RN work often oversimplified as "completing tasks", ignoring its critical role in patient safety

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Registered nurses are too often viewed as task completers rather than as being critical to safety. Despite repeated evidence showing a relationship between nurse staffing and patient safety, researchers have found that this had “little impact on policy”.

Alison Leary, from London South Bank University, and Geoffrey Punshon, from University of South Eastern Norway, made the observations in a new report, “Determining acute nurse staffing: a hermeneutic review of an evolving science”, evaluating a large number of existing studies on hospital nurse staffing. 

The article, published in the British Medical Journal showed that out of 769 studies reviewed, 767 demonstrated some association between nurse staffing and factors such as safety, staff or patient satisfaction, working conditions, and work left undone. However, none were found to have examined nursing in terms of being a safety critical industry or a profession highly reliant on knowledge.

“This might be because the approach to workforce modelling in nursing is focused on linear, deterministic approaches such as time and motion or time filled with tasks,” the review said. “This is more akin to workforce modelling in the service industries.”

In addition, the report found nursing workload was usually calculated as “countable tasks”, which was “likely to be an oversimplification of complex work” and did not recognise other factors such as the contribution nurses made to workplace culture and climate.

However there was deemed to be overall benefit in having registered nurses with a degree level qualification in the workforce, the review said. ”Although the relationship between staffing in acute care and factors such as units, safety or workload is complex, the evidence suggests an interdependent relationship which should only be dismissed with caution. The nature of these relationships should be further examined in order to determine nurse staffing,” the researchers said. “The body of knowledge appears substantial and complex yet appears to have little impact on policy.”

The review suggested that evidence from other safety critical disciplines could be better used and applied to nursing. 

Professor Leary said viewing nurses as safety critical could help people understand "the risk that good nursing-care manages, which largely goes unnoticed”.

“There is a lot of evidence to support a relationship between registered nurse staffing and patient safety but it’s rarely used by decision makers. Nursing is not simply the delivery of tasks. It requires continuous decision making and the assessment of risk,” she said. “Nursing is a knowledge intensive occupation that is safety critical,” Professor Leary said.