Transcription of Ensuring quality, safety
1 Ensuring quality , safety and positive patient outcomesWhy investing in nursingmakes $enseIssues PaperAustralian Nursing Federation | 2009 Ensuring quality , safety and positive patient outcomeswhy investing in nursing makes $enseThis document was prepared by:Fiona ArmstrongANF Federal Professional Officer (2005-2008)With editorial assistance from:Elizabeth RealeANF Federal Professional Research Officer ISBN: 978-0-909599-56-0 Australian Nursing Federation, 2009 Australian Nursing FederationLevel 1, 365 Queen Street, Melbourne 3000 T: 61 3 9602 8500F: 61 3 9602 8567"No one runs hospitals: nurses hold the system together, but don't have anyauthority."John Menadue, 2007 Table of contents1.
2 Introduction32. Executive summary and recommendations53. Nurse staffing, skill-mix and patient outcomes 11 Nurse staffing11 Nursing skill-mix14 Residential aged care164. Nursing workload and patient outcomes185. Nurses' work environment and patient outcomes 206. Economic and human costs 237. Legal liabilities 288. Discussion 309. Conclusion 37 IntroductionThe contribution of nurses to the health and wellbeing of any community, society or nation is its inception, nursing has been a profession which has promoted public health, eased pain andsuffering, advocated for the weak and the vulnerable, and educated the community, to achieve abetter quality of productivity studies demonstrate the vital importance of health to national are profound economic costs to a society if policy and action do not deliver optimum wellbeing.
3 Evidence suggests that failing to prevent ill health by investing in health promotion andpreventive health programs is costing Australia billions of dollars each to invest in nursing has profound social and economic impacts too. As the largest healthprofession, and one with multiple specialties, nurses work everywhere health care is provided. No other health professional group offers the same capacity for health care delivery as provided by qualified nurses has the capacity to save lives, prevent complications, prevent suffering, promote wellbeing,and save money. To understand how they do this, it is first importantto understand exactly what nurses journalist and nursing advocate, Suzanne Gordon, offers this summary: Using their considerable knowledge, [nurses] protect patients from the risks and consequencesof illness, disability, and infirmity, as well as from the risks and consequences of the treatment of illness.
4 They also protect patients from the risks that occur when illness and vulnerability make itdifficult, impossible, or even lethal for patients to perform the activities of daily living - ordinary actslike breathing, turning, going to the toilet, coughing, or Nurses, regular, ordinary,bedside nurses, not just nurse practitioners or advanced practice nurses, are constantly participatingin the act diagnosis, prescription, and treatment and thus make a real difference in ..outcomes." 2 Across the globe, the contribution and significance of nursing to the wellbeing of the human populationis recognised by many - demonstrated by the acknowledgement by the World Health Assembly ofthe importance of nursing and midwifery to "health systems, to the health of the people they serve,and to efforts to achieve the internationally agreed health-related development goals".
5 3A combined statement from the World Health Organisation, the International Council of Nurses (ICN)and the International Confederation of Midwives (ICM) in March 2007 declared that increasing nursingworkforce capacity, improving skill mix and creating positive workplace environments were " the general health of all nations".4 However nurses are being forced to work with insufficient staffing, overwhelming workloads, andinadequate skill mix, resulting in avoidable deaths and injury, causing nurses to abandon the profession, and compromising the health of the entire quality , safety and positive patient outcomes:Why investing in nursing makes senseIt is time governments and the community in Australia considered the risks of failing to invest innursing, and the consequences of this as the economic costs are enormous and cannot be ignored.
6 The contribution of good health to the social and economic attributes of any nation cannot beunderestimated. All individuals hope to remain free from illness or suffering and all governmentsmust act to produce social and public policies to ensure their communities maintain optimum healthand wellbeing. As the largest health profession in the world, the work of nurses is integral toachieving those aims. Evaluating nurses' contribution to a nation's health, wellbeing and productivity is therefore vitalsocial and public policy analysis. The subsequent development and implementation of public healthpolicies to maximise the delivery of nursing care is essential. 4 Ensuring quality , safety and positive patient outcomes:Why investing in nursing makes senseExecutive summaryNurses work in every type of health setting, in widely dispersed geographical locations and in everykind of clinical practicearea, caring for the health and wellbeing of people from gestation through todeath.
7 They are uniquely positioned then, to have a profound impact on the health and wellbeing ofthe people to whom they provide services. However recognition of the value and capacity of nursingcare is substantially underestimated among governments, policymakers and health care institutionsat local, national, and international levels. This paper seeks to demonstrate to Australian governments, health policymakers, the nursing professionand the community,the value and contribution nurses make to positive patient presents a summary of the best available evidence on the effectiveness of nursing care and thecontribution that nurses make to improving population health.
8 The paper also highlights the economicand human costs associated with poor access to quality nursing care can and does make substantial contributions to reductions in morbidity and interventions are cost-effective and as such, investing in more nursing will pay for care and surveillance, education and interventions which prevent adverse outcomes andkeep people well, nursing care contributes to the health of the community and the health of the in nursing care provides returns of better care outcomes and less use of expensive healthcare resources. These benefits extend well beyond the walls of health care settings, as those whohave recovered from or avoided illness (and their carers) can contribute to national productivitythrough participation in the community and the workforce.
9 The community's health and wellbeingdepends on are significant risks for the community however if there is an ongoing failure to acknowledgethe value of nursing's contribution. The risks posed to patients and nurses themselves when nursesare forced to work beyond the limits of safety with insufficient experience, not enough staff, and toomany patients are considerable. There are also significant implications for health care budgets inchoosing not to recognise the contribution of nursing care. This paper presents strong evidence that failing to staff hospitals and health care services in Australiawith sufficient numbers of appropriately qualified nurses is contributing to avoidable deaths and illnessand quality care requires that health services have:!
10 An adequate number of nurses; !an appropriate skill mix (proportion of registered nurses to enrolled nurses and nursing assistants);!nurses who are educationally and clinically prepared;!a manageable workload for nurses; and !sufficient resources to enable nurses to deliver the best possible to provide these measures has significant impacts on the safety and quality of care and arekey factors in the unacceptably high risks of errors and adverse events that occur in Australian hospitals and health care settings. 5 Ensuring quality , safety and positive patient outcomes:Why investing in nursing makes sense2 However nurses are continually faced with the challenge of justifying their demands for adequatestaffing and manageable workloads.
