Unsafe Work and Workspace Design

Several aspects of the way in which nurses’ work is designed pose threats to patient safety. The long work hours of some nurses represent one of the most serious threats. While most nurses typically work 8- or 12-hour shifts, some work much longer hours. In one study, 3.5 percent of scheduled shifts exceeded 12 hours, including “shifts” as long as 22.5 hours.2 In another study, 27 percent of full-time hospital and nursing home nurses reported working more than 13 hours at a stretch one or more times a week.3 The effects of fatigue on human performance are well known. Prolonged periods of wakefulness (e.g., 17 hours without sleep) can produce performance decrements equivalent to a blood alcohol concentration (BAC) of 0.05 percent, the BAC level defined as alcohol intoxication in many western industrialized countries (Dawson and Reid, 1997; Lamond and Dawson, 1998).4

Other nursing work processes, such as medication administration, are often carried out in ways that are conducive to the commission of errors and without the support of newer technologies that can prevent errors in medication administration. One study of preventable adverse drug events in hospitals found that 34 percent of medication errors took place in the course of administering the drug (a nursing role), as opposed to occurring as a part of ordering, transcribing, or dispensing the drug (Bates et al., 1995). A similar 6-month study of all adverse drug events in two tertiary care hospitals found that 38 percent occurred during the administration of the drug by nursing staff (Pepper, 1995).

Other inefficient care processes and workspace design features decrease patient safety by reducing the amount of time nurses have for monitoring patients and providing therapeutic care. For example, while not intrinsically dangerous to patients, documentation of patient information and care processes consumes an estimated 13–28 percent of a hospital nurse’s time (Pabst et al., 1996; Smeltzer et al., 1996; Upenieks, 1998; Urden and Roode, 1997). For home care nurses, the time required is estimated to be much greater as a result of regulatory requirements for patient information and assessment (Trossman, 2001). Other inefficiencies arise from interruptions


Unpublished data from Ann Rogers, Ph.D., University of Pennsylvania (manuscript in preparation).


Unpublished data from Alison Trinkoff, Ph.D., University of Maryland at Baltimore, National Institute for Occupational Safety and Health grant R01OH3702 (personal communication. April 9, 2003).


In the United States, BAC-level definitions of intoxication are set by the states. Limits of 0.08 and 0.10 are typical for adult drivers; the majority of states set lower levels for drivers under 21 years of age (e.g., 0.00–0.07) (Wagenaar et al., 2001).

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