Culture of safety: Our members tell us we’re not even close

We still have a long way to go in establishing a culture of safety in our hospitals and other medical facilities. We aren’t even close to ensuring nurses work in a just culture, where they can report errors knowing that the hospital will look closely at how to improve systems rather than just blaming the individual nurse. Of course, there are rare cases where a nurse makes a careless and egregious error, but my questions are: Were the systems in place that prevent mistakes? Were there double checks and adequate staffing and support from managers to push error rates down to near zero? Was there an established process for reporting errors or near misses without retaliation? Too often, the answers to these questions are “no, no and no.”

In 2011, the Washington State Nurses Association ran a survey of our members to get their impressions of patient safety and management support for a culture of safety where they worked. In 2016, designated the Culture of Safety year by the American Nurses Association, we re-ran the same survey. We hoped to find that things had changed for the better, but on balance, they have not. Some things have changed in some places, but they haven’t changed nearly enough.

It is particularly disturbing that in 2016 our nurses see less of a commitment on the part of hospitals to patient safety and fewer resources being put into it. In 2011, 33 percent of our nurses disagreed with the statement “The actions of hospital/workplace management show that patient safety is a top priority.” This year, the number who disagreed rose to 42 percent.

When we first ran the survey in 2011, the responses from about 850 WSNA members demonstrated that, although there were some positives, nurses saw serious safety deficiencies in hospitals around Washington state. On the plus side, the vast majority of nurses agreed that people in their units supported one another and worked together as a team. However, nearly half of respondents said they saw patient safety problems in their units, and more than half said patient safety was sacrificed to get more done. Far too many were hesitant to report an error because they thought they would be disciplined or even fired. At that time, WSNA was working hard to advocate for our members, to educate people on what a culture of safety is and how it can be achieved, and to share resources to help nurses protect themselves and their patients.

Results from the 2016 survey show that, on most measures, we have made absolutely no progress in creating a culture of safety in our hospitals and other medical facilities where RNs provide care. Some of the places where we most wished to see positive change remained alarming. More than half of the 1,670+ nurses who responded to our survey in 2016 agree that “Things ‘fall between the cracks’ when transferring patients from one unit to another” and that “Hospital/workplace management seems interested in patient safety only after an adverse event happens.” As before, about one-third said they “would hesitate to report an error or patient safety concern because I am afraid of retaliation or being disciplined.”

Health care’s ongoing march toward fewer nurses doing more with less is taking its toll — on nurses and on their patients. In 2011, 48 percent of our survey respondents did not feel their units had “enough staff to handle the workload.” In 2016 a whopping 64 percent don’t feel there is enough staff. Washington nurses are even more concerned than before about patient safety being sacrificed to get more done and by what they view as an over-reliance on agency and temporary staff to plug staffing holes. This trend is infinitely distressing to nurses, whose primary concern is the well-being of their patients.

Five years ago, 47 percent of our nurses gave their facilities an overall grade of “excellent” or “very good” when it comes to patient safety. In 2016, only 38 percent gave their facilities those grades.

Hospitals and other medical facilities can do better — they must do better. The Washington State Nurses Association is committed to keeping the twin issues of safe care for patients and a just culture for nurses in the spotlight, and we will continue to push for improvements. It’s important to our nurses, and it’s important to their patients.