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146 unit 2 | Working Within the Organization CikguOnline
skilled nursing care. The number of aging baby staffing, the model of care, and professional
boomers will significantly increase the demands nursing practice (Ritter-Teitel, 2002).
on the health-care systems and increase the
needs for RNs. Safety in the U.S. Health-Care
■ Increased demand for nurses. As health care System
moves to a variety of community settings, only
the most acute patients remain in the hospital. Patient safety is the prevention of harm caused by
The transfer of less acute patients to nursing errors. The IOM defines errors as “the failure of a
homes and community settings creates addition- planned action to be completed as intended (e.g.,
al job opportunities. Research supporting error of execution) or the use of a wrong plan to
improved patient outcomes when patient care is achieve an aim (e.g., error of planning) (IOM,
provided by RNs as opposed to unlicensed per- 2000, p. 57). It is important to note that errors are
sonnel will also increase demand for RNs. unintentional and that not all errors lead to an
■ Aging nursing workforce. In 2000, fewer than adverse event causing harm or death.
one in three RNs was younger than 40 years of
age. The percentage of nurses age 40–49 years is Types of Errors
currently more than 35%. To Err is Human (2000) relied on the work of
Leape et al. (1993) to categorize types of errors
In March 2004 the average age of the RN popula-
(Box 10-7). After categorizing types of errors,
tion was 46.8 years of age, up from 45.2 in 2000.
Leape and colleagues found that 70% of all errors
The RN population under the age of 30 dropped
were preventable.
from 9% of the nursing population in 2000 to 8%
Human errors can occur for many reasons. Skill-
in 2004 (AACN, 2008).
based errors can be slips or lapses when the actions
■ Job dissatisfaction. Staffing levels, heavy taken by the provider were not what was intended
workloads, increased use of overtime, lack of (Duke University Medical Center, 2005). An
sufficient support staff, and salary discrepancies example of rule-based error is an experienced nurse
between nurses and other health-care profes- administering the wrong medication by picking up
sionals have contributed to growing dissatisfac- the wrong syringe.
tion and lower retention of nurses. Many
facilities are now using workplace issues and
incentives as a retention strategy. box 10-7
■ Reduction in and shortage of nursing faculty. As Types of Errors (IOM, 2000, p. 36)
retirements for faculty continue, the shortage
Diagnostic
of faculty continues to affect the number of Error or delay in diagnosis
students admitted to nursing programs. In Failure to employ indicated tests
2007 nursing programs reported more than Use of outmoded tests or therapy
750 open nursing faculty positions (AACN, Failure to act on results of monitoring or testing
2008). In addition, nursing programs turned Treatment
Error in the performance of an operation, procedure, or test
away over 40,000 qualified nursing applicants,
Error in administering the treatment
in part, due to the shortage of nursing faculty Error in the dose or method of using a drug
(AACN, 2008). Avoidable delay in treatment or in responding to an abnor-
■ The need to control spiraling health-care costs, mal test
along with the issues of supply and demand for Inappropriate (not indicated) care
nursing services will continue. According to the Preventive
ANA, more than 40% of nurses graduate initially Failure to provide prophylactic treatment
from associate-degree nursing programs. You, Inadequate monitoring or follow-up of treatment
personally, will be affected by trends in health- Other
Failure of communication
care delivery, but you can also be a major voice
Equipment failure
in decision making (Nelson, 2002). As in the Other system failure
past, cost control and demand for nursing
Leape, Lucian; Lawthers, Ann G.; Brennan, Troyen A., et al. Preventing medical
services will most likely involve changing nurse injury. Qual Rev Bull. 19(5):144–149, 1993.