Report links nursing care to patient safety

Overworked staff can affect patient safety

Do nurses at your agency complain they are overworked and understaffed? If so, you may have a bigger problem than retention on your hands — compelling new evidence suggests poor nursing conditions put patients in danger.

Patients may be harmed due to fatigued nurses coping with inefficient work processes, intimidating and unsupportive leaders, and an organizational culture of blame, according to Keeping Patients Safe: Transforming the Work Environment of Nurses, recently released by the Washington, DC-based Institutes of Medicine (IOM).

"Quality managers should pay close attention," urges Lillee Gelinas, RN, MSN, vice president and chief nursing officer for VHA Inc. and co-chair of a National Quality Forum (NQF) committee that reported on core measures assessing nursing care. "This is not just another report coming out of Washington — it is enormously important and is taking the industry by storm. It has shocked a lot of people."

In addition, the NQF has endorsed a set of 15 Nursing-Sensitive Performance Measures to provide a framework for evaluating the quality of nursing care. "These are 15 measures that hospitals need to be accumulating data around and reporting," Gelinas says. (For information, go to and click on "Nursing Care Measures Project.")

This is the first set of voluntary consensus standards to look at nursing care specifically, explains Kenneth W. Kizer, MD, MPH, president and CEO of NQF. "Some health systems may have measured this internally, but this is the first attempt to put national measures in place," he notes.

What’s more, the emphasis on nursing will continue to increase in the quality world, Kizer predicts, adding that there is no question that nursing is closely linked to quality and patient outcomes. "Now that we can view nursing care though the objective lens of performance measures, this will become increasingly recognized."

There are no current plans to report the data publicly, but that could change, he says. "It is reasonable to assume that at some point, it will be made public, because that is the direction we’re going in."

Kizer points to widespread coverage of the nursing home measures endorsed by NQF in 2003. "These are reported in newspapers across the country routinely. While the hospital measures are being made available on web sites, they are not necessarily reported in newspapers. But that is just a matter of time."

When this occurs, he adds, patients will be better informed about health care quality than ever. "As consumers get more knowledgeable, they will be looking for this information, just as people now look at reports comparing automobiles, washers, and toasters and everything else."

Since these 15 measures may end up being publicly reported in the future, it gives you an added incentive to improve, Gelinas advises.

"You want to make sure they’re good data being publicly reported and not halfway good data. Can you imagine if your failure-to-rescue data are not the cleanest, so they show a high failure to rescue rate, and that gets published? You don’t want that for your organization." If and when the new measures are publicly reported, patients may begin asking their physicians questions such as, "What is the nursing turnover rate for the [agency]?" she points out. "It’s not something patients would normally ask. But we know that has an impact on how good your nursing care will be and whether you’ll be put at risk or not."

It’s possible that you already are collecting the data you’ll need for the new nursing care measures, such as smoking cessation counseling for pneumonia patients. "Quality managers may well be collecting this information already," Kizer says.

Regardless, your data collection burdens are unlikely to decrease anytime soon, so you’ll need to develop ways to streamline the process. "There will be more and more performance measurement and reporting down the road," he adds.

"We are just at the beginning of the era of making health care much more transparent and accountable. This is just the latest development in performance measurement and reporting. Stay tuned: There are others to follow," Kizer continues.

[For more information, contact:

  • Lillee Gelinas, RN, MSN, Vice President, Chief Nursing Officer, VHA Inc., 220 E. Las Colinas Blvd., Irving, TX 75039. Phone: (972) 830-0239. E-mail:
  • Kenneth W. Kizer, MD, MPH, President, CEO, National Quality Forum, 601 13th St. N.W., Suite 500 N., Washington, DC 20005. Phone: (202) 783-1300. Fax: (202) 783-3434. E-mail:]