Study: patient safety culture in nephrology nurse practice settings

A groundbreaking study of nephrology nurses has revealed an overall culture of patient safety and teamwork, however there is room for improvement in key areas needed to keep patients - and providers - safe.

In the September/October 2014 issue of the Nephology Nursing Journal (NNJ), authors Beth Ulrich, EdD, RN, FACHE, FAAN, and Tamara Kear, PhD, RN, CNS, CNN, report on a comprehensive research project they conducted for the American Nephrology Nurses' Association (ANNA).

The article, "Patient Safety Culture in Nephrology Nurse Practice Settings: Initial Findings," outlines research that is the first of its kind to focus specifically on patient safety culture in all nephrology nurse practice settings. The article provides an overview of results, from error reporting and staffing challenges to manager expectations and best practices.

An additional article in the journal, "Patient Safety and Patient Safety Culture: Foundations of Excellent Health Care Delivery," also written by Ulrich and Kear, gives a sweeping summary of patient safety and patient safety culture in the United States as well as past research that launched patient safety into the national spotlight.

ANNA Study

Recognizing a dearth of information regarding safety specific to all nephrology nurse practice settings, Ulrich and Kear set out to pinpoint exactly which areas were strong, and which needed attention to better guide future safety practices and improve outcomes.

They surveyed almost 1,000 ANNA members using a survey composed of items from two Agency for Healthcare Research and Quality (AHRQ) patient safety survey tools. The authors also compared their results to AHRQ data.

The overall rating of patient safety in nephrology nurse practice settings was favorable, with 26% of respondents ranking it 'excellent' and 51% ranking it 'very good.' Additionally, and not surprisingly, according to the authors, teamwork was revealed as a primary strength.

"Since the early days of nephrology care, we have worked as a team with physicians, social workers, dieticians, and patient care technicians," Ulrich, who is also the editor of NNJ, writes in her editorial. "Not that it is practiced everywhere, but it is one of the hallmarks of our specialty."

The issues that received scores lower than AHRQ comparative data included handoffs, infection control, medication errors, communication, prioritization, staffing and workload, according to study results.

Some respondents described a rushed nature in their practice setting which led to incomplete work, errors and other challenges. The respondents cited long hours and staffing shortages as contributing factors, with only 61% of respondents saying their unit had sufficient staff to meet the workload.

Safety Across the Board

In her editorial, Ulrich also notes that safety practices in a health care facility aren't just for patients, but are synergistic with the safety of nurses and other providers.

"Safe patient handling and infection control, for example, increase safety for staff as well as patients," she writes, adding that the same basic safety components apply to all individuals within the facility.

Nurses are Invested

The authors were impressed by the excellent response of ANNA members to the survey and pointed out that many provided lengthy narratives and descriptions to the questions. This bodes well, the authors say, as nurses have a key frontline role in championing safer care.

"Nurses remain central to providing an environment and culture of safety," the authors write, "and as a result, nurse are emerging as safety leaders in the health care setting."

Ulrich also points out that "It is every nurse's responsibility to be a leader and an advocate in ensuring patient safety - whether the nurse is the solo RN in a clinic, one of several RNs in a hemodialysis unit, or one of hundreds of RNs in a hospital."

She said nothing that facilitates safety is too basic to ignore.

"No colleague or health care practitioner is exempt from peer review on safety practices, and no other work moves forward if the patient is not, above all else, safe in our care."

ANNA leaders are excited about the value of the study across the industry.

"The results of this research will provide valuable information to nurses, managers and administrators, hospitals, dialysis organizations, and ANNA," said ANNA President Sharon Longton, RN, BSN, CNN, CCTC. "The study will serve as a baseline and launching pad for future studies in the safety of nephrology patients in all health care settings."

Additional results will be published in future NNJ issues.