Performance Health Partners
Empowering Nurse Leadership to Take the Lead on Patient Safety
Nurse leadership forms the backbone of nursing teams and care delivery, and the impact of their actions has long-lasting effects on healthcare...
There are more than five million nurses in the United States and a recent survey shows nearly a third of them are thinking of quitting. That would be a devastating blow for patients and healthcare organizations.
Escalating rates of healthcare worker burnout and workplace violence, coupled with unprecedented staffing shortages, are prominent factors driving nurses away from their profession. Many of these issues are preventable and highlight the urgent need for systemic changes in healthcare employee safety.
Ahead of National Nurses Month, we sought the insights of four seasoned nurses to shed light on the critical issue of workplace safety. Drawing from their personal experiences, we explore the challenges nurses face daily, the measures that can enhance their safety, and the role healthcare leadership should play in fostering a secure and supportive environment.
Their candid responses not only highlight the need for immediate action but also offer practical recommendations to improve nurse safety in the workplace, thereby ensuring nurses feel safer and enhancing retention in this essential sector.
How can healthcare organizations better support nurses in reporting and addressing safety concerns?
"By reinforcing that the safety of HCPs comes first in patient care from a top-down approach, nurses will have a leg to stand on when facing challenging situations. More nurses will feel supported by their organization and likely report concerns earlier, reducing the risk of physicality they receive by patients. When nurses feel supported, they also feel empowered to advocate for change. Creating a culture of safety where nurses are seen as the experts they are in care delivery can augment an organization’s strategy to achieve high quality patient satisfaction and reduce nursing staff shortages.
Leadership needs to put more nurses in charge at the C-suite level to truly become innovators in healthcare delivery. Nurses are the most trusted professionals; it’s imperative to the future of healthcare that they are put in roles where they can advocate for policy change and drive evidence-based practices to provide access to the highest quality of care to all individuals."
"In the emergency department (ED) setting, I find it challenging to take the time to investigate concerns I have about safety. For example, I am responsible for screening older patients for elder abuse and children for non-accidental trauma. On busy days (i.e. most days), I feel pressured to move swiftly through all of my patient screenings. This makes it difficult for me to catch some of the more subtle signs of abuse. In my opinion, healthcare organizations could better support nurses in addressing safety concerns by fostering a culture of consideration versus a focus on throughput."
What role does leadership play in promoting and maintaining workplace safety for nurses?
"I think all leaders need to lean into the situation, understand the staffing levels, and what we are asking nurses to do, and identify which tasks can be reduced. Specifically, with EHR (electronic health records), we collect so much data and, in some instances, it never gets touched or used and just becomes noise. So, it’s leadership’s responsibility to understand what nurses are doing on a day-to-day basis, the volume of choices they need to make on any given day, and have real conversations around if there are areas where it can be scaled back."
"Overall, I think creating a culture of safety for nurses starts with senior leadership in an organization. They have to advocate for their staff to truly be an organization focused on improving patient outcomes. This includes ensuring safe patient-nurse ratios, adequate resources (people and equipment), adequate compensation, and promoting a culture of well-being."
How do you think improving nurse safety in the workplace can positively affect patient care and outcomes?
"One thing we really need to work on is cementing the idea that system errors and failures happen, and we need a non-punitive culture of safety that openly discusses mistakes. Of the things I’ve seen throughout my career [is that] people make mistakes and there is such a level of shame associated with that. The system errors are often translated differently on the staff side, such as their ability to function as a caregiver.
It’s not fair when we look again at the dozens of choices and decisions nurses must make daily, only for the Swiss cheese model to align, leading to an error. We’ve all made mistakes; I’ve made clinical errors myself, and it’s demoralizing.
You feel shame and shame leads to some of those errors not being discussed or as openly engaged with. And many of those mistakes are due to systemic failures, yet the blame unfairly falls solely on the nurses. This can often also bring up feelings of distrust among coworkers. So, I think we need to embrace kindness in terms of dealing with clinical errors and system breakdowns."
"Improving workplace safety and creating healthier work environments will help retain and recruit individuals in healthcare. Healthcare is a more sustainable career with less burnout. I often use the analogy that focusing on recruitment and not retention is like pouring water into a bucket with a hole in it. Patients benefit from having healthy nurses who are not distracted, overwhelmed, or overworked."
- Ahnyel Burkes, DNP,RN-BC,NEA-BC
What are your thoughts on the current state of burnout among healthcare professionals?
"I’ve seen a lot of nurses, clinicians in all fields burned out and leaving healthcare all together. Every day, someone reaches out to me saying they’re feeling burned out or they’re leaving healthcare all together. Which is sad and unfortunate, thinking of all the time and schooling our healthcare workers put in just to walk away from it.
About 18% of nurses do not make it past year one, so this isn’t sustainable, and something needs to change. We have to work on the working conditions that are driving people out of healthcare. I think there also needs to be some push on the legislative side as well, going in favor of nurses to combat burnout."
From your perspective, what are the most common safety challenges that nurses face in their day-to-day work?
"Violent patients are the most common safety challenge for nurses in the emergency department. When a patient comes in restrained, it is incumbent upon us to find a way to de-escalate the patient and get them out of restraints as soon as it is safe to do so.
However, it is difficult to predict when a violent patient will become violent again. I have cared for patients who became violent suddenly after a period of relative calm. When a patient has certain illicit drugs in their system, they can have unpredictable strength and be erratically violent to themselves and anyone around them."
Can you provide insights into how teamwork and collaboration contribute to a safer healthcare environment?
"The American Association of Critical Care Nurses has designated six evidence-based standards to define a healthy work environment: skilled communication, true collaboration, appropriate staffing, meaningful recognition, effective decision-making, and authentic leadership. Healthcare is a team effort and only works well when the team functions at its highest capacity.
Many errors can be avoided with effective communication and a well-functioning team. Psychological safety is also essential, so team members feel supported when raising concerns. When communication is fragmented, and teams do not work well together, it enhances the opportunity for errors, increases the workload by creating redundancy, and decreases morale, which is related to employee turnover."
- Ahnyel Burkes, DNP,RN-BC,NEA-BC
Based on your experience, what are the top three changes or improvements you believe should be implemented to enhance nurse safety?
"First, instituting shared governance allows those providing care to participate in decision-making and provide perspectives from those doing the work.
Second: Increase accountability for protecting nurses and other healthcare workers by creating environmentally safe care areas, supporting healthcare workers in reporting post-occurrences, and providing preventive support such as adequate staffing, physical space design, and much more.
Third: Redesign systems utilizing design thinking in an effort to reduce administrative burden and duplicate documentation to allow more time for nurses to be aware of their surroundings and reduce burnout."
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