Patient, nurse injuries linked, approach similarly

A safe working environment for nurses is also a safe environment for the patients in their care, according to a new study led by public health researchers at Drexel University in Philadelphia.

Researchers, led by Jennifer Taylor, PhD, an assistant professor in Drexel's School of Public Health, found that safety climate was associated with patient and nurse injuries, which suggests that patient and nurse safety might be linked outcomes.1 For each 10-point increase in the average safety climate score, the odds of decubitus ulcer declined by 44-48% and the odds of nurse injury declined by 40-45%.

Patient and nurse injuries are both cause for increasing concern in the healthcare industry, Taylor says, not only due to the pain and suffering experienced by those directly affected, but also because both types of injuries contribute to the rising cost of healthcare due to the need for extended hospital stays for patients and hiring temporary staff to replace injured nurses. However, most research considers patient safety and occupational safety in isolation.

"Our findings suggest that patient safety and occupational safety for nurses may be related by common causes and should be considered together in future studies," Taylor says. "We've always looked at patient safety and occupational safety as two separate issues, but everything we do in a healthcare organization is a continuum. Start looking at patient safety and occupational safety together, because they're directly related."

One example is the installation of lifting devices that simultaneously prevent lifting injuries for nurses but also help avoid falls for patients, Taylor says. Less obvious is an improvement such as computerized physician order entry (CPOE). The CPOE might improve patient safety and reduce adverse drug events for patients, but it also can reduce stress on providers. It reduces stress-related effects including injuries that can occur when employees are too harried or tired to use proper procedures.

Another example would be making changes to employee policies, such as allowing nurses more autonomy to choose their own schedules. That change could lead to happier employees, which in turn could result in more attentive care for patients, Taylor explains.

The study included data from a large urban hospital, including 28,876 patient discharges on 29 nursing units employing 723 registered nurses. For each nursing unit, researchers collected nurses' responses to a survey of safety attitudes (a measure of safety climate) as well as hospital-reported nurse and patient injury data collected the following year. Patient injury data included commonly-preventable hospital injuries: falls, pulmonary embolism/deep vein thrombosis (PE/DVT), and decubitus. Nurse injury data included needlesticks, splashes, slips, trips, and falls.

Turnover increases nurse, patient injuries

The findings also indicate that increased turnover of nurses should be considered a risk factor for nurse and patient injuries: With each 10% increase in a unit's nurse turnover rate, researchers observed a 68% increase in the odds of nurse injury, as well as increased patient risk for PE/DVT.

The researchers note that a study of this type could not identify the specific causes of the associations found between factors of safety climate and nurse turnover, and reported injuries. Future studies should track injuries and safety factors over time and in different types of hospital environments, Taylor says. "This is one of few studies that have identified predictors of both nurse and patient injury in the hospital setting," she says. "We need to look deeper into hospital organizations to understand the cause and effect relationship."

Risk managers should factor occupational safety effects into patient safety improvements, and vice versa, Taylor says.

"When you're assessing the potential for improvement in length of stay and adverse events, you might want to assess what the workforce thinks about the change and if you are seeing any benefits to them in terms of increased productivity, less time away from work for illness and injuries," Taylor says. "What you put in place for patients may also have unexpected benefits for employees."


1. Taylor JA, Dominici F, Agnew J, et al. Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions. BMJ Qual Saf 2011. Doi:10.1136/bmjqs-2011-000082.


• Jennifer Taylor, PhD, MPH, Drexel University School of Public Health, Philadelphia. Telephone: (215) 762-2590. Email: