Identifying and using tools for reducing risks to patients and health care workers: a nursing perspective.

BACKGROUND: Research efforts and policy initiatives in health care errors and injury to health care workers have attracted increasing attention in recent years. An emerging theme in both these areas is the importance of organizational and other systems factors in the occurrence of medical error and health care worker injury. These commonalities call for the identification of common research efforts and, when appropriate, policy efforts. MOVING FROM HYPOTHESIS TO CONCLUSION: The proposition that health care error and worker injury are linked to the same organizational variables requires further research and deserves the same type of human factors approach that has characterized much of the investigative efforts that have occurred in the patient safety arena during the past decade. Serious problems exist with respect to access to data on staffing levels, skill mix, consecutive work hours, and other information that is crucial to examining the link between practice conditions, health care error, and health care worker injury. HUMAN FACTORS: One important resource in identifying effective approaches to prevent error and health care worker injury is the field of human factors, the discipline concerned with the design of tools, machines, and systems that takes into account human capabilities, limitations, and characteristics. CONCLUSION: The potential benefits of linking patient safety and health care worker safety efforts are significant. The research, experience, and successful practices from multiple disciplines must be utilized in identifying areas of common interest and concern in advancing work in both of these important areas.

Policy imperatives for nursing in an era of health care restructuring.

Nursing faces a markedly different health policy landscape from that which it saw during efforts for national health care reform. Sweeping changes in both the practice and political environments have required refocused policy priorities for nursing, which largely concentrate on issues of utilization of RNs and its effect on patient safety and quality of care. Nursing will need to work hard to preserve the level of unity that was achieved during health care reform but that remains critical in the face of important new challenges to the profession.