Nurses leading on patient safety
Article first published online: 28 FEB 2005
Journal of Advanced Nursing
Volume 49, Issue 6, page 563, March 2005
How to Cite
(2005), Nurses leading on patient safety. Journal of Advanced Nursing, 49: 563. doi: 10.1111/j.1365-2648.2004.03330.x
- Issue published online: 28 FEB 2005
- Article first published online: 28 FEB 2005
For health care systems all around the world, patient safety is one of today's hot issues. Last spring, in Canada, health care professionals, hospital administrators, and policy makers held their breath in anticipation of the results of a landmark Canadian study on patient safety. Would the results show the Canadian health system in better or worse shape than other countries?
The Canadian Adverse Events Study (Baker et al. 2004) indicated that the incidence rate of adverse events in hospitals in Canada was 7·5%, echoing findings from similar studies in the United States, the United Kingdom, and Australia. These statistics confirm what registered nurses (RNs) and other health professionals have been trying to address for years: namely, that even in the best of health care systems, patient safety is compromised by system frailties.
The Canadian Nurses Association (CNA) welcomed this study because having that baseline data serves as a catalyst for change. With over 232,000 RNs employed in nursing in Canada – the largest group of health professionals – RNs are in an optimal position to strengthen the patient safety net. The quality of care provided, however, is currently compromised by years of restructuring, and cutbacks have eroded the environment in which RNs provide care. The escalating shortage of RNs, as well as increased fiscal restraint, has forced some employers into inappropriate staffing practices. Fewer RNs caring for sicker patients with less support than ever before have meant increased workloads, time pressures and stress, and less time is spent caring for each patient. Such working conditions put the health of nurses, and consequently their patients, is at risk.
The sustainability of any health system rests upon a vibrant nursing workforce. Research shows that the ratio of RNs involved in direct patient care has an impact on patient outcomes – the higher the RN patient ratio, the better the outcome (Tourangeau et al. 2002). Pan-Canadian and international health human resource planning is required if we are to attract new nurses to the profession and retain experienced nurses by improving the quality of workplace environments.
In the spring of 2003, Canadians’ eyes were opened to one of the negative impacts of inadequate staffing practices with the outbreak of SARS within our borders. Currently, only 54% of RNs have full-time jobs – a strategy used to avoid paying employee benefits – and so many now work for more than one employer. During the SARS outbreak, staff were restricted to working for only one employer to help contain the spread of this communicable disease. While this measure was put in place to protect patients, the public, and health professionals, it created staff scheduling nightmares, compounding the shortage across the system and highlighting the dangers of the casualization of the nursing workforce. Thousands of scheduled appointments, surgeries and treatments were postponed, creating many months of backlogs and more importantly, increasing the pain, anxiety and risk of those waiting for diagnosis, treatment and care. In addition, we discovered that cutting public health nursing services to a minimum meant there was no ability to respond to an emergency situation, such as the one that SARS forced us to face.
Patient safety is a shared responsibility. System accountability requires that all members of the health care team work collaboratively to identify and manage problems in the system. Strong leadership from the nursing profession is essential, in our case involving CNA and nursing leaders, and there is evidence that progress with the patient safety agenda is now being made. A growing body of nursing research is being conducted to address patient safety issues and, last December, Canada established the Canadian Patient Safety Institute, with two nurses on its founding board.
While much work needs to be done, CNA is confident that through its leadership, on-going research, education, best practices and the promotion of quality practice environments, the nursing profession will push on the patient safety agenda – and raise the bar from just safety, to quality. That, after all, is our profession's raison d’être.
Lucille Auffrey RN MN Executive Director, Canadian Nurses Association, Ottawa, Ontario, Canada. E-mail: firstname.lastname@example.org
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- 2002) Nursing-related determinants of 30-day mortality for hospitalized patients. Canadian Journal of Nursing Research 33(4), 71–88. , , & (