1. By: Anabela Dos Santos, RN 7/8/15
Safe Staffing
By:
Anabela Dos Santos, RN
7/8/15

2. Introduction Nurses burning out due to1:
Nursing shortage
Chronic understaffing
Job dissatisfaction
Safe staffing mandate in California2
Lobby Congress for safe staffing

3. Background
Nurses have been reporting unsafe staffing for over 2 decades3
Typical nurse work environment holds serious threats to patient safety4
Burned out nurses make errors5
Hospitals with unsafe staffing experience additional deaths6
-Typical nurse work environment: extended work hours, fatigue, mandatory overtime, poorly designed care processes, workload issues, environmental issues, lack of support systems (reliance on memory) barriers to effective communication
-Medication errors increase by 18% with unsafe staffing
-Compared to hospitals with safe staffing

4. Significance Distrust in American Healthcare System7
Federal Government funding more research
Landmark Aiken study in 20028
Success in California9
-1993 IOM report concluded insufficient evidence to support safe staffing
-1999 IOM report: To Err is Human: Building a Safer Health System
-Aiken study shows correlation between nurse staffing and patient outcomes
-Aiken study shows correlation between nurse staffing and job satisfaction
-California had no hospital closures, increased hospital income, and decrease in nurse turnover

5. Search Strategy PCOM online library
Ebsco Host (AltHealth Watch, Medline with full text, and CINAHL)
Keywords: Safe Nurse Staffing
Keywords: Linda Aiken
IOM reports

6. Guiding Framework Jean Watson’s Theory of Human Caring10
Caring Science10
Caritas10
Sixth Carative Factor
Eighth Carative Factor
6th Carative factor: creative problem solving for comprehensive assessment
8th Carative factor: creation of a safe space

7. Analysis of Issue
Meta-analysis of 90 studies show safe staffing is key to11:
Patient safety
Nurse retention
Cuts costs12:
$3 billion in savings
Reduction in hospital re-admissions
$4 million saved in adverse events
-Savings are per year

8. Analysis of Issue
Regardless of studies and initiatives, organizations continue to13:
Decrease nurse staffing
Eliminate role of Chief Nursing Executives
Not involve nurses in decision making
Design unsafe work conditions/workspace
Increase mandatory documentation
Provide a punitive culture for reporting errors/prevention of errors

9. Trends
Medicare / Medicaid and private insurers denying payment for preventable hospital injuries/illnesses13
Bipartisan legislation introduced to federal and state governments for safe staffing14
Some states have mandatory reporting15
Magnet approach16
-Endorsed by ANA, the Registered Nurse Safe Staffing Act (H.R. 2083/ S. 1132)

10. Trends Major national initiatives that affect nurses17: IOM reports:
To Err is Human: Building a Safer Health System(1999)
Crossing the Quality Chasm: A New Health System for the 21sst Century(2001)
Keeping Patients Safe: Transforming the Work Environment for Nurses (2004)
5 million lives campaign
Transforming care at the bedside
-5 million lives campaign from Institute for Healthcare Improvement
-Transforming care at bedside from Robert Wood Johnson Foundation

11. Implications Established National Nursing Advisory Committee18
The Joint Commission initiatives19:
15 national voluntary consensus standards for nursing sensitive care
Nursing sensitive measures in hospital accreditation process
The Safe Staffing Act of
Hold hospitals accountable
Require all states to publicly report staffing levels
-The Institute for Healthcare Improvement established 1st National Nursing Advisory Committee in 2003
-National Quality Forum endorsed the 15 national voluntary consensus standards for nursing sensitive care in hospitals in 2004
-Endorsed by ANA, the Registered Nurse Safe Staffing Act (H.R. 2083/ S. 1132
Safe Staffing Act of 2015 would:
-Lower rates of patient falls
-Lower rates of infections
-Lower rates of medication errors
-Lower rates of death

12. References
2, 3, 8Aiken, L.H., Clarke, S.P., Sloane, D.P., Sochalski, J.P., & Silber, J.H. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Journal of American Medical Association, 288(16),
9, 11Aiken, L.H., Sloane, D.M., Cimiotti, J.P, Clarke, S.P., Flynn, L., Seago, J., Spetz, J., & Smith, H.L. (2010), Implications of the California Nurse Staffing Mandate for Other States, Health Services Research, 2010 Aug; 45(4): Doi: /j x
12, 13, 20American Nurses Association. (2015). The Registered Nurse Safe Staffing Act. Retrieved May 18, 2015 from: pdf?docID=2361

13. References
13,17, 18, 19Finkelman, A. & Kenner, C. (2013). Professional nursing concepts- Competencies for quality leadership. (2nd Ed.) Burlington, MA: Jones & Bartlett Learning.
6Furillo, J. (2014). Safe staffing as a matter of law. Journal of the New York State Nurses Association, 4.
¹,11,Nantsupawat, A., Srisuphan, W., Kunaviktikul, W., Wichaikhum, O., Aungsuroch, Y., & Aiken, L. H. (2011). Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand. Journal of Nursing Scholarship, 43(4), doi: /j x

14. References
4, 5, 7 Page, A., (2004), Keeping Patients Safe: Transforming the Work Environment of Nurses. Retrieved May 18, 2015 from: isbn:
14, 15 Registered Nurse Safe Staffing Bill Introduced in Senate. (2014), Nursing News, 38(4), 17.
9, 16Smith, A. (2002). Evidence of our instincts: an interview with Linda H. Aiken. Nursing Economic$, 20(2),

15. References
10Watson, J & Woodward T. K. (2010) Jean Watson’s theory of human caring. In M.E. Parker and M. C. Smith Nursing theories & nursing practice (3rd Ed.) (pp ), Philadelphia, PA: F.A. Davis Company