The decade-old system that specifies least standards for staffing in nursing homes need to be restructured, the report says. The U.S. Department of Health and Human Services must call for nursing homes to have at least one RN within the facility during all times. Based on the departments' 2001 report to Congress on minimum staff-to-patient ratios for nursing homes, the HHS should mention the staffing levels that increased with the number of patients. Central and state report cards on nursing homes should give information on levels of nursing staff, and measuring of staffing levels should be developed for hospital report cards. The healthcare facilities should avoid using nurses from temporary agencies to fill the vacancy. (Substantial Changes Required in Nurses Work Environment to Protect Patients from Health Care Errors) Working for long hours on the part of the nurse's makes them fatigue since it decreases their energy and reduces their attention to the patient and thereby poses to be a serious danger to the patients. Most of the nurses work for 8-12 hours per shift and some work for more hours. Those concerned regulatory bodies of the state should disallow nursing staff from working longer than 12 hours per day and more than 60 hours every week. In addition to changes in staff levels and working hours, the plans of restructuring of the hospital which began in the mid-1980s brought about considerable changes in how nurses function. As a major step in humanizing nurses work atmosphere and bringing back trust, the report advises health care organizations to involve nurse leaders at all management levels and to seek input from nursing staff regarding decisions about work design and execution. Nurses are in major positions to help identify unproductive work processes that could lead to mistakes, recognize reasons of nursing staff turnover, and find out suitable staff levels for each unit.

Orientation programs for newly appointed nurses and ongoing education programs are being held back due to cost factors, though surveys point out that many licensed nurses who are newly permitted do not have the overall thorough preparation to offer care for present days' patients. Many RNs are not getting continuing education and training to accommodate themselves with the current growth of latest technology and medical knowledge. Health care organizations should devote financial funds to support nursing staff in the current attainment and preservation of knowledge and skills. The committee's suggestions are given at a time when there is a high turnover of nursing staffs, as well as a nursing scarcity that is expected to deteriorate in the future. The health care organizations are helped in employing and maintaining nurses by executing the suggested changes in nurses' work atmosphere. As the supply of nurses is unluckily made thin right now, they must be encouraged by work processes, work space, working hours, staffing practices and a culture that increasingly protects against mistakes and eagerly spots and alleviates mistakes when they take place. If the recommendations suggested by the report are followed, then nurses will like to stay in health care organizations. (Substantial Changes Required in Nurses Work Environment to Protect Patients from Health Care Errors)

Recommendations for a better nursing Work Environment:

The American Nurses Association - ANA highly praised the Institute of Medicine (IOM) for a report, which shows a clear relation between the nursing work atmosphere and patient safety, and advises improvements in health care working conditions that would lead to safer patient care. Based on a survey released in 2000 by to Err is Human IOM study, which shows that 98,000 patients die yearly due to medical errors, a study Keeping Patients Safe: Transforming the Work Environment of Nurses, were made on these recommendations. ANA has long asserted that better patient safety and quality of care cannot be attained without spending in and appraising nursing, said ANA President Barbara Blakeney, MS, APRN, BC, ANP. The study gives proof that immediate steps are to be taken to make better the nurses' working conditions and by doing so the patients can be prevented from mistakes. Blakeney noted that Congress should take immediate action on several awaiting legislative measures that would improve the nursing work atmosphere. (ANA Commends IOM Report Outlining Critical Role of Nursing Work Environment in Patient Safety)

These include proposals that 1) authorize safe nurse/patient ratios, 2) strictly control the insecure practice of compulsory overtime, and 3) offer adequate funding for nursing workforce development. Blakeney says that the nurses and patients across America are asking...

The study notes frankly that the typical nurse's work environment creates a serious threat to patient safety in all four of the basic workings of all organizations like organizational management practices, workforce operation practices, work plan, and organizational culture. Major among these changes are that a culture of safety in nursing is required to be created and maintained. ANA agreed unreservedly with the study's finding that many hospitals do not have sufficient numbers of nurses, a practice that jeopardizes patients, and the finding that insecure work practices and workspace plan create fear to patient safety. It also agreed that piecemeal approaches are not enough and that further study is required and this study must be an integral part of the continuing process. Actually, ANA supported the report's proposal to reduce the number of hours a nurse can work to 12 hours in any 24-hour period and 60 hours in any seven-day period - the same limits being proposed by the Safe Nursing and Patient Care Act of 2003.
In other words, banning compulsory overtime for nurses is necessary for safe patient care. And compulsory overtime could be abolished if Congress were to pass the Safe Nursing and Patient Care Act. It is ANA's agreement that nurse leaders must also vigorously ask for direct-care nursing staff and sponsor them to have a greater voice and additional chances to take part in decision-making. In short, anywhere and every time possible, vanguard nurses must be engaged in any decisions that disturb their work life and patient care. Blakeney was mainly firm about the requirement for a greater connection between management practices, the work environment and safety. One probable solution which has been pointed out that was also stressed in the IOM report was the American Nurses Credentialing Center - ANCC Magnet Recognition Program, which concentrates on excellence in nursing services for attaining safer patient care. (ANA Commends IOM Report Outlining Critical Role of Nursing Work Environment in Patient Safety)

Amenities nominated by ANCC as 'Magnets' have proven track records for keeping nurses, even at the time of scarcity, because they put a high responsibility on nursing leadership. Average nurse maintenance in Magnet facilities is double long as that of non-Magnet institutions. Moreover, patients in Magnet facilities go through lesser negative outcomes, duration of stay is short, and have increased contentment with their health care services. ANA further supported the proposal that hospitals and nursing homes directly engage nursing staff at the unit level in deciding and assessing needs of staff. ANA made available the principles in 2000 to help nurses in determining correct and needed staffing. The principles not only record the number of patients but also look after the staffing concerns like the experience level of unit nurses, the rigorousness of patients' conditions and the accessibility of support services and amenities.

Finally, while approving that the report speaks of making a culture of safety in nursing care, Blakeney notified the committee to take on a wider view the complete work atmosphere with an eye for forming a work culture where brilliance in nursing care is given and not simply patient safety. This condition is present in Magnet facilities, which have been shown to employ and preserve more nurses while also offering outstanding and noticeably safer nursing care. Currently there is a shortage of nurses in the country and it needs around one million new nurses by 2010. There are many studies that point out that due to scarcity of nursing staff there is greater patient mortality. This study reinforces the connection between nursing care, work atmosphere and greater patient safety. It is now in the hands of the decision makers to take proper action and allocate the resources required to realize these suggestions, in order to employ and retains nurses and keep the patients safe. There is also a second report Crossing the Quality Chasm: a New Health System for the 21st Century, which centers on patients' experiences and how Microsystems of care like nursing units should be tailored to minimize mistakes. This report centers mainly on organizations of health care and their work atmospheres. (ANA Commends IOM Report Outlining Critical Role of Nursing Work Environment in Patient Safety)

Conclusion:

Current nursing work environment faces shortage of nurses, extended working hours for nurses leading to fatigue, less importance to nursing and high turnaround rate. Demand of nurses is…