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New Institute of Medicine Report Recommends Improvements in Working Conditions for Nurses
The Institute of Medicine (IOM) recently released a report condemning certain practices that they say contribute to patient injuries. Keeping Patients Safe: Transforming the Work Environment for Nurses finds that the typical work environment of nurses is characterized by many serious threats to patient safety. These threats are pervasive throughout health care organizations, and eliminating them will require multi-pronged solutions. Keeping Patients Safe is a follow-up to the 2000 IOM report To Err is Human: Building a Safer Health System, which estimated that as many as 98,000 hospitalized Americans die each year as a result of errors in their care.
The authors found compelling evidence that:
- Many hospital restructuring initiatives have focused on increasing efficiency but have been undertaken in ways that have damaged trust between nursing staff and management and pose a risk to patient safety.
- The long work hours of some nurses represent a serious threat to patient safety. Twenty-seven percent of full-time hospital and nursing home nurses reported working more than 13 consecutive hours once a week or more.
- Scaled-back orientation programs and in-service training has resulted in a workforce that lacks skills in recognizing abnormal findings and responding to emergencies.
- Nursing processes, such as medication administration, are often carried out in ways that can lead to errors and without the support of newer technologies that can prevent errors.
The IOM calls on health care organizations and the U.S. Department of Health and Human Services to implement policies and regulations to improve working conditions for nurses. Major IOM recommendations include:
- States should prohibit nursing staff from providing patient care in excess of 12 hours in any given 24-hour period and in excess of 60 hours per 7-day period.
- Hospitals and nursing homes should identify needed staffing for each patient care unit per shift; empower nursing staff to regulate unit work flow; and involve direct care nursing staff in identifying the causes of turnover and in developing methods to improve retention.
- Management should facilitate input of direct care nursing staff into operational decision making; work design should balance efficiency and safety, and demonstrate trust in workers and promote trust by workers.
- Health care organizations should dedicate budgetary resources to support nursing staff in their acquisition and maintenance of knowledge and skills.
- Health care organizations should provide nursing leadership with resources that enable them to design the work environment and care processes to reduce errors. These efforts should concentrate on various phases of work, including non-value-added activities performed by nurses such as locating and obtaining supplies, looking for personnel, completing redundant and unnecessary documentation, and compensating for poor communication systems.
A copy of Keeping Patients Safe: Transforming the Work Environment of Nurses is available through the National Academies Press .
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