Nursing Role in Patient Safety: Issues and Solutions

Introduction

The nursing workforce is the largest workforce in the healthcare industry. Nursing staff in hospitals are primarily tasked with patient surveillance in both ambulatory settings and care facilities — a function also referred to as patient monitoring, evaluation, or assessment. Patient surveillance is important for recognizing errors and preventing adverse incidents. Most patient safety experts believe in cultivating an impartial system that acknowledges both systemic and individual contributions to adverse incidents and successful outcomes, thereby facilitating a reduction in errors. This notion is addressed in To Err is Human, which states that the prevention of error and the augmentation of patient safety are best achieved when a system is designed around an individual approach that targets the underlying conditions giving rise to errors. Since nurses constitute the largest workforce in the healthcare industry and are largely engaged in the detection, commission, and prevention of errors and accidents, they and their work environment are key factors in patient safety (Page & Institute of Medicine [U.S.], 2004).

This paper highlights some of the issues that are currently major causes of concern within the nursing industry. This approach helps identify human aspects and systemic flaws that exist within healthcare and then address these issues at their root. Patient care and safety is defined as the provision of an appropriate and ethical standard of medical care in which a patient's medical concerns are adequately addressed and resolved, and no additional concerns arise due to carelessness or mistakes. This is an extremely important issue for nursing, as nurses are the medical care providers who have the most interaction with patients; when nurses perform their role effectively, the overall standard of patient care and safety improves.

For this reason, the paper examines the main issues by dividing them into historical, social and cultural, political, and ethical dimensions, as well as barriers to resolution. The primary concern for all nurses is patient safety. The paper highlights why patient safety is important and the role nurses play in its provision. It then moves on to the social and cultural aspects of the nursing industry and identifies communication as one of the key determinants of appropriate patient care — when communication deteriorates, patient safety is compromised. Accurate reporting is recognized as another important facet of high-quality patient care, and the role of nurses in accurate reporting is examined under the political concerns of current nursing structures. The combination of human and system errors, and the effect this has on error reporting, is identified as a major ethical concern. Furthermore, the paper discusses the role of Registered Nurses (RNs) in the current structure, as well as the overall positive effect they have on patient care and safety. The paper concludes with a recognition of the need to further investigate the incorporation of technological advancements in medicine and the impact of those advancements on nursing in the short and long term.

Historical Analysis

The safety of patients is one of the most critical issues in healthcare, and nurses are the primary professionals responsible for detecting errors and preventing harm. It is not only their job description but their code of ethics that requires nurses to facilitate safe, competent, and ethical care. Patient safety is the top priority of the nursing profession and is of vital concern to nurses working in community settings, acute care hospitals, and long-term care facilities. It is of major importance across all fields of practice, including education, clinical practice, research, and management and leadership positions.

The Agency for Healthcare Research and Quality (AHRQ) has led a nationwide effort to reduce medical errors and increase patient safety. AHRQ established a research and demonstration program to finance research identifying sources of medical errors and to create models for reducing their frequency. The program also encourages impartial reporting, review, corrective action, and the reduction of administrative paperwork. Regardless, changes remain important in areas such as accreditation, regulation, payment, and policy, all of which affect healthcare delivery (Canadian Nurses Association & [University], 2004).

Social and Cultural Analysis

Communication among health personnel is a significant problem that hinders patient safety. A 2008 alert from The Joint Commission (TJC) addressed rude and disruptive communication between healthcare professionals as counterproductive to patient safety. The alert stated that inappropriate and disruptive behavior can give rise to medical errors, hinder patient satisfaction, produce adverse outcomes, elevate the cost of care delivery, and cause physicians, managers, and administrators to seek new work environments. Teamwork, collaboration, and communication are the foundation of safe and high-quality patient care. In order to guarantee a culture of safe practice and quality care, healthcare organizations must address the behavioral issues of professionals within their facilities (Cherry & Jacob, 2014).

The adoption of a human factors approach to patient safety has resulted in a reduction of errors in healthcare facilities prone to adverse incidents — an approach modeled in part on the aviation industry. This approach emphasizes the relationships among workers, the tools they employ, and their work environments. For example, automated drug dispensing machines have been developed so that medications can be administered without relying solely on a nurse's memory, thereby reducing the risk of medication errors.

Political Analysis

To contribute more meaningfully to patient safety efforts, nurses believe that their perspectives must be taken into account and that nursing management must be responsive to concerns and information regarding patient safety. Some nurses believe that sharing critical information could be used against them and therefore hesitate to report issues relating to practices and patients. During years of healthcare restructuring, clinical nurse specialist, nurse manager, and nurse educator positions were reduced, and many chief nursing officer positions were eliminated. As a result, nurses were often absent from decision-making processes within healthcare facilities because their leaders were no longer represented in management. Chief nursing officers were redistributed across departments, and nurse managers were assigned larger numbers of nursing units. These changes weakened nurses' capacity to counter the threats to patient safety that arise within healthcare environments (Canadian Nurses Association & [University], 2004).

At present, data on nurses' contributions to patient safety and their professional perspectives have been largely limited due to numerous factors. Current databases do not adequately capture variables relevant to nursing, and available data from reporting systems are not always reliable. The problem begins with conflicting definitions of patient safety and extends from database inadequacies and definitional inconsistencies to a lack of robust approaches for detecting and tracking errors across healthcare systems. It is strongly recommended that lessons learned from accidents be integrated with quality care and patient safety frameworks rather than treated as isolated adverse incidents. The literature examining patient safety outcomes in relation to nursing actions is expanding. Outcomes examined include patient falls, medication errors, pressure sores, and hospital-acquired infections (White & McGillis Hall, 2001). Continued work in this area is expected to create a more competitive and improvement-oriented work environment that places patient safety at the forefront (Canadian Nurses Association & [University], 2004).

Nurses and other healthcare personnel generally agree that teamwork and collaboration enhance patient safety. However, numerous factors hinder a productive work environment. Breakdowns in communication have been identified at critical junctures, such as during shift rotations and patient transfers from one ward to another (Cook et al., 2000). Nursing research consistently demonstrates that poor communication negatively affects patients. Poor decisions and inadequate communication can result in incorrect patient assessment, errors in judgment and diagnosis, and insufficient patient monitoring.

Conclusion

All nurses need to play their part in enhancing patient safety and protection. As healthcare providers who spend the greatest amount of time with patients — looking after them, caring for them, and coordinating their care — nurses can play a pivotal role in the consolidation of patient safety. The nursing perspective on reducing errors and improving system viability should reflect an all-encompassing approach that involves the public, healthcare providers, administrators, educators, employers, researchers, and governments at all levels of the healthcare system.

References

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White, P., & McGillis Hall, L. (2001). Patient safety outcomes. In D. M. Doran (Ed.), Nursing sensitive outcomes: State of the science (pp. 211–242). Toronto: Jones & Bartlett.

Cook, R. I., Render, M., & Woods, D. D. (2000). Gaps in the continuity of care and progress on patient safety. British Medical Journal, 320, 791–794.

Institute of Medicine of the National Academies. (2003). Keeping patients safe: Transforming the work environment of nurses.

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