- Failure to improve hospital work environments continues to put patients at risk, a new Health Affairs study finds.
- The researchers analyzed nurse and patient appraisals at 535 hospitals in four states between 2005 and 2016 to see whether their work environment had improved and the extent to which those changes affected patient safety.
- Just over a fifth (21%) of the hospitals showed significant improvements (better than 10%) in work environment scores, while 7% did worse. Where clinical care environments improved, nurses and patients cited positive strides on patient safety indicators.
Nurses are the backbone of the healthcare system and on the front lines of patient care. But burnout and managerial support work-life balance are concerns, as is not being allowed to practice at the top of their license.
In a 2017 survey, nearly half of nurses said they were thinking about leaving the field due to feeling overworked, workplace harassment or inadequate pay. About two-thirds blamed their heavy workload on the ongoing nursing shortage.
According to the study, a third of nurses rated their work environment as fair or poor in 2015 to 2016. Burnout was particularly high, with nearly a third of bedside nurses registering high on the Maslach Burnout Inventory, according to the study.
Hospitals with improved workplace environments performed better on a number of patient safety indicators. The number of patients rating their hospital favorably increased 11% and those who would recommend the hospital grew 8%. At the same time, positive nurse appraisals on quality of care and patient safety each rose 15%.
By contrast, hospitals where work environments decline saw a 19% drop in nurses giving favorable grades on patient safety.
The ramifications of a poor workplace environment can be far-reaching. Clinical safety interventions like surgical checklists and rapid-response teams are often undermined due to issues like staff shortages or missing equipment or supplies. According to the study, nurses are forced to drop what they're doing on average once an hour to deal with operational shortcomings.
"Our findings confirm that nurses spend substantial time troubleshooting recurring operational problems, interrupting care and creating patient safety hazards," the authors write. "RNs are an expensive and scarce resource to use in this manner, when their greatest value is in direct patient care … [M]ore attention is needed to redesign work flows to permanently solve persistent operational failures that take nurses away from direct patient care."
The study has policy implications.
Including quality work environment indicators such as nursing leadership effectiveness and good nurse-physician relationships in regulatory incentives could spur needed changes, the authors suggest. CMS could also require public reporting of nurse staffing levels on the Hospital Compare website. Five states already have such policies.
Encouraging a blame-free culture could also enhance safety and reduce adverse events by making nurses feel secure in coming forward about errors and hazardous conditions.