Professional News 2006

May 2006

Safe staffing saves lives

The decision of the International Council of Nurses (ICN) to focus on safe staffing for International Nurses Day this year is, surely, music to the ears of most nurses around the globe. It is recognition of this essential requirement that is one of the key issues affecting the ability of nurses to provide safe, quality care.

The anecdotal evidence has always existed, but a growing base of indisputable evidence from sound, rigorous, scientific research now supports what nurses have always known: the provision of an adequate number of appropriately educated nurses (ie. safe staffing) has a significant effect on positive patient outcomes.

Evidence now exists that demonstrates safe staffing leads to increased recovery times; reduced morbidity; reduced risk of falls; a decreased incidence of pressure areas; and lower rates of pneumonia, urinary tract infections, shock, gastrointestinal bleeding, cardiac arrest, as well as reductions in that ultimate poor outcome: death.

These are just some of the better known positive patient outcomes possible when institutions practice safe staffing of nurses. It will come as no surprise to ANF members to learn hospitals with a high rate of union membership among nurses have better patient outcomes.

These hospitals demonstrate reduced mortality from myocardial infarction, and the authors state the findings demonstrate there is a 'positive relationship' between patient outcomes and unionised nurses.
Other less well known outcomes include the findings that safe staffing is better for nurses (again, no surprise to any nurse), leads to greater job satisfaction, and less burnout. This, if nothing else, should be welcomed by employers - staff turnover is expensive - and so are the costs of increased patient morbidity and mortality.

In Australia it is estimated that deaths from adverse events in the nation's hospitals are around 18,000 deaths per year. If this statistic related to road accidents (which it far exceeds) or airline crashes, it would engender community outrage - and presumably the most rapid and powerful policy responses. But somehow because it occurs in that most conservative of industries, health care, responses are ponderously slow.

What is most remarkable about all these statistics however, is the reluctance, in Australia at least, of policy makers and safety and quality experts to acknowledge this obvious means of avoiding adverse events. To my mind it constitutes a simple equation: more nurses equals increased patient safety.
This is not a message policymakers are always willing to hear. The issue of patient safety is becoming a hot topic in terms of adverse events. It is hoped the release of the ICN toolkit on safe staffing, and continued lobbying by the ANF, will highlight the positive effects of nurse staffing on reducing adverse events.

Acknowledgement is slowly coming, and we must take heart that changes are occurring internationally, with the recognition of the inseparability of nurses work environments and patient safety acknowledged in a 2004 Institute of Medicine report Making patients safer: Transforming the work environment of nurses.

Prior to its demise last year, the Australian Council for Safety and Quality in Health Care had begun some key work in the campaign to reduce the rate of adverse events and improve safety and quality in Australian hospitals: reducing hospital acquired infections, minimizing medication errors, and preventing patient falls. These issues are acutely sensitive to nurse staffing and have the potential to be positively influenced by nursing care.

The ANF will continue to argue at every possible opportunity, that substantial improvements in the quality and safety of Australian hospitals cannot be achieved without the involvement of the most populous group of health care professionals: nurses. It is the ANF's view that addressing the issue of nurse staffing is central to reducing the alarming incidence of adverse events in Australian hospitals, as is the involvement of nurses in the development of national, state and institutional solutions to problems with quality and safety.
The ICN toolkit on safe staffing is available online at www.icn.ch/indkit2006.pdf. It contains information intended for use by individual nurses, nursing associations, health ministries and health institutions to provide information to support the argument for safe staffing. There is a staffing assessment tool; activities to improve safe staffing; a sample press release to help highlight the issue in the community; and examples of nurse-patient ratios.

References
Aiken, L.H. et al 2002. Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction, JAMA, 2002, 288, pp. 1987-1993.
Bostick, J.E. 2004 Relationship of nursing personnel and nursing home care quality, Journal of Nursing Care Quality, 19(:2), pp. 130-136.
Needleman, J. et al 2002, Nurse-staffing levels and the quality of care in hospitals, New England Journal of Medicine, 346(:22), pp. 1715-1722.
Seago, J.A. and Ash, M. 2002 Registered nurse unions and patient outcomes, Journal of Nursing Administration, 2002, 32(:3), pp.143-51.
Sovie, M.D and Jawad, A.F. 2001 Hospital restructuring and its impact on outcomes, Journal of Nursing Administration, 31(:12), pp.588-600.
Wilson, R.M. et al 1995. The Quality in Australian Healthcare Study, Medical Journal of Australia, 163, pp.458-471.

Fiona Armstrong
ANF Professional Officer