4 ways to improve the nursing environment, patient safety

The nursing world has changed for the better throughout the past decade, but there is room for improvement as patients remain at risk for serious harm and disruptive behavior in the workplace continues, according to a new brief from the Robert Woods Johnson Foundation (RWJF).

Healthcare organizations must make even more systemic, interprofessional and cultural changes to ensure nurses work in an environment that encourages patient safety, efficiency and accountability, the brief states. 

"Ten Years After Keeping Patients Safe: Have Nurses' Work Environments Been Transformed?" examines the changes that hospitals made since the original report "Keeping Patients Safe: Transforming the Work Environment of Nurses," which the Institute of Medicine (IOM) published in 2004.

The original report found there was a lack of commitment by organizations to sustain change over time in the face of adversity, a lack of consistent involvement in process design by frontline staff, and a lack of measurement and feedback to staff who participate in the improvement process, according to the brief.

The IOM recommended that hospitals create:

  • governing boards that focus on safety

  • leadership and evidence-based management structures and processes

  • effective nursing leadership

  • safe and adequate staffing

  • organizational support for ongoing learning and decision support

  • mechanisms that promote interprofessional collaboration

  • work design that promotes safety

  • organizational culture that continuously strengthens patient safety

Since 2003, Transforming Care at the Bedside (TCAB), funded by the RWJF and developed in collaboration with the Institute for Healthcare Improvement, helped frontline nurses address quality and safety issues on their units. 

The group saw significant reduction in injury-producing falls, decreased incremental (unplanned) overtime with a savings of more than $1,900 per month, a decrease in nurse turnover from 18 to 3 percent, and an 8 percent increase in nurse time spent at the bedside. In addition, nurses were able to implement practices suggested by the American Organization of Nurse Executives' Care Innovation and Transformation program hospital-wide to 47 departments and three affiliated hospitals.

To continue making positive changes in the nursing environment, the latest brief encourages organizations to harness nurse leadership and foster interprofessional collaboration in four ways:

  • Monitor nurse staffing and ensure that all healthcare settings are adequately staffed with appropriately educated, licensed, and certified personnel

  • Create institutional cultures that foster professionalism and curb disruptions

  • Harness nurse leadership at all levels of administration and governance

  • Educate the current and future workforce to work in teams and communicate better across the health professions

To learn more:
- here's the brief
- read the original report