Staffing and resource adequacy strongly related to RNs’ assessment of patient safety: a national study of RNs working in acute-care hospitals in Sweden

Abstract

IntroductionAlthough registered nurses (RNs) are central in patient care, we have not found prior research that specifically addresses how RNs assess the safety of patient care at their workplace and how factors in RNs’ work environment are related to their assessments. This study aims to address these issues.Methods9236 RNs working with inpatient care in 79 acute-care hospitals in Sweden completed a national population-based survey, including Practice Environment Scale of the Nursing Work Index—Revised and items from Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture. Correlation coefficients (Pearson and Spearman) and proportional odds regression were used for analysis.ResultsNursing work environment factors were strongly related to RNs’ assessments of patient safety. RNs’ perception of having adequate staffing and resources improved their assessment of patient safety by at least two and a half times (OR 2.74 CI 2.52 to 2.97). RNs with a higher level of involvement in direct patient care gave a better patient safety grade than RNs with a more supervisory role. Most, but not all, patient safety culture items were related to RNs’ assessed patient safety grade. We found that work experience seemed to have no influence on RNs’ patient safety assessment.ConclusionsWhile previous research emphasises patient-to-nurse ratios in strengthening patient safety practices, this study complements this by emphasising RNs’ own perception of having enough staff and resources to provide quality nursing care, as well as having good collegial nurse–physician relations and the presence of visible and competent nursing leadership—all factors highly related to RNs’ assessment of the safety of patient care at their workplace.

Association between workload of the nursing staff and patient safety outcomes

“…Likewise, the inverse significant association (p<0.01) found between the workload and the level of satisfaction of the patients with the care received by the nursing team is consistent with the results of other studies, which indicated that higher numbers of patients assigned to the nursing team decrease patient satisfaction and that the restriction or reduction of nursing staff has a negative repercussion on patients' and professionals' perception of safety in care environments (4)(5)(23)(24) . Despite the differences in context, working hours, professional training and others, studies in different countries indicated that the increase in the number of nurses and nursing hours in patient care, as well as a higher proportion of nurses in teams composed also by professionals with a vocational education can improve quality and safety outcomes for patients in hospitals.…”

Fatores intervenientes na produção do cuidado em enfermagem

“…When closer involvement with direct patient care occurs, assessment becomes more assertive; and, when human capital and resources are adequate, there is a better perception about patient safety. (18) The complexity of interventions associated with intense specialization and the transformations that occur in healthcare work imposes a coordinated and integrated approach among various professionals to meet the dimensions of human care. The multidisciplinary team meetings stand out as a practice that improve collaboration in the therapeutic plan, from the perspective of comprehensiveness and interdisciplinary attitude.…”

Study of adaptation and validation of the Practice environment scale of the nursing work index for the portuguese reality

“…A favorable working environment increases the interception of medication errors in intensive care (9) . The relationship between a positive working environment and the satisfaction and retention of nurses was also demonstrated (10)(11) , as well as the safety of clients (12)(13) . In contrast, when the work environment is not favorable, the lack of satisfaction of nurses, the burnout syndrome, emotional exhaustion and intention to leave the place of work/service are observed (14)(15)(16)(17)(18)(19) .…”