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Nurse Wellbeing and Patient Safety

Last Updated: June 5, 2024
Created By: Lorri Zipperer, Cybrarian, AHRQ PSNet Team

Description
This curated library highlights existing strategies intended to improve nurse wellbeing that directly contribute to improved patient safety rather than the personal experience or resilience of nurses.
Library Organization
Custom - This library is organized by custom section header names.
Foundations (6)
Page A; Committee on the Work Environment for Nurses and Patient Safety, Board on Health Care Services. Washington, DC: The National Academies Press; 2004. ISBN: 9780309090674.

This AHRQ-funded Institute of Medicine study identifies solutions to problems in hospital, nursing home, and other health care organization work environments that threaten patient... Read More

Institute of Medicine. Washington, DC: The National Academies Press: 2011.

The effective engagement of nursing is key to patient safety and care quality improvement. This text examines the potential of the profession as arbiters and leaders of efforts to redesign... Read More

Patrician PA, Bakerjian D, Billings R, et al. Nurs Outlook. 2022;70:639-650.

Clinician well-being has important implications for patient safety and quality of healthcare delivery. In this study, researchers used a concept analysis to identify attributes of nurse well-being at the... Read More

AORN J. 2022;115:454-457.

This position statement outlines recommendations from the Association of periOperative Registered Nurses on core components of safe perioperative nursing and its role in strengthening patient safety. Elements... Read More

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Kathleen Sanford DBA, RN, FAAN, FACHE; Sue Schuelke PhD, RN-BC, CNE, CCRN-K; Merton Lee, PharmD, PhD; Sarah E. Mossburg, RN, PhD |

This piece discusses virtual nursing, an approach to care that incorporates an advanced practice nurse into hospital-based patient care through telehealth. Virtual nursing increases patient safety and may enable expert nurses to... Read More

Quick Safety. July 15, 2019;(50):1-4.

This newsletter article discusses nurse burnout and how to reduce conditions that contribute to the problem. Recommendations focus on the role of leadership in fostering resilience, organizational... Read More

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Lewis L, ed. J Nurs Adm. 2014;44(suppl 10):S1-S53.

The Magnet Hospital Program recognizes hospitals with a track record of maintaining an excellent work environment for nurses. Articles in this special issue highlight organizational elements that contribute to... Read More

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Wagner VD, ed. AORN J. 2014;100:351-456.

Articles in this special issue explore strategies to establish a culture of safety in health care settings, including coaching to improve team briefing and debriefing discussions, a guideline to confirm safe... Read More

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All Library Content (23)
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Conroy SA, Vogus TJ. Health Care Manage Rev. 2023;49:68-73.
Becoming a high reliability organization remains challenging due to the many contributing factors involved. This study linked unit-level nurse pay to high reliability characteristics of information sharing and safety organizing. Higher minimum pay, higher average pay, and lower pay dispersion are positively associated with information sharing and safety organizing.
Kathleen Sanford DBA, RN, FAAN, FACHE; Sue Schuelke PhD, RN-BC, CNE, CCRN-K; Merton Lee, PharmD, PhD; Sarah E. Mossburg, RN, PhD |

This piece discusses virtual nursing, an approach to care that incorporates an advanced practice nurse into hospital-based patient care through telehealth. Virtual nursing increases patient safety and may enable expert nurses to continue to meet patient needs in future staffing shortages.

Kathleen Sanford

Kathleen Sanford is the chief nursing officer and an executive vice president at CommonSpirit. Sue Schuelke is an assistant professor at the College of Nursing–Lincoln Division, University of Nebraska Medical Center. They have pioneered and tested a new model of nursing care that utilizes technology to add experienced expert nurses to care teams, called Virtual Nursing.

Aiken LH, Lasater KB, Sloane DM, et al. JAMA Health Forum. 2023;4:e231809.
While the association between clinician burnout and patient safety are not new, the COVID-19 pandemic brought this safety concern back to the forefront. In this study conducted at 60 US Magnet hospitals, nurses and physicians reported high levels of burnout and rated their hospital unfavorably on patient safety. Increased nurse staffing was the top recommendation to reduce burnout with less emphasis on wellness and resilience programs.
Cho H, Steege LM, Arsenault Knudsen ÉN. Res Nurs Health. 2023;46:445-453.
Psychological safety, the feeling of confidence that speaking up will not result in punishment or shame, can have a positive impact on both patient and healthcare worker outcomes. Conducted in 2021, this study involved 867 hospital nurses in the United States. Nurses with higher psychological safety were more satisfied with their jobs, less likely to leave in the next year, and reported higher patient safety ratings.
Zhong J, Simpson KR, Spetz J, et al. J Patient Saf. 2023;19:166-172.
Missed nursing care is a key indicator of patient safety and has been linked to safety climate. Survey responses from 3,429 labor and delivery nurses from 253 hospitals across the United States found an average of 11 of 25 aspects of essential nursing care were occasionally, frequently, or always missed. Higher perceived safety climate was associated with less missed care. The authors discuss the importance of strategies to reduce missed care, such as adequate nurse staffing, ensuring nonpunitive responses to errors, and promoting open communication.
Patrician PA, Bakerjian D, Billings R, et al. Nurs Outlook. 2022;70:639-650.
Clinician well-being has important implications for patient safety and quality of healthcare delivery. In this study, researchers used a concept analysis to identify attributes of nurse well-being at the individual level (e.g., satisfaction, compassion) and organizational/community level (e.g., teamwork, pride in work). These findings can support the development of a standardized definition of nurse well-being to guide future research and policy considerations around well-being and burnout.

Neft MW, Sekula K, Zoucha R, et al. AANA J. 2022;90(3):189-196. 

Healthcare workers who are involved in a patient safety incident may experience adverse psychological outcomes. This integrative review summarizes the importance of organizational safety culture and highlights strategies and programs (such as the RISE support program and peer support teams) for supporting healthcare professionals after involvement in a patient safety incident.
Hasselblad M, Morrison J, Kleinpell R, et al. BMJ Open Qual. 2022;11:e001315.
Disruptive patient behaviors in the hospital not only pose a risk to staff safety, but may also experience patient safety risks such as misdiagnosis. A behavioral intervention team (BIT) was deployed on two adult medical-surgical wards to evaluate the effectiveness of an intensive behavioral management intervention. While there were no differences in the number of behavioral issues reported in the intervention or control group, nurses rated BIT as the most beneficial support to manage patients exhibiting disruptive behaviors.
Jun J, Ojemeni MM, Kalamani R, et al. Int J Nurs Stud. 2021;119:103933.
Burnout among nurses can compromise safe patient care and lead to poor outcomes. This systematic review identified five organizational-level outcomes associated with nurse burnout – (1) patient safety, (2) quality of care, (3) nurses’ organizational commitment, (4) nurse productivity, and (5) patient satisfaction – and these themes were consistently inversely associated with outcome measures.

Institute of Medicine. Washington, DC: The National Academies Press: 2011.

The effective engagement of nursing is key to patient safety and care quality improvement. This text examines the potential of the profession as arbiters and leaders of efforts to redesign healthcare processes. The authors examine policy, organizational, and practice barriers to the expansion of the role.

Quick Safety. July 15, 2019;(50):1-4.

This newsletter article discusses nurse burnout and how to reduce conditions that contribute to the problem. Recommendations focus on the role of leadership in fostering resilience, organizational strategies to enhance nurse empowerment, and frontline learning and regular measurement of staff perceptions of their well-being at work.
Ross J. J Perianesth Nurs. 2017;32:653-655.
Work environments can affect the safety of nursing care, and recently bullying has been recognized as an important factor to consider. This commentary summarizes early efforts to raise awareness of unprofessional and disruptive behaviors among nurses, the detrimental impacts of bullying on safety and work culture, and the importance of leadership in creating a healthy work environment.
Moran D, Wu AW, Connors C, et al. J Patient Saf. 2020;16:e250-e254.
Medical errors and adverse events can have a devastating psychological impact on the providers involved, often referred to as second victims. Increasingly, health care institutions are implementing programs designed to provide emotional support to team members who experience emotional distress as a result of adverse events. This study provides an economic cost–benefit evaluation of the Resiliency In Stressful Events (RISE) program at Johns Hopkins Hospital. Investigators estimate a savings of $22,576.05 per nurse who used the RISE program and suggest that the hospital might save as much as $1.81 million annually as a result of RISE. These findings are consistent with a previous study, which demonstrated the positive impact of an emotional support program on work-related outcomes such as turnover intentions and absenteeism. In a past PSNet perspective, Susan Scott discussed the second victim phenomenon and its impact on health care providers.
Organizational Policy/Guidelines
AORN J. 2022;115:454-457.
This position statement outlines recommendations from the Association of periOperative Registered Nurses on core components of safe perioperative nursing and its role in strengthening patient safety. Elements discussed include error reduction, leadership engagement, and safe working environment..
Silver Spring, MD: American Nurses Association; September 2014.
Fatigue is known to contribute to mistakes and omissions in nursing care. This position statement outlines the shared responsibility of nurses and health care organizations to limit the conditions that contribute to nurse fatigue such as shift work, personal habits, and mandatory overtime.
Hall LH, Johnson J, Watt I, et al. PLoS One. 2016;11:e0159015.
Many experts have raised concerns that increasing clinician burnout will hinder patient safety. This systematic review found that poor well-being and burnout in health care workers were associated with worse patient safety outcomes. The authors suggest that improving well-being at work for health care staff should be a part of patient safety efforts.
Special or Theme Issue

Wagner VD, ed. AORN J. 2014;100:351-456.

Articles in this special issue explore strategies to establish a culture of safety in health care settings, including coaching to improve team briefing and debriefing discussions, a guideline to confirm safe perioperative on-call staffing, and the value of workforce safety to promote high reliability.
Tweedy JT. Boca Raton, FL: CRC Press; 2014. ISBN: 9781482230277.
This publication provides information about the role of nurses in health care safety and explores how organizational dynamics, leadership, and hazard identification can affect the abilities of frontline nurses to deliver safe care. Helpful resources such as checklists, sample control plans, and review exercises are also included.
Special or Theme Issue

Lewis L, ed. J Nurs Adm. 2014;44(suppl 10):S1-S53.

The Magnet Hospital Program recognizes hospitals with a track record of maintaining an excellent work environment for nurses. Articles in this special issue highlight organizational elements that contribute to patient safety, including committed leadership, continuous quality improvement, and the link between patient assessments of care and safety culture.