Keeping patients safe: transforming the work environment of nurses

Ann (Ann E. K.) Page

National Academies Press, 2004 - Medical - 462 pages

Building on the revolutionary Institute of Medicine reports "To Err is Human and "Crossing the Quality Chasm, Keeping Patients Safe lays out guidelines for improving patient safety by changing nurses' working, conditions and demands. Licensed nurses and unlicensed nursing assistants are indispensable participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform--monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis--provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system. Over the last two decades, substantial changes have been made in the organization and delivery of health care--and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk. This newest edition in the groundbreaking Institute of Medicine series discusses these key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.

Contents

• Nursing Inseparably Linked to Patient Safety: 23
• THOUSANDS OF HEALTH CARE ERRORS: 24
• WHY HEALTH CARE ERRORS OCCUR: 27
• THE CENTRAL ROLE OF NURSES IN PATIENT SAFETY: 31
• PATIENT SAFETY RISK FACTORS IN NURSES WORK AND WORK ENVIRONMENTS: 37
• THREATS TO PATIENT SAFETY POSED BY WORK ENVIRONMENT FACTORS: 46
• ESSENTIAL TO PATIENT SAFETY: 47
• REFERENCES: 49
• A Framework for Building Patient Safety Defenses into Nurses Work Environments: 53
• THE NEED FOR BUNDLES OF MULTIPLE MUTUALLY REINFORCING PATIENT SAFETY DEFENSES: 55
• AN EVIDENCEBASED MODEL FOR SAFETY DEFENSES EN WORK ENVIRONMENTS: 56
• UNIQUE FEATURES OF HEALTH CARE THAT HAVE IMPLICATIONS FOR PATIENT SAFETY DEFENSES: 61
• REFERENCES: 63
• Nurses Caring for Patients Who They Are Where They Work and What They Do: 65
• WHERE NURSES WORK: 76
• WHAT NURSES DO: 89
• REFERENCES: 101
• Transformational Leadership and EvidenceBased Management: 108
• THE ESSENTIAL PRECURSOR: 109
• FIVE ESSENTIAL MANAGEMENT PRACTICES: 112
• UNEVEN APPLICATION OF EVIDENCEBASED MANAGEMENT PRACTICES EM NURSES WORK ENVIRONMENTS: 131
• MODELS OF EVIDENCEBASED MANAGEMENT IN NURSES WORK ENVIRONMENTS: 147
• USE OF EVIDENCEBASED MANAGEMENT COLLABORATTVES TO STIMULATE FURTHER UPTAKE: 153
• REFERENCES: 156
• Maximizing Workforce Capability: 162
• PROMOTING SAFE STAFFING LEVELS: 163
• SUPPORTING KNOWLEDGE AND SKILL ACQUISITION AND CLINICAL DECISION MAKING: 201
• FOSTERING INTERDISCIPLINARY COLLABORATION: 212
• REFERENCES: 218
• Work and Workspace Design to Prevent and Mitigate Errors: 226
• DESIGN OF WORK HOURS: 227
• DESIGN OF WORK PROCESSES AND WORKSPACES: 239
• REFERENCES: 277
• Creating and Sustaining a Culture of Safety: 286
• ESSENTIAL ELEMENTS OF AN EFFECTIVE SAFETY CULTURE: 287
• NEED FOR A LONGTERM COMMITMENT TO CREATE A CULTURE OF SAFETY: 295
• BARRIERS TO EFFECTIVE SAFETY CULTURES FROM NURSING AND EXTERNAL SOURCES: 299
• PROGRESS IN CREATING CULTURES OF SAFETY: 303
• NEED FOR ALL HCOS TO MEASURE THEIR PROGRESS IN CREATING CULTURES OF SAFETY: 307
• RECOMMENDATIONS: 309
• REFERENCES: 310
• Implementation Considerations and Needed Research: 312
• HEALTH CARE ORGANIZATIONS AND OTHER PARTIES SHOULD NOT WAIT TO ACT: 313
• MULTIPLE MUTUALLY REINFORCING SAFEGUARDS ARE NEEDED: 315
• BENEFITS IN ADDITION TO PATIENT SAFETY ARE LIKELY: 316
• ADDITIONAL RESEARCH IS REQUIRED TO FURTHER INCREASE PATIENT SAFETY: 322
• RECOMMENDATION: 325
• Committee Membership and Study Approach: 329
• Interdisciplinary Collaboration Team Functioning and Patient Safety: 341
• Work Hour Regulation in SafetySensitive Industries: 384
• Index: 437

Bibliographic information

• Title: Keeping patients safe: transforming the work environment of nurses; Quality chasm series; The Richard and Hinda Rosenthal lectures ; 2003
• Editor: Ann (Ann E. K.) Page
• Contributors: Ann (Ann E. K.) Page, Institute of Medicine (U.S.). Committee on the Work Environment for Nurses and Patient Safety
• Edition: illustrated
• Publisher: National Academies Press, 2004
• ISBN: 0309090679, 9780309090674
• Length: 462 pages
• Subjects: Medical / Health Care Delivery; Medical / Nursing / Management & Leadership; Medical / Nursing / Nurse & Patient