NSG 601 Reflect on two safety issues you have noticed in your workplace

NSG 601 Reflect on two safety issues you have noticed in your workplace

NSG 601 Reflect on two safety issues you have noticed in your workplace

One of the major responsibilities of a patient care environment is to ensure that patients are safe. However, some of the care settings present more security issues and challenges than others. One of such is the psychiatry patient care setting. Hence there is always a need to create an environment that can foster patient safety, patient recovery, and a safe working environment for the nursing staff (Slemon et al., 2017). While several safety issues can arise in a psychiatric patient care settings, some of the safety issues that have been noticed in my workplace are workplace aggression/violence and stress emanating from long hours of work. Violence and aggressive behavior are a threat to both the  patients and the staff. The hazards in the work environment may impair both the nurses ability to provide quality service and risk the patients’ lives. The second safety risk in my workplace is the stress emanating from long work hours. In my work place nurses are expected to work a 12 hour shift however sometimes you are mandated to stay longer depending on patient work load and nurse availability.  Ideally, the relationship between work schedules and safety in the work environment is a complex issue characterized by the needs of the work environment (Polacek et al., 2015). The long hours of work cause stress to the nurses, which is often associated with various risks in the work environment which can negatively impact patient care especially in psychiatric unit in which is imperative for nurses to stay alert.  Sometimes patients on a psych unit are unpredictable and can endanger others, so it is important for the nurse to not be drained but rather to stay alert.

Strategies to promote workplace safety require an evidence-based understanding of the issues. To reduce aggression and violence in psychiatric facilities, the management must establish education and training programs to lay out both acceptable and unacceptable behaviors within the facility (Slemon et al., 2017). Besides, the facility should establish reporting procedures and reduce the ‘normalization’ of workplace violence. According to Gaynes et al. (2017), one of the best evidence strategies of addressing violence and aggressive behavior is through a preventive strategy of offering a calm environment that thwarts aggression and violence. In addition, in some active aggression and violence cases, the staff can implement seclusion without restraint or with restraint however, least restrictive measure should be considered first. .

For safety issues originating from working for long hours, the facility must review human resources and employ more staff to enable adequate rest for better service delivery to our patients (Slemon et al., 2017). In addition, the management team should also implement strategies to improve the design of the nurses work hours and should promote frequent breaks when working long hours so that nurses are not burnt-out and tired. As a result,  nurses are able to remain focus while on the unit and are ready to handle any crisis or emergency situations that frequently arises on a psychiatric unit.

References

Gaynes, B. N., Brown, C. L., Lux, L. J., Brownley, K. A., Van Dorn, R. A., Edlund, M. J., … & Lohr, K. N. (2017). Preventing and de-escalating aggressive behavior among adult psychiatric patients: a systematic review of the evidence. Psychiatric services68(8), 819-831. https://doi.org/10.1176/appi.ps.201600314 (Links to an external site.).

Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry24(4), e12199. https://doi.org/10.1111/nin.12199 (Links to an external site.)

Polacek, M. J., Allen, D. E., Damin-Moss, R. S., Schwartz, A. J. A., Sharp, D., Shattell, M., … & Delaney, K. R. (2015). Engagement as an element of safe inpatient psychiatric environments. Journal of the American Psychiatric Nurses Association21(3), 181-190.

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There are increasing safety issues in healthcare for many reasons. In my current workplace, the necessity of boarding

NSG 601 Reflect on two safety issues you have noticed in your workplace
NSG 601 Reflect on two safety issues you have noticed in your workplace

critically ill patients in the Emergency Department (ED). While COVID has increased this necessity, this has occurred for many years. The Joint Commission defines boarding as “the practice of holding patients in the ED or another temporary location after the decision to admit or transfer has been made” (Mohr et al., 2020). This can become hours or days. Evidence based practice indicates that during this time, patient safety is diminished due to delays in care, lack of knowledge of how to care for the critically ill patients, and decreased competence in Intensive Care Unit (ICU) care bundles (Mohr et al., 2020). This not only creates patient safety problems, but decreases patient satisfaction and nurse satisfaction due to overwhelming staffing needs. The effort to change this needs to be system wide. Step-down units have been identified as having a positive impact on the decrease of boarding patients, cross training nursing staff, identifying ED prime surge times, and decreasing the misuse of ICU beds (Mohr et al., 2020).

The majority of nurses have dealt with bullying in school and the workplace. The damage it causes is undeniable. This damage not only causes problems for nurses, but provides multiple issues for healthcare organizations. Social media has only made this environment increase. The outcome for nurses and organizations include excessive turnover, poor patient care secondary to a hostile work environment and increased anxiety, and financial loss due to wasted time and training on new employees (Edmonson & Zelonka, 2019). There are numerous ways to address nurse bullying that begin with admitting there is a problem and being willing to address the problem, commit to zero-tolerance as addressed in policies while providing a safe environment to report issues, and offer behavioral health for the perpetrator and victim (Edmonson & Zelonka, 2019).

References:

Edmonson, C. & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic. Nurs Admin Q, 43(3), 274-279. https://doi.org/10.1097/NAQ.0000000000000353

Mohr, N. M., Wessman, B. T., Bassin, B., Elie-Turenne, M. C., Ellender, T., Emlet, L. L., Ginsberg, Z., Gunnerson, K., Jones, K. M., Kram, B., Marcolini, E., & Rudy, S. (2020). Boarding of critically ill patients in the emergency department. Critical Care Medicine, 48(8), 1180-1187. https://doi.org/10.1097/CCM.00000000000004385

Healthcare safety is a topic that has become more apparent in my career and as a member of the leadership team on my hospital unit. As a member of the leadership team, there are healthcare safety issues that are witnessed on a daily basis that ultimately reflect on patient care and patient safety. Two safety issues that I have noticed in my workplace are staffing levels and an increase in patient falls.

When considering safety issues, it is important to consider human factors, a culture of safety, and best practices. For example, staffing levels are a human factor that have a direct relation to patient safety and adequate patient care. When a unit is short staffed, there is a large risk for errors that will affect patient safety (Finkelman, 2021). Recently, there has been a large rate of nurse turnover on the hospital unit. This has led to short staffing and higher nurse to patient ratios. Park et al. (2021) describes how proper nursing ratios affects nursing care provided to patients. When nurses are adequately staffed, then they will have more time to care for patients to the best of their ability. Using evidence and research to support proper staffing and safe nurse patient ratios would be important for patient safety. The problem recently, however, has been staff retention and the number of nurses available to hire. These factors are just as important in regard to patient safety.

One safety issue that has increased, which can be attributed to short staffing, is patient falls. There has been an increase in patient falls on the hospital units. Most falls noted have been during times that staffing is not up to par. When the unit runs short on nursing staff, patients are at increased risk for falls and other harmful events. Because of this, it would be important to use the evidence demonstrated by the correlation of short staffing and increased falls to influence leadership to support safe staffing levels. There are many different healthcare safety issues that influence patient safety. Human factors, a culture of safety, and best practices are important in considering safety issues on hospital units.

References

Finkelman, A. (2021). Quality Improvement: A Guide for Implementation in Nursing. 2nd Ed. Jones & Bartlett Learning.

Park, M.,Yang,  E., Lee, M., Cho, S., Shim, M., & Lee. S., (2021). The nurse staffing in intensive care units based on nursing care needs: A multicenter study. Journal of Korean Critical Care Nursing14(2), 1–11. https://doi-org.rivier.idm.oclc.org/10.34250/jkccn.2021.14.2.1 (Links to an external site.)