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.

Operational failures – breakdowns in care processes, such as distractions or situational constraints – can impact healthcare delivery. This cross-sectional analysis using population-based survey data from 11,709 nurses examined the relationship between operational failures, patient satisfaction, nurse-reported quality and safety, and nurse job outcomes. Findings indicate that operational failures negatively impact patient satisfaction, quality and safety, and contribute to poor nurse job outcomes, such as burnout.  

… can improve patient outcomes.  … McHugh  MD, Aiken LH, Sloane DM, et al. Effects of nurse-to-patient ratio …

… ratios may be especially pronounced for Black patients. … Carthon MB, Brom H, McHugh M, et al. Better nurse staffing is associated with survival …

… implications of understaffing, even before COVID-19.     … Lasater KB, Aiken LH, Sloane DM, et al. Chronic hospital nurse understaffing meets …

Prior research suggests that improved nursing resources may be associated with decreased mortality and adverse events. However, less is known about how changes to nursing resources in the inpatient setting may affect quality and safety over time. In this study involving 737 hospitals and survey data from nurses obtained in 2006 and 2016, researchers found that after adjusting for numerous factors, better nursing resources in terms of work environment, staffing, and education was associated with improvement in quality and patient safety outcomes. A PSNet perspective discussed the impact of nursing resources on patient safety.

Factors in the hospital work environment can affect nurses' ability to provide safe care. In this survey study, investigators examined trends in nurse ratings of their work environment and patient ratings of care quality at 535 hospitals between 2005 and 2016. Over this time frame, about 20% of hospitals showed significant improvements in work environment scores, while 7% of hospitals demonstrated declining scores. There was an association between an improving work environment and better patient satisfaction. The authors conclude that lack of improvement in work environments may worsen safety culture and impede efforts to enhance patient safety. A PSNet interview with Linda Aiken discussed how nurse staffing and the work environment can affect patient safety and outcomes.

This cross-sectional study found that nurses reporting a lower level of engagement also described worse patient safety in their work environment. These concerns were exacerbated when higher patient–nurse staffing ratios were present. The authors suggest that increasing nurse engagement may improve patient safety.

… for adverse outcomes earlier in their course. A past WebM&M commentary highlighted important issues associated with …

Researchers analyzed patient discharge data and hospital characteristics, as well as patient and nurse survey data, across adult acute care hospitals in six European countries. After adjusting for hospital and patient variables, they found that hospitals in which nursing care was provided to a greater degree by skilled nurses had lower odds of mortality. The authors argue against replacing professional nurses with nursing assistants and suggest that doing so may compromise patient safety by increasing preventable deaths.

This survey of nurses found that those who rated their work environment as poor were more likely to report quality and safety problems, underscoring the well-described link between nurses' working conditions and patient safety. Improving nurse working conditions is a patient safety strategy.

… subsequent readmissions are warranted. A recent AHRQ WebM&M perspective discusses the nursing workforce and patient safety. … Carthon JM, Lasater KB, Sloane DM, Kutney-Lee A. The quality of hospital …

This retrospective cohort study across nine European countries revealed that higher patient–nurse staffing ratios increased the likelihood of inpatient mortality. A larger proportion of nurses with bachelor's degrees decreased this risk, consistent with previous research that found a relationship between nurse education levels and patient outcomes. This finding emphasizes the importance of maintaining an adequately staffed and trained nursing workforce to support safety in hospitals.

… nurse staffing and workload is discussed in this AHRQ WebM&M commentary . … Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health …

… increased as nurses worked longer shifts. … Stimpfel  AW, Sloane DM, Aiken LH.  Health Aff (Millwood) . …

Seminal studies in the United States have shown strong associations between nurses' working conditions and patient safety, with high patient-to-nurse ratios and greater patient turnover being linked to increased mortality. This multinational survey of nurses and patients found that improved nurse work environments and reduced patient-to-nurse ratios were linked to better perceptions of quality and patient satisfaction. Moderately strong correlations were found between patient satisfaction and nursing reports of care quality, although there were wide variations in both measures across different countries. This study lends additional support to the view that improving the work environment for nurses can strengthen patient safety.

The association between lower patient-to-nurse ratios and inpatient mortality has been demonstrated in classic studies, providing an impetus for laws in 15 states that mandate the maximum number of patients per nurse. This study explores the mechanism by which reducing patient-to-nurse ratios improves outcomes. Using a large database of patient discharges and nurse surveys from 665 hospitals in 4 states, the authors found that decreasing the number of patients per nurse improved mortality and failure to rescue predominantly in hospitals rated as having a good work environment. Hospitals with a poor work environment derived no benefit from reducing patient-to-nurse ratios. The critical role that nurses play in ensuring patient safety is discussed further in this Patient Safety Primer.

Electronic health records (EHRs) offer great promise in improving patient safety, but remain underutilized in both inpatient and ambulatory settings. While physicians have voiced concerns about EHRs' ability to improve quality of care, this survey found that bedside nurses generally felt that even relatively simple EHRs (including clinical documentation and computerized provider order entry) did in fact improve patient safety. Prior studies have also found that EHRs improve nursing efficiency and the safety of nursing medication administration.

Many hospitals address the nursing shortage by employing supplemental or “temporary” nurses. As temporary nurses may be less familiar with hospital procedures, the concern has been raised that excessive use of temporary nurses may affect patient safety. In this study, researchers sought to characterize the qualifications of temporary nurses and analyze the effect of increased use of temporary nurses on nurse-reported perceptions of patient safety and quality of care. The authors found that inadequate overall nurse staffing correlated with worsened perception of patient safety (as documented in prior research), but the proportion of temporary nurses did not. Temporary nurses were also equally qualified compared with permanent nurses. The authors conclude that many hospitals likely use temporary nurses to ameliorate overall nursing shortages, and that use of temporary nurses alone does not appear to affect patient safety.

… nurse retention and satisfaction. … Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing …