Sharing responsibility for safe staffing: there are many barriers to overcome before the principles of safe staffing and healthy workplaces become fully part of the practice environment.

Sharing responsibility for an issue or task means each participant contributes knowledge and possible solutions equally. Being able to participate requires an environment that supports openness and a willingness for change to occur.

The ability to improve situations takes a concerted effort from all parties as willing participants. If organisations such as government departments. employer and professional organisations have different opinions on safe staffing issues, the community, which places immense trust in health practitioners to be their advocate or safety net, may develop reservations about the quality and safety of services provided.

There have been crucial developments within health care this year alone, with the Quality Improvement Committee publishing a report into sentinel and serious events in district health boards (DHBs) in the 2006/7 year. (1) Learning from such reports informs clinicians and employers of their shared responsibility to improve the health care environment. The burden of accountability must be a shared responsibility.

An open approach can ensure a commitment to improving quality in health care in New Zealand. Noticeably absent in the data of reportable events are the aged-care and primary health sectors. The Health and Disability Commissioner's annual report of 2007 notes that the DHBs, as the country's Largest health providers, are subject to the greatest number of complaints. (2) However, anecdotally, it seems the numbers of complaints from the aged and primary health sectors are increasing. Nurses working in the aged and primary sectors must also have an environment where reportable events can be openly disclosed and discussed within appropriate frameworks.

The key to improving services is the ability to collect data on areas of risk, such as short staffing, medication errors and adverse patient outcomes. One of the key issues facing nursing is data. How do we improve systems, if the data is incomplete or not openly discussed? Members from different health care sectors state they are tired of completing incident reports and perceiving no demonstrable changes.

Nurses have a responsibility to report events in practice that compromise patients' outcomes, eg an acute staffing crisis. There are reportable event systems that capture such events. With the introduction of electronic reporting, data can now be collated very soon after an event. However, there are issues for practitioners who say an e-lodgement can take 20 to 30 minutes to complete. This in itself Leads to inadequate reporting of events and consequently adds to the issue of incomplete data. If there is in fact a decline in reported events because of the introduction of electronic systems, we need to explore why this is occurring and implement systems and support to overcome any barriers. A recurring theme from members is the absence of feedback and noticeable change in the practice environment. The Ministry of Health's reportable events guidelines state:

"Employees are provided with feedback about reportable events. This will include:

(a) feedback to the reporting individual if possible and/or practical

(b) feedback to employees generally on the actions taken to address concerns raised through the reportable events system, such as via an employee, newsletter or o quality improvement newsletter

(c) the effects of improvements; for example quality of outcome, time saved, harm prevented, or dollars saved." (3)

The Safe Staffing and Healthy Workplaces Committee of Inquiry's 2006 report states there are five barriers to full participation in incident reporting. These are a culture of blame, organisational issues such as lack of responsiveness when reporting does occur, keeping incident reporting manageable, separating quality and safety, and, finally, the disproportionate burden of accountability falling on nurses. (4)

In emergencies, standards that guide practice may not be adhered to. However, there is a risk such tack of adherence to standards may be seen as "normal practice". When nursing practice needs to adapt to meet workplace demands, nurses must ensure that decision making of this kind follows robust frameworks.

The Nurses' Board of Victoria, Australia, has released a framework that nurses can use to critique their practice or enhance their practice. (5) This states that "organisations have a duty to provide a safe environment, qualified staff and policies to support staff."

To continue advocating for improved systems, nurses must be able to hold forums where they can openly critique the structures that influence nursing practice. Having a shared purpose to improve quality and safety in health care, regardless of where nurses work, will lead to a shared responsibility to embed the principles of safe staffing and healthy workplaces.

References

(1) Quality Improvement Committee. (2007) Commentary On Sentinel & Serious Events Reported By District Health Boards--2006/07. http://www.qic.health.govt.nz/moh.nsf/indexcm/qic-sentinel-and-serious- events-report-0607. Retrieved 18/03/08.

(2) Health and Disability Commissioner. (2007) Annual Report for the year ending 30 June 2007. http://www.hdc.org.nz/files/hdc/publications/website-annual-report07.pdf. Retrieved 10/10/07.

(3) Ministry of Health (2001) Reportable events guidelines, http://www.moh.govt.nz/moh,nsf/fefd9e667cc713e9cc257011000678d8/ ddfcefcd693aebc4cc256ad0007f41bb/$FILE/ReportableEvents .pdf. Retrieved 18/03/08.

(4) Safe Staffing/Healthy Workplaces Committee of Inquiry (2006) Report of the Safe Staffing/healthy workplaces Committee of Inquiry. Wellington: author, http://www.nzno.org.nz/Site/Campaigns/ safestaffing.aspx. Retrieved 14/12/06.

(5) Nurses Board of Victoria (2006) Guidelines: Scope of Nursing and Midwifery Practice. http://www.nbv.org.au/media/43986/guidelines%20for%20scope%20of% 20practice.pdf. Retrieved 10/03/08.

By professional nursing adviser Suzanne Rolls