The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March–May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March–July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.

Background: Every one out of 10 nurses reported suffering from high levels of burnout worldwide. It is unclear if burnout affects job performance, and in turn, impairs patient safety, including medication safety. The purpose of this study is to determine whether nurse burnout predicts self-reported medication administration errors (MAEs). Methods: A cross-sectional study using electronic surveys was conducted from July 2018 through January 2019, using the Copenhagen Burnout Inventory. Staff registered nurses (N = 928) in acute care Alabama hospitals (N = 42) were included in this study. Descriptive statistics, correlational, and multilevel mixed-modeling analyses were examined. Results: All burnout dimensions (Personal, Work-related, and Client-related Burnout) were significantly correlated with age (r = −0.17 to −0.21), years in nursing (r = −0.10 to −0.17), years of hospital work (r = −0.07 to −0.10), and work environment (r = −0.24 to −0.57). The average number of self-reported MAEs in the last 3 months was 2.13. Each burnout dimension was a statistically significant predictor of self-reported MAEs (p < .05). Conclusions: Nurse burnout is a significant factor in predicting MAEs. This study provides important baseline data for actionable interventions to improve nursing care delivery, and ultimately health care, for Alabamians.

Background: Intensive care unit (ICU) nurses are at an increased risk of post-traumatic stress disorder (PTSD) due to their stressful work environment. Using the Walker and Avant conceptual analysis method, we sought to review the literature to better understand PTSD as it pertained to ICU nurses and its impact on their lives, patient care, and health care organizations. Methods: For the review, we searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO. The keyword searches included the terms “post-traumatic stress disorder” AND “psychological stress” AND “intensive care unit nurses.” Abstract and full text reviews were conducted. Ten articles met our inclusion criteria of being published in the past 10 years (2010–2020), peer reviewed, written in English, and referred specifically to PTSD and psychological stress in ICU nurses. Findings: Antecedents for PTSD in ICU nurses are their stressful work environment, where exposure to traumatic events is experienced, and a lack of support from their manager, coworkers, and organization. Defining attributes for ICU nurses with PTSD included reexperiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Consequences identified included burnout, job dissatisfaction, and the intention to leave their job. The conceptual definition of PTSD in ICU nurses was illustrated by the attributes, antecedents, consequences, model case, empirical referents, and by the negative impact on the nurse, patients, and the health care organization. Conclusion/Application to Practice: Hospital administrators, nurse managers, and occupational health nurses should ensure that policies and interventions are in place to recognize and reduce the risk of PTSD among ICU nurses.

Worldwide, nurses have been reporting high levels of burnout. Given the high prevalence of nurse burnout, measurements of burnout need to be carefully considered for their validity and reliability. Our research team used a relatively new instrument to measure burnout among nurses: the Copenhagen Burnout Inventory (CBI). This 19‐item instrument measures burnout in three dimensions: Personal, Work‐related, and Client‐related Burnout. However, the psychometric properties of the CBI have not been examined in nurses. Thus, the purpose of this study was to determine the psychometric properties of the CBI in a state‐wide survey of inpatient staff nurses. A total of 928 registered nurses working in Alabama‐area hospitals (N = 42 hospitals) participated in this study. Confirmatory factor analysis resulted in an adequate fit to the data and supported construct validity. As evidence of convergent validity, the CBI was moderately to highly correlated with measures of the overall work environment, job satisfaction, and intent to leave, in the anticipated directions. The Cronbach's alphas for Personal Burnout, Work‐related Burnout, and Client‐related Burnout were 0.91, 0.89, and 0.92, respectively, demonstrating excellent internal consistency reliability for the subscales. Based on our data, the CBI demonstrates adequate validity and reliability for measuring burnout among frontline nurses. As nurses provide care to the most vulnerable patients in healthcare systems, their psychological well‐being is important due to the impact on quality of care on patient outcomes. The availability of the CBI on its website allows nurses, nurse managers, and researchers to evaluate burnout in a variety of nursing populations with no licensing costs.

Background: Burnout impacts nurses' health as well as brain structures and functions including cognitive function, which could lead to work performance and patient safety issues. Yet, few organization-level factors related to patient safety have been identified. Purpose: This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment. Methods: A cross-sectional electronic survey was conducted among nurses (N = 928) in acute care Alabama hospitals. Results: In multilevel ordinal mixed-effects models with nurses nested within hospitals, all burnout dimensions of the Copenhagen Burnout Inventory (OR for +1 SD ranging 0.63-0.78; P < .05) and work environment (OR for +1 SD ranging 4.35-4.89; P < .001) were related to the outcome of patient safety grade after controlling for nurse characteristics. Conclusions: Results indicate that health care organizations may reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level.