Healthcare Workforce Safety: Nurse Safety and Patient Safety Go Hand in Hand

­Healthcare workforce safety depends on both nurse safety and patient safety. Nurses and other healthcare staff rely on safe working environments, capable leaders, support for personal well-being, and of course, respect. Patients depend on competent, compassionate care, physical security, and the satisfaction of knowing they’re well cared for. How can healthcare organizations and leaders achieve these goals by protecting nurse and patient safety congruently?

Adequate healthcare staffing prioritizes safe patient care

The benefits of proper staffing within healthcare organizations are numerous. Conversely, inadequate staffing negatively impacts nurse safety and patient safety. Nursing staff shortages lead to high patient-to-nurse ratios, which can threaten both nurses and patients.

In a 2022 ConnectRN survey, 65% of nurses reported inadequate staffing. ECRI, a healthcare technology and safety company, reported staffing shortages as the top patient safety concern of 2022.

Correlations between staffing and patient outcomes

A 2021 nursing research study conducted by members of the Center for Health Outcomes and Policy Research at the University of Pennsylvania found the following correlations between safe nurse staffing and patient outcomes after assessing 87 acute care hospitals in Illinois:

  • Patient mortality and length of stay decreased when nurses cared for fewer than five patients.
  • Outcome regression models revealed that a 4:1 patient-to-nurse ratio would have decreased the number of patient deaths and reduced patient length of stay by a total of 40,000 days, saving the healthcare systems a combined $117 million per year.

Research has shown that adequate nurse staffing also has the following patient safety and organizational success impacts:

  • Decrease in hospital-acquired infections
  • Decrease in falls and patient injuries
  • Decrease in readmissions

Steps to improve your staffing status

How do healthcare organizations achieve safe staffing? Leaders may not be able to rectify staffing problems quickly, but several actions can lessen their impact.

  • Continually reevaluate safe patient-to-nurse ratios.
  • Track spending shortfalls that could create funding for more healthcare staff.
  • Develop strategies to fight nurse burnout and turnover.
  • Improve nurse onboarding to assess and improve nurse retention and competence.
  • Emphasize nurses’ professional responsibility to promote patient safety.
  • Prioritize teamwork among your nursing staff.
  • Standardize the practice of regular patient safety huddles among your teams.

Physical safety of nurses safeguards the physical safety of patients

In Maslow’s hierarchy of needs, safety is at the base of the pyramid of human needs, making personal security imperative for the well-being of both nurses and patients. When nurses feel that they have physical protection against violence and other threats in the care setting, they can better convey this sense of security to their patients.

Nurses experiencing physical violence

Healthcare organizations must take steps to ensure the physical safety of their nurses and other healthcare providers. Media reports of random acts of violence are commonplace, and healthcare settings are not immune.

One meta-analysis study involving healthcare professionals found that 61% reported verbal abuse, 50.8% reported psychological abuse, 39.5% stated that they had been threatened with violence, and 13.7% had experienced physical violence. During the COVID-19 pandemic, 44% of nurses reported experiencing physical violence, and 68% reported verbal abuse.

The physical safety of nurses and patients also includes safe patient handling. According to the Occupational Safety and Health Administration (OSHA), musculoskeletal disorders related to patient handling are healthcare workers’ primary source of injury.

Steps to improve physical safety

Maintaining a safe environment is critical for all care settings. How can healthcare organizations ensure the physical safety of their nurses and patients?

  • Provide effective security training for hospital security personnel and administrators.
  • Consider weapon detection systems such as metal detectors and bag checks.
  • Implement de-escalation protocols and education, including active-shooter drills.
  • Administer regular education on the use of safe patient-handling equipment.
  • Assign adequate staffing for patient moves and transfers.
  • Consider patient status during assignments to allow nurses and support staff to be attentive to a potentially troubled patient or family member.

Well-supported nurses provide better patient care

The role of good leadership in a hospital setting and its impact on nursing and patient safety are undeniable. Staff nurses often perceive themselves to be at the bottom of the ladder within a hospital organization. While this is not true, nurses are led by a complex chain of command whose top tiers can seem distant and uninvested in staff. According to an ANA survey, nurses are calling for help, with only 24% of nurses saying they felt supported and 11% feeling empowered.

Leaders connecting with their nurses

Amy Matthews, MSN, RN, NE-BC, Associate Executive Director of Patient Care Services and Chief Nursing Officer at Phelps Hospital Northwell Health in Sleepy Hollow, New York, acknowledged the importance of presence and communication with staff. “I try to at least get to some of the units each day. Also, when I have too many meetings in a row, I feel very much like, ‘What am I doing here.’ [Visiting the units] reminds me of why I am here, why we are all here.”

Matthews also discussed the importance of the clinical nurse educator as part of the leadership team. “Nurse educators are there to support the staff. They should be very engaged [with] the type of patients, the education needs of the unit, [and] making sure everyone is as comfortable as they can be in taking care of patients.”

Steps to improve nurse leader involvement

Often, leaders can make a tremendous difference in the work of their staff with a few intentional behaviors. Influential leaders in the healthcare setting can impact nursing and patient safety by:

  • Taking action to remedy short staffing by personally observing units and documenting the impacts
  • Addressing unit needs for equipment and resources to care for patients safely
  • Providing adequate ongoing education to fill knowledge gaps and strengthen nurse competence
  • Acknowledging and enacting solutions for nursing concerns
  • Being approachable, authentic, and encouraging

Emotionally healthy nurses can excel in their work

Personal nurse safety includes mental well-being. Emotionally, physically, and spiritually balanced nurses can provide attentive, undistracted patient care. Healthcare organizations should take responsibility to support their nurses’ mental well-being, and doing so can pay off. A meta-analysis literature review showed a $3.27 return on investment in healthcare costs for every dollar spent on wellness programs.

Steps to support nurse mental health and well-being

Not sure where to start? Examples of employer-provided wellness benefits include:

  • Personal and health coaching services to inspire healthy choices and promote preventative healthcare
  • Financial coaching and assistance for education programs to support financial security
  • Employer discounts for community-based assistance programs to expand your offerings
  • Child care support for shift workers is a desired benefit that is not often available, according to our 2022 Nurse Salary Research Report.

Healthcare organizations’ investment in their nurses’ well-being provides returns in the form of safe patient care by:

  • Combating burnout, increasing retention, and decreasing turnover
  • Promoting feelings of value, appreciation, satisfaction, and respect
  • Decreasing missed work time by encouraging a healthy lifestyle

Nurses who feel valued provide respectful care for patients

Appreciation for nurses’ work begins at the unit leadership level. Charge nurses, coordinators, managers, and directors must have a pulse on their staff. Coming together to discuss issues is immensely important. Huddles promote patient safety, but they can also facilitate teamwork, provide a place to respectfully air grievances, and build rapport among nurses and leaders. Good communication is a foundational tenet of respect.

Margaret Peri, RN, now retired after a 40-year career as a med-surg, ICU, and emergency room nurse in New York City, recalls the significance of huddle meetings. “All nurses from all shifts would briefly gather every day in a quiet place to discuss any issues or worries.” Peri added that this practice also gives newer nurses a platform to voice concerns in their transition to practice and address issues such as lateral violence among healthcare staff.

Nurses who feel respected improve safe patient care by:

  • Providing care with a sense of purpose and calling
  • Acting with greater integrity
  • Being vigilant about promoting patient safety
  • Being more compassionate and empathetic
  • Contributing to greater patient satisfaction

Nurse safety and patient safety are interwoven aspects of quality care. Healthcare organizations must recognize their necessity and interdependency on the path to economic recovery and success.

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Danielle Rush has been a labor and delivery and postpartum nurse for nearly a decade. Her most prized role is that of educator for fellow nurses and patients. She is passionate about sharing her knowledge so that parents can make informed healthcare decisions and advocate for themselves. She earned her BSN from the University of North Carolina at Wilmington.

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