurses are talking about the same levels of problems as here in the U.S."
In the conclusion of his presentation, Clarke noted, "Remedying problems with understaffing and poor working climates could be one of the most important steps in building a safer health care system."
This "Best Practices" meeting was designed as an upbeat follow-up to a conference last year that linked patient safety and working conditions. Speakers discussed programs that have decreased back injuries, needlesticks, nosocomial infections, and other hazards.
James P. Bagian, MD, PE, director of the National Center for Patient Safety at the Veterans Health Administration, spoke of that agency’s pace-setting work to redesign care processes to be both patient-friendly and worker-friendly.
"This [link between patient and worker safety] has momentum, and we want to keep that momentum going," says Gregg Meyer, MD, director of the Center for Quality Measurement and Improvement at the Agency for Healthcare Research and Quality in Washington, DC.
While Foley and others called for more research to establish the link between staffing and other working conditions and patient safety, Meyer noted that many hospitals already have success stories to share.
"We want to move those [examples] into more generalized practice, while at the same time building more of a knowledge base," he says.
Participants even heard from the chairman of the board of Alcoa about how worker safety can improve productivity and performance — thus creating a better business environment. That "human factors" perspective is just emerging in health care, says Elise Handelman, MEd, RN, COHN-S, director of OSHA’s office of occupational health nursing.
"We’ve focused on patient care but haven’t looked at the whole work environment," she says. "There are situations where we can improve the situation for both [workers and patients]."
[Editor’s note: Hospital Employee Health will highlight some of the best practices in upcoming issues. More information on the conference can be found on the Web site of the Quality Interagency Coordination Task Force at www.quic.gov.]
Reference
1. Clarke SP, Aiken LH, Sloane DM, et al. Staffing and professional practice environments in hospitals as keys to nurse and patient safety. Presented at Enhancing Working Conditions and Patient Safety: Best Practices. Pittsburgh; October 2000.
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