The safety of employees in a healthcare setting should be the greatest concern for healthcare officials. Patients being the sole consumers of healthcare commodities need the greatest care, which also entails ensuring their safety through the reduction of errors that could otherwise lead to long hospital stays, injuries, and premature deaths. On the other hand, the nursing staff is the only workforce among the health practitioners that are in constant direct contact with the patient. Nurses are exposed to dangers such as assault from patients or their families, injuries due to fatigue, and exposure to chemicals. This paper seeks to discuss in detail patient and nurse safety in a healthcare setting.
Patient Safety
The safety of patients forms the foundation of healthcare delivery in any competent facility. More than a century and a half ago, Florence Nightingale indicated that “the very first requirement in a hospital is that it should do the sick no harm” ( Friesen, Farquhar & Hughes, 2005, p. 3). The Institute of Medicine also echoed this concern in its report released a decade ago, “ To Err is Human: Building a Safer Health System ”, which estimated that approximately a million people got injured in healthcare facilities while at least 98,000 died due to medical errors. Further, the report indicated that care systems should focus on creating a safe environment free from patient harm ( Institute of Medicine, 2000) . A study conducted by James that primarily targeted errors of commission indicated that approximately 400,000 patients die prematurely every year and serious injuries were 10 to 20 time more common than mortality. An estimated 400,000 deaths and approximately four to eight million serious harms translate to at least 1,096 deaths and between 10,959 and 20,918 injuries daily (James, 2013). Besides injury and death, lapses in patient safety lead to increased length of stay in hospitals.
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The adverse effects on patients are not as a result of malicious intent from the people obligated to take good care of them but due to a myriad of complexities surrounding the contemporary healthcare system ( Institute of Medicine, 1999). Several factors contribute to the successful treatment of a patient and not just the competence of the healthcare provider. Friesen, Farquhar & Hughes (2005) asserts that w hen several practitioners such as physicians, nurses, social workers, epidemiologists, pharmacists, and others are entwined, it becomes more complicated to guarantee the safety of care, unless the system is designed to enable accurate, timely, and complete information and understanding by the concerned healthcare providers.
The safety of a patient is an issue of concern for all healthcare facilities globally whether privately owned or funded by the government. There is a dire need for healthcare organizations to implement safety frameworks that will minimize existing and potential errors as well as instill a culture of safety and minimize medical errors ( Institute of Medicine, 2000). The Institute of Medicine in its report defined an error as
“The failure of a planned action to be completed as intended (i.e., error of execution) or use of a wrong plan to achieve an aim (i.e., error of planning), an adverse even as an injury caused by medical management rather than the underlying condition of the patient” ( Institute of Medicine, 2000, p 28).
Errors in a healthcare setting can be minimized or prevented by putting in place frameworks that make it difficult for individuals to error and easy for them to do the right thing. This implies that a healthcare facility needs to have a culture of safety that guides the behavior of healthcare practitioners. For example, a situation where a physician prescribes antibiotics without considering a patient’s underlying condition and whether the drugs will assist the case, or administering several drugs with no consideration on potential reactions could lead to adverse patient injuries in the process. Whether such a case would be reported and resolved; or suppressed for fear of blame and retribution depends on the safety culture in the facility.
Various researchers have developed strategies to enhance patient safety. The Institute of Medicine released reports in 2001 and 2004, which focused on providing guidelines to healthcare facilities on the effective ways of implementing a culture of patient safety in hospitals. According to the Institute of Medicine (2001), the purpose of healthcare is to provide a high quality of care to the population, but it constantly failed to do so due to the frequent patient harms. However, the existing gap between the desired and the actual healthcare is attributed to the ever increasing number of patients, understaffing, a poor organization in the healthcare system to meet the challenges, the need to manage more, do more, as well as watch more. The report indicates that a reduction in patient injuries, illnesses, and disabilities calls for the collaboration and commitment of stakeholders in the healthcare fraternity.
Parties should be committed to adopting a shared vision of six specific aims for improvement built around the following: safety (designed to avoid injuries to patients), effectiveness (provision of services based on scientific knowledge and refrain from providing them to those who may not benefit), patient-centered (care should respond to individual needs, values, and preferences), timely (reduce harmful delays and waits especially for the receiver and caregivers), efficiency (minimizing of wastage of equipment, supplies, and energy), and equity (providing quality care for all individuals irrespective of race, socioeconomic status, geographical location, gender, religion, and ethnicity) (Institute of Medicine, 2001).
Nurses have a significant effect on the safety of patients as well. The Institute of Medicine (2004) also indicated that their work environment should be redesigned to enable them to deliver safer patient care. The report affirmed that the actions of nurses had a direct effect on quality patient outcomes and their vigilance reduced the occurrence of errors. Nursing environments characteristics such as the organizational leadership approach, employee deployment practices, job design, and organizational culture posed serious threats to patient safety. Typically, factors such as consistently failing to follow the established organizational safety practices, unsafe employee deployment practices, unsafe workspace design, and castigatory cultures that impeded the reporting and error prevention all affected patient safety. The report recommended the use of transformational leadership style, boosting employee capabilities, employing evidence-based approaches to care, designing the workspace to mitigate errors, and employing a safety culture as the pathway to eliminating safety issues in hospitals.
Safety for Nurses
The United States Bureau of Labor Statistics study that analyzed data from 1989 to 2011 indicated that hospitals recorded twice as high rates of injury as compared to the entire private sector in the whole of America. This included the healthcare practitioners. For instance, in 2011, the healthcare facilities registered 6.8 work-related injuries for every 100 full-time workers; in total, there were more than 58,000 work-related injuries in that particular year (Bureau of Labor Statistics, 2013). Due to the high number of injuries, the hospital is a hazardous workplace because of several factors such as the unique risks involved (lifting and repositioning patients with limited mobility), the unique culture (caregivers are ethically required to do no harm, and some may put their health at risk in order to save a patient), and considering that it is not like an assembly line, since health professionals are expected to respond to unpredictable situations as quickly as possible ( Trinkoff et al., 2008). It implies that the sector will continue to record higher injuries among nurses than any other industry.
Nurses in particular work in highly stressful environments characterized by work-related injuries and illnesses. Lack of well-rested and healthy nursing staff can have an inverse effect on patient safety. Several factors such as the immediate work context, organizational characteristics, and changes in the external industry related to the healthcare environment can contribute to potential injuries to the nursing workforce ( Trinkoff et al. , 2008). Other factors include staff shortages, employment under different programs such as pool and traveling staff, and the patient turnaround time such as early discharges that contribute to long working hours can all contribute to the diminished safety of nurses. Due to the hazards surrounding the nursing staff, many may in the short-term suffer musculoskeletal disorders, infections, mental health problems, and other injuries, which long-term effects may involve cardiovascular ailments, metabolic problems, and neoplastic diseases ( Registered Nurses Association, 2007). The nurses’ work in itself is precarious; hence the need to make the work environment safer for them to operate.
Work Schedules, for instance, the speed of rotation, the time, pattern, length of shifts, as well as rest breaks can affect the way nurses perform their duties. Approximately 30% of workers who work on night shifts (9 p.m to 8.am) and 26% of those on rotating shifts experience long-term sleepiness and insomnia while awake, which affects their ability to perform duties safely and effectively. This exposes them to potential injuries musculoskeletal injuries and needlesticks. Other factors include long-term exposure to chemicals (skin contaminants, sterilants, medications, and latex), and workplace violence (physical assault from patients or their families) ( Trinkoff et al ., 2008). The data indicate clearly that nurses are at a higher risk and this can have a direct effect on patient outcomes.
Conclusion
The study delved on patient and nurse safety in a healthcare setting. It established that patients suffer extended hospital stays, injuries, and premature deaths due to lack of safety in hospitals. Hospitals need to put in place effective organizational safety practices, better employee deployment practices, safe workspace design, and non-castigatory cultures that encourage reporting and error prevention . On the other hand, Nurses are the most vulnerable employees who need a safer workplace to shield them from violence, musculoskeletal disorders, infections, mental health problems, and other injuries.
References
Bureau of Labor Statistics. (2013). Facts about hospital worker safety . Retrieved from www.osha.gov/dsg/hospitals.
Friesen, M. A., Farquhar, M. B., & Hughes, R. (2005). The Nurse's role in promoting a culture of patient safety (pp. 1-26). Center for American Nurses.
Institute of Medicine. (1999). To Err is Human: Building a Safer Health System (pp. 28-38). Washington, DC: National Academies Press.
Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century. The National Academy of Sciences . Retrieved 1/11/2018 from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf
Institute of Medicine. (2004). Keeping patients safe. Transforming the work environments of nurses . Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/ Reports/2003/Keeping-Patients-SafeTransforming-the-Work-Environmentof-Nurses.aspx
James, J.T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety , 9(3), 122-128
Registered Nurses Association. (2007). Workplace health, safety, and well-being of the nurse . Retrieved from https://rnao.ca/sites/rnao-ca/files/Workplace_Health_Safety_and_Well-being_of_the_Nurse.pdf
Trinkoff, A. M., Geiger-Brown, J. M., Caruso, C. C., Lipscomb, J. A., Johantgen, M., Nelson, A. L., Sattler, B, A., & Selby, V. L. (2008). Personal safety for nurses: An Evidence-Based handbook for nurses. NCBI . Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2661/
