Nursing Care Delivery Models

The topic of patient safety is receiving increasing attention. The releases of significant patient safety publications are stepping up the necessity for all of us to understand the issue to the best of our ability and apply this knowledge and understanding to our daily responsibilities. The timely release of this Canadian Nurses Association (CNA) Patient Safety Resource Guide is a welcome resource for the nurses of Canada. Every nurse in Canada must "step up to the plate" and take action within his/her own arena of health care.

Why should Patient Safety rank as such a high importance at this time? Surely every nurse would say that they are safety focused every minute of their day. Is patient safety not the bottom rung of the health care standards ladder? The good news is that patient safety is positioned as the issue that becomes the springboard for significant changes in the way nurses practice and for the environments in which they practice. These resultant changes could have significant benefits, both for providers and consumers of health care.

Regrettably yet fortuitously, this renewed focus on patient safety may draw attention to the critical nursing and patient care issues that have concerned many nurses since the cutbacks and restructuring of health care commenced about a decade ago. Some of these impacts included the escalating workload, reduction in support services and delays in replacing and repairing the equipment and tools nurses require to provide patient care.

The springboard to change is now here and ready for action. What does patient safety mean to the nurses of Canada? Every nurse has the ability and the responsibility, both individually and collectively, to identify patient safety issues within his/her own realm of practice and influence change.

Nurses are present in the majority of health care settings 24 hours a day, seven days a week. Nurses witness and experience the risks within health care that are being discussed and researched. In a series of focus groups conducted across Canada during spring 2002, nurses within the Academic Health Science Centres (AHSC) unanimously indicated that risk within their own health care practice environment was escalating. Our nursing colleagues identified major factors contributing to this escalating risk, including excessive workload, reduction in support services, increasing technology and lack of appropriate functioning equipment. (Nicklin & McVeety, 2002; Robblee & Nicklin, 2003).

This acknowledgement of nurses brings with it our accountability to participate actively in risk identification, problem solving and implementation of necessary changes. It is not sufficient to identify the fact that risk is escalating and then sit back and expect others to correct the situation.

An environment that presents risk for our patients also presents risk for the care providers. Consequently, strategies to address patient safety - to develop a culture of safety - will in turn lead to improvements in the quality of the practice environment. This is an issue of utmost importance to all nurses. As issues are identified, such as poor staffing levels and poorly maintained equipment, resolved risk to our patients will decrease and simultaneously improve practice environments. Won't this, in turn, strengthen our ability to retain and recruit nurses into the nursing profession?

In all likelihood, as more research is published, as evident in a preliminary way by this Patient Safety Resource Guide, the risks within health care will prove to be even greater than initially thought. This will lead to more research projects related to risk identification, and strategies to address the deficiencies will multiply. The evidence of measurable improvement unfortunately may be slower to evolve.

This is a key period for the nursing profession; one in which there is an opportunity to play a crucial role in controlling the degree of risk. Reading articles about patient safety and becoming informed is the first important step. Once informed, the second crucial step is taking action. Positive impact on improvements requires the effective partnership of the entire health care team. Participating actively with our health care colleagues in addressing risk is essential.

The ultimate goal of developing a culture of safety has tremendous potential to benefit our patients and the health care team. Nurses and other health care colleagues must provide more than "just safe care." Seize the opportunity to become informed, strengthen your knowledge base about patient safety and actively participate in the improvements required.

This CNA Patient Safety Resource Guide provides a wealth of references and provides the resource necessary to becoming informed, to taking that first important step. Every nurse must accept his/her accountability and move forward with concrete evidence of a commitment towards participating in shaping a culture of safety.

References:

Nicklin, W. (2003). Patient safety: Springboard to nursing accountability. Canadian Journal of Nursing Leadership, 16(4), 66-68.

Nicklin, W. L., & McVeety, J. (2002). Canadian nurses' perceptions of patient safety in Canadian hospitals. Canadian Journal of Nursing Leadership, 15(3), 11-21.

Robblee, J. A., & Nicklin, W. L., (2003). Comment on view of practicing physicians and the public on medical errors. New England Journal of Medicine, 348, 1184-1185.