Safe StaffingBy:

Anabela Dos Santos, RN7/8/15

Introduction

• Nurses burning out due to1:• Nursing shortage• Chronic understaffing• Job dissatisfaction

• Safe staffing mandate in California2

• Lobby Congress for safe staffing

Background

• Nurses have been reporting unsafe staffing for over 2 decades3

• Typical nurse work environment holds serious threats to patient safety4

• Burned out nurses make errors5

• Hospitals with unsafe staffing experience additional deaths6

Significance

• Distrust in American Healthcare System7

• Federal Government funding more research• Landmark Aiken study in 20028

• Success in California9

Search Strategy

• PCOM online library• Ebsco Host (AltHealth Watch, Medline with full text, and

CINAHL)• Keywords: Safe Nurse Staffing• Keywords: Linda Aiken• IOM reports

Guiding Framework

• Jean Watson’s Theory of Human Caring10

• Caring Science10

• Caritas10

• Sixth Carative Factor• Eighth Carative Factor

Analysis of Issue

• Meta-analysis of 90 studies show safe staffing is key to11:• Patient safety• Nurse retention

• Cuts costs12:• $3 billion in savings• Reduction in hospital re-admissions• $4 million saved in adverse events

Analysis of Issue

• Regardless of studies and initiatives, organizations continue to13: • Decrease nurse staffing• Eliminate role of Chief Nursing Executives• Not involve nurses in decision making• Design unsafe work conditions/workspace• Increase mandatory documentation• Provide a punitive culture for reporting errors/prevention of errors

Trends

• Medicare / Medicaid and private insurers denying payment for preventable hospital injuries/illnesses13

• Bipartisan legislation introduced to federal and state governments for safe staffing14

• Some states have mandatory reporting15

• Magnet approach16

Trends

• Major national initiatives that affect nurses17:• IOM reports:

• To Err is Human: Building a Safer Health System(1999)• Crossing the Quality Chasm: A New Health System for the 21sst

Century(2001)• Keeping Patients Safe: Transforming the Work Environment for Nurses

(2004)

• 5 million lives campaign • Transforming care at the bedside

Implications

• Established National Nursing Advisory Committee18 • The Joint Commission initiatives19:

• 15 national voluntary consensus standards for nursing sensitive care • Nursing sensitive measures in hospital accreditation process

• The Safe Staffing Act of 201520

• Hold hospitals accountable• Require all states to publicly report staffing levels

References• 2, 3, 8Aiken, L.H., Clarke, S.P., Sloane, D.P., Sochalski, J.P., & Silber, J.H. (2002).

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Journal of American Medical Association, 288(16), 1987-1993.

• 9, 11Aiken, L.H., Sloane, D.M., Cimiotti, J.P, Clarke, S.P., Flynn, L., Seago, J., Spetz, J., & Smith, H.L. (2010), Implications of the California Nurse Staffing Mandate for Other States, Health Services Research, 2010 Aug; 45(4): 904-921. Doi:10.1111/j.1475-6773.2010.01114.x

• 12, 13, 20American Nurses Association. (2015). The Registered Nurse Safe Staffing Act. Retrieved May 18, 2015 from: http://www.rnaction.org/site/DocServer/Registered_Nurse_Safe_Staffing_Act_of_2015.pdf?docID=2361

References• 13,17, 18, 19Finkelman, A. & Kenner, C. (2013). Professional nursing

concepts-Competencies for quality leadership. (2nd Ed.) Burlington, MA: Jones & Bartlett Learning.

• 6Furillo, J. (2014). Safe staffing as a matter of law. Journal of the New York State Nurses Association, 4.

• ¹,11,Nantsupawat, A., Srisuphan, W., Kunaviktikul, W., Wichaikhum, O., Aungsuroch, Y., & Aiken, L. H. (2011). Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand. Journal of Nursing Scholarship, 43(4), 426-432. doi:10.1111/j.1547-5069.2011.01419.x

References

• 4, 5, 7 Page, A., (2004), Keeping Patients Safe: Transforming the Work Environment of Nurses. Retrieved May 18, 2015 from: http://www.nap.edu/catalog/10851.html, isbn: 0-309-52732-5

• 14, 15 Registered Nurse Safe Staffing Bill Introduced in Senate. (2014), Nursing News, 38(4), 17.

• 9, 16Smith, A. (2002). Evidence of our instincts: an interview with Linda H. Aiken. Nursing Economic$, 20(2), 58-61.

References

• 10Watson, J & Woodward T. K. (2010) Jean Watson’s theory of human caring. In M.E. Parker and M. C. Smith Nursing theories & nursing practice (3rd Ed.) (pp. 351-369), Philadelphia, PA: F.A. Davis Company