federal government to fund more research on why errors occur and how to prevent them, to collect data on patient safety, to support the acquisition of information technology, and to disseminate patient safety information to consumers and providers (Clancy and Scully, 2003) have been a key stimulus for these efforts. Significant improvements in the safety of patients have also been spurred by health care purchasers’ preferentially selecting HCOs based on their adoption of certain patient safety actions (e.g., computerized physician order entry), accreditation standards on patient safety adopted by the Joint Commission on Accreditation of Healthcare Organizations [JCAHO], continued public attention to patient safety from the media, and the internal commitment to patient safety made by many HCOs. However, adoption of patient safety practices has been uneven (Boodman, 2002; Millenson, 2003). HCOs that have been slower to respond to past IOM recommendations will have more work to do in implementing those contained in this report.

The committee adhered strictly to its charge to identify “potential improvements in health care working conditions that would likely increase patient safety.” The committee did not address working conditions that would increase worker safety, nurse retention or recruitment, or patient satisfaction with care. Yet we repeatedly noted how often patient safety practices identified from the evidence reviewed for this study were the same as those recommended by organizations studying the nursing shortage, worker safety, and patient satisfaction. We note that retention of nurses and other health care workers in short supply, increased patient satisfaction with care, and potentially some return on financial investment may also result from undertaking the recommendations of this report.

Better Retention of Nurses and Other Health Care Workers in Short Supply

The nursing shortage discussed in Chapter 3 has been the subject of much study. Many expert panels and organizations have identified the need for HCOs to undertake actions to retain the nurses they already employ as an essential strategy for addressing this shortage (AHA Commission on Workforce for Hospitals and Health Systems, 2002; GAO, 2001; JCAHO, 2002; Kimball and O’Neil, 2002). It has been observed that even if the nursing education pipeline can be stimulated to increase the supply of new nurses, hospitals and other HCOs will still face shortages in nursing staff if work environments are so inhospitable that nurses leave to work in other places or abandon the practice of nursing altogether. Indeed, some have asserted that there is not a shortage of nurses, only a shortage of nurses who want to work in hospitals under today’s working conditions (Lafer et al., 2003).

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