Safe Staffing By Anabela Dos Santos RN 7815

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

Introduction • Nurses burning out due to 1: • Nursing shortage • Chronic understaffing • Job dissatisfaction • Safe staffing mandate in California 2 • Lobby Congress for safe staffing

Background • Nurses have been reporting unsafe staffing for over 2 decades 3 • Typical nurse work environment holds serious threats to patient safety 4 • Burned out nurses make errors 5 • Hospitals with unsafe staffing experience additional deaths 6

Significance • • Distrust in American Healthcare System 7 Federal Government funding more research Landmark Aiken study in 20028 Success in California 9

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

Guiding Framework • Jean Watson’s Theory of Human Caring 10 • Caring Science 10 • Caritas 10 • Sixth Carative Factor • Eighth Carative Factor

Analysis of Issue • Meta-analysis of 90 studies show safe staffing is key to 11: • Patient safety • Nurse retention • Cuts costs 12: • $3 billion in savings • Reduction in hospital re-admissions • $4 million saved in adverse events

Analysis of Issue • Regardless of studies and initiatives, organizations continue to 13: • • • 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

Trends • Medicare / Medicaid and private insurers denying payment for preventable hospital injuries/illnesses 13 • Bipartisan legislation introduced to federal and state governments for safe staffing 14 • Some states have mandatory reporting 15 • Magnet approach 16

Trends • Major national initiatives that affect nurses 17: • IOM reports: • To Err is Human: Building a Safer Health System(1999) • Crossing the Quality Chasm: A New Health System for the 21 sst Century(2001) • Keeping Patients Safe: Transforming the Work Environment for Nurses (2004) • 5 million lives campaign • Transforming care at the bedside

Implications • Established National Nursing Advisory Committee 18 • The Joint Commission initiatives 19: • 15 national voluntary consensus standards for nursing sensitive care • Nursing sensitive measures in hospital accreditation process • The Safe Staffing Act of 201520 • Hold hospitals accountable • Require all states to publicly report staffing levels

References • • • 2, 3, 8 Aiken, 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), 1987 -1993. 9, 11 Aiken, 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): 904 -921. Doi: 10. 1111/j. 1475 -6773. 2010. 01114. x 12, 13, 20 American Nurses Association. (2015). The Registered Nurse Safe Staffing Act. Retrieved May 18, 2015 from: http: //www. rnaction. org/site/Doc. Server/Registered_Nurse_Safe_Staffing_Act_o f_2015. pdf? doc. ID=2361

References • 13, 17, 18, 19 Finkelman, A. & Kenner, C. (2013). Professional nursing concepts-Competencies for quality leadership. (2 nd Ed. ) Burlington, MA: Jones & Bartlett Learning. • 6 Furillo, 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), 426 -432. doi: 10. 1111/j. 1547 -5069. 2011. 01419. x

References • 4, 5, 7 Page, • 14, 15 Registered • 9, 16 Smith, A. , (2004), Keeping Patients Safe: Transforming the Work Environment of Nurses. Retrieved May 18, 2015 from: http: //www. nap. edu/catalog/10851. html, isbn: 0 -309 -52732 -5 Nurse Safe Staffing Bill Introduced in Senate. (2014), Nursing News, 38(4), 17. A. (2002). Evidence of our instincts: an interview with Linda H. Aiken. Nursing Economic$, 20(2), 58 -61.

References • 10 Watson, J & Woodward T. K. (2010) Jean Watson’s theory of human caring. In M. E. Parker and M. C. Smith Nursing theories & nursing practice (3 rd Ed. ) (pp. 351 -369), Philadelphia, PA: F. A. Davis Company