In 3/12/13 article, “Patient Safety Programs Ineffective Most Nurses Say“, by Alexandra Wilson Pecci, there are alarming statistics from a recent American Nurse Association (ANA)and GE Healthcare survey of 500 practicing RNs in the US, 200 in the UK and 200 in China.
What is going on when 94% of nurses surveyed say that their hospitals have programs in place that promote patient safety and only 41% consider their hospitals to be safe?
What is going when 90% of nurses say it’s important to have a culture where nurses are not penalized for reporting errors or near misses, and 59% agree that nurses often hold back reporting patient errors in fear of punishment and (62%) say the same about reporting near-misses?
What is going on when only 37% of nurses rated their hospital as excellent at communication with the patient and only (31%) say their hospital is excellent at communication between staff?
We’ve known about the scope of errors and patient safety issues for over a decade! Yet problems with organizational culture and inter-professional communication persist and patients and healthcare professionals suffer. Here are some thoughts I have:
1. Nurses often don’t have time to do all the things we should the right way. Staffing constraints, disruptive behavior, workload expectations, and time limitations do not allow for following protocols, procedures, and policies let alone, stopping and listening respectfully to all patients all the time. We know we should. We know how. We simply don’t have the resources to do things properly.
2. There is an overall lack of trust between staff and leadership in many facilities. It is way too easy to blame nurses for doing things wrong when an error occurs rather than doing In Depth Root Cause Analysis (RCA)to discover all of the systems’ factors. Nurses become second victims and underlying problems remain hidden. I can’t help but mention ‘checklists‘ here. These are amazingly effective at times, but in a culture of scarcity may only solve one area of trouble while another pops up.
3. Nurses stop speaking up about needs and resources because of a history of receiving a backlash such as ‘the nurse needs time management’ or ‘the nurse isn’t a teamplayer’ or ‘the nurse has a negative attitude’. Teaching and training for speaking up without doing the same for listening is a mixed message and further erodes trust.
4. It is not even safe to talk about shortcuts among nurses because it is admitting to wrongdoing. Many work-arounds lead to normalization of deviance and these patterns remain hidden. Did you realize the top 3 categories of root causes of all sentinel events in 2010, 2011, and 2012 according to the Joint Commission are: Leadership, Human Factors, and Communication?
5. Many healthcare practice settings have toxic cultures and the resent NPSF report ‘Through the Eyes of Workforce” is a very helpful guide.
For example, taking meal and rest breaks is a common issue among busy healthcare workers. When strapped for time, some nurses punch out for their lunch but continue to work. They do this despite management pressure to take meal and rest breaks because they want to get out on time, avoid negative feedback re: overtime or time management, and maybe some other factors re: self awareness re; fatigue and/or fears about inadequacy. But the organization’s efforts to ensure nurses take breaks may focus more on their liability or desire to appear to make sure nurses take breaks than making sure they CAN take there breaks. When I punch out from my per diem RN job, I get a digital message, “Did you take an uninterrupted 30 min break?” If I punch “Yes”, another question comes up, “You said you took and uninterrupted 30 min break. Is this correct?” Right next to the time clock is a message in big red font from the Director of Nurses (DON) reading something like, “IF YOU DO NOT TAKE YOUR 30 MINUTE MEAL BREAK YOU MUST GET APPROVAL FROM THE DON OR SUPERVISOR.”
I see this as an effort to control and document organizational commitment, helpful in a lawsuit perhaps, rather than any real effort to solve the problem. What would really help would be a leadership that asks nurses, “What do you need to ensure that you take a 30 min break?” And then listen and work together for solutions. The former puts nurses on the defensive and is punitive in tone and nature. The other seeks to collaborative address the problem. Some solutions would be staffing, delegation skills, and maybe time management.
To end this on a positive note, there is vast potential for problem-solving ideas from nurses and other frontline staff. Assertive nurses plus assertive, informed, patients/advocates, plus collaborative leadership is the ticket to safer, more cost-effective care, optimal patient experience, and rewarding careers.