Table 1

Necessary Patient Safeguards in the Work Environment of Nurses

Governing Boards That Focus on Safety
  • Are knowledgeable about the link between management practices and patient safety.
  • Emphasize patient safety to the same extent as financial and productivity goals.
Leadership and Evidence-Based Management Structures and Processes
  • Provide ongoing vigilance in balancing efficiency and patient safety.
  • Demonstrate and promote trust in and by nursing staff.
  • Actively manage the process of change.
  • Engage nursing staff in nonhierarchical decisionmaking and work design.
  • Establish the organization as a “learning organization.”
Effective Nursing Leadership
  • Participates in executive decisionmaking.
  • Represents nursing staff to management.
  • Achieves effective communication between nurses and other clinical leadership.
  • Facilitates input from direct-care nursing staff into decisionmaking.
  • Commands organizational resources for nursing knowledge acquisition and clinical decisionmaking.
Adequate Staffing
  • Is established by sound methodologies as determined by nursing staff.
  • Provides mechanisms to accommodate unplanned variations in patient care workload.
  • Enables nursing staff to regulate nursing unit workflow.
  • Is consistent with best available evidence on safe staffing thresholds.
Organizational Support for Ongoing Learning and Decision Support
  • Uses preceptors for novice nurses.
  • Provides ongoing educational support and resources to nursing staff.
  • Provides training in new technology.
  • Provides decision support at the point of care.
Mechanisms That Promote Interdisciplinary Collaboration
  • Use interdisciplinary practice mechanisms, such as interdisciplinary patient care rounds.
  • Provide formal education and training in interdisciplinary collaboration for all health care providers.
Work Design That Promotes Safety
  • Defends against fatigue and unsafe and inefficient work design.
  • Tackles medication administration, handwashing, documentation, and other high-priority practices.
Organizational Culture That Continuously Strengthens Patient Safety
  • Regularly reviews organizational success in achieving formally specified safety objectives.
  • Fosters a fair and just error-reporting, analysis, and feedback system.
  • Trains and rewards workers for safety.

Source: Committee on the Work Environment for Nurses and Patient Safety, 20046: pages 16-17. Reprinted with Permission. ©2004 National Academy of Sciences.

From: Chapter 22, Practice Implications of Keeping Patients Safe

Cover of Patient Safety and Quality
Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Hughes RG, editor.

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