1
Name of student
Name of institution
Course code
Date
Patient safety and nursing workload
2
Introduction
Patient safety is one of the most significant priorities for healthcare nurses. Patient
wellbeing is a discipline in healthcare that emerged with the ever-evolving healthcare
schemes' complexity and due to the growth of patient safety issues within healthcare facilities.
The discipline aims to reduce patient errors, risks, and potential harm to patients during
healthcare provision. The critical element of the discipline is a progressive improvement
based on learning from adverse errors and events (W.H.O, 2019). Patient safety is vital in
delivery of quality health services. Hence, there is a global consensus that quality healthcare
delivery should be safe, effective, and patient-centered. To realize quality health services, they
must be equitable, timely, efficient, and integrated (W.H.O, 2019).
What contributes to patient harm occurrences? To answer the question, extensive
research has identified several risk factors associated with patient safety. Some of the risk
factors identified are related to the working environment of nurses, such as the organizational
structure of work, leadership, workload, burnout on the part of the nursing team, academic
environment, etc. (Carlesi K et al. 2017). In this paper, I will analyze the risk factors
contributing to nursing safety, while emphasizing the nurse's workload and burnout as the
most significant risk factors.
This paper aims to identify the patient safety risk factors and factors that lead to
nurses' workload and burnout within the healthcare systems leading to increased risks in
patient safety. I will also look into ways that stakeholders in the healthcare industry can work
in consolidation to eliminate risk factors associated with nurses' workload and burnout.
3
Most significant patient safety issues.
WHO has recognized patient well-being as a universal issue and consequently
characterized it as a international effort; in response to the problem, WHO is seeking to
benefit patients in both rich and developing countries, developing and developed alike. Global
estimates reveal that millions of patients each year suffer from safety-associated disabilities,
death or injuries due to unsafe medical procedures. The calculations also show that around
50% of these outcomes are preventable (Pelzang & Hutching ton, 2018).
Despite WHO positioning patient safety as a global priority, improvement of the same
has proved challenging in emerging nations due lack of reliable statistical data that can
quantify the issue related to unsafe health care services, to qualify informative patient safety
initiatives (Pelzang & Hutchington, 2018). Most of the current data come from high-income
or developed countries. However, it is reported that low-income countries have more
prevalence of patient safety issues compared to developed countries.
Below are some of the most common patient safety concerns and distresses
Prescription/medicine mistakes
Healthcare related contagions
Postoperative-related complications and surgical errors
Diagnostic related faults.
Blood analysis and laboratory related errors.
Injuries associated with falls
Communication associated errors.
4
Patient identification-related errors.
Nursing workload as a contributing factor to patient safety
The increased nursing workload is associated with patient safety in most healthcare
facilities that have reported patient safety incidences. A research study conducted in Chile and
Latin America revealed a significant relationship between nursing workload and patient
safety. The study identified understaffing as the major contributing factor to nursing
workload, whereby one nurse is assigned more than the internationally recommended nurse-
to-patient ratio, leading to overworking and burnout which increases the chances of mistakes
or errors happening (Carlesi K et al. 2017)
The study further identified that the issue of nurses' workload is an administrative
failure to provide adequate staffing. The administration is responsible for hiring new nurses to
satisfy the recommended nurse-to-patient ratio to avoid workload for the nursing staff. Such
an action can help to reduce the probability of errors and mistakes happening that lead to
patient safety issues (Pignatiello G, 2020). How do nurses' workloads contribute to patient
safety? Studies show that when one nurse has to attend to many patients within a single shift,
she or he may not have sufficient time to perform tasks that directly affect patient safety.
When nurses are overworked, it also affects the caregiver's decision to perform certain
procedures.
Causes for the increase in nursing workload
The four main reasons for the increase in nursing workload identified by the American
healthcare system include: Insufficient nurses supply, continuous increase in demand for
nurses, overtime increment policies and reduced staffing, and reduced patient length of stay
5
(Carayon & Gurses, 2008). Firstly, the increase in nurses' demand results from an aging
population; in America, the over 65 populations are expected to grow by 54%, which is the
population with more healthcare needs. Secondly, the nursing supply is inadequate to meet
demand, and projections show that the shortage will get even worse as demand increases and
nursing schools cannot meet the growing ultimatum (Carayon & Gurses, 2008). Whenever a
nurse deficiency arises, the workload upsurges for those nurses that remains.
Thirdly, since the 1990s, healthcare costs have increased significantly; hence to
respond to the same, hospitals reduced the nursing official and executed overtime rules that
were mandatory to encounter sudden requirements (Carayon & Gurses, 2008). Lastly, due to
the increased healthcare cost burden, healthcare establishments were forced to lessen the
distance of stay for patients. As an outcome, nurses today attend to sicker patients than before,
making their work more intensive.
Own reflection concerning nursing workload
Nursing overload not only compromises patient safety but also reduces morale and
affects nurses' job satisfaction, leading to high nurse turnover and an even more severe
shortage. A shortage of nurses causes them to perform unprofessional tasks to cover the
reduced staffing, such as housekeeping tasks, patient transportation, ordering, or ancillary
services. The healthcare fraternity and stakeholders must resolve the nursing workload to
improve the patient safety directly affected by the same. And in so doing improve the morale
and job satisfaction of nurses to ensure quality healthcare provision and improved procedural
services.
6
Nurses deal with sick patients who require adequate attention. When the nurses who
are supposed to attend to these patients are overworked, they cannot attend to patient needs
satisfactorily, which leads to increased patient safety issues in numerous healthcare facilities
that experience nursing workload due to one reason or the other.
Nursing leadership responsibility in nursing workload
Nursing leadership plays a significant role in nurses' immediate lives and has a pivotal
impact on the entire healthcare system. A nurse manager is responsible for the day-to-day
operations within the work setting. This includes employee selection, hiring of new staff,
orientation, allocation of resources, patient safety, and management, among others (Strudwick
G, 2019). They supervise and influence the practice of the largest number of nurses and
healthcare providers within the healthcare system.
That said, the managers are also responsible for identifying issues that affect nurses'
welfare and providing an immediate resolution. For instance, the issue concerning nursing
workload should be resolved by hiring more nurses. Managers must involve all the other
stakeholders to discuss the nurse's welfare and act as the nurse's ambassador.
Examples of real time patient safety scenarios.
Due to high number of patients that a nurse has to attend to, nurse confuses and gives the
wrong drugs to a patient.
In surgical wards, as a result of workload, surgical procedures are not followed to the
latter leading to postoperative infections.
Nurse gives the wrong blood test results to a patient.
Nurse makes a mistake in patient identification.
7
Conclusion
In conclusion, a nurse's workload directly affects patient safety. It also affects the
quality of care provided by overworked nurses. We have encountered several factors that
contribute to nursing workload, ranging from increased demand, economic-related issues, an
aging population that demands more health care, etc. Stakeholders must find a solution to the
nursing workload, improve the value of healthcare, and improve patient care procedures.
When nurses are assigned a proportionate number of patients, they can work efficiently and
diligently.
8
Strudwick, G., Nagle, L., Kassam, I., Pahwa, M., & Sequeira, L. (2019). Informatics
Competencies for Nurse Leaders: A Scoping Review. The Journal of nursing
administration, 49(6), 323–330. https://doi.org/10.1097/NNA.0000000000000760
W.H.O, (2019). Patient safety. Retrieved October 3, 2022, from https://www.who.int/news-
room/fact-sheets/detail/patient-safety
Pelzang R, Hutchinson AM (2018) Patient safety issues and concerns in Bhutan's healthcare
system: a qualitative exploratory descriptive study
BMJ;8: e022788 . doi: 10.1136/bmjopen-2018-022788
References
Carlesi, K. C., Padilha, K. G., Toffoletto, M. C., Henriquez-Roldán, C., & Juan, M. A. (2017).
Patient Safety Incidents and Nursing Workload. Revista latino-americana de
enfermagem, 25, e2841. https://doi.org/10.1590/1518-8345.1280.2841
Carayon P, Gurses AP. Nursing Workload and Patient Safety—A Human Factors Engineering
Perspective. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based
Handbook for Nurses. Rockville (M.D.): Agency for Healthcare Research and Quality
(U.S.); 2008 Apr. Chapter 30. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK2657/
Hessels, A., Paliwal, M., Weaver, S. H., Siddiqui, D., & Wurmser, T. A. (2019). Impact of patient
safety culture on missed nursing care and adverse patient events. Journal of nursing care
quality, 34(4), 287.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561834/
9
Pignatiello, G. A. (2020). Evidence-Based Review and Discussion Points. American Journal of
Critical Care, 29(5), 369-370.https://aacnjournals.org/ajcconline/article-
abstract/29/5/369/31135
