By Professor Anne Marie Rafferty
Let’s face it ‘workforce’ is not the sexiest of subjects. The combination of work + force suggests something hard and difficult is upon us. Yet everything in healthcare depends upon it. Patient safety can all too easily be captured by the technical and sexy subjects of Artificial Intelligence: wearables, promising techy short cuts to wicked, intractable solutions. We invest hope and hype in these and other techy totems. But the unalloyed truth is that safety is hard work principally because it is enabled by human interaction and practices, practices which are embodied, literally in the human frame and behaviours. Here at the Centre, we are keen to drop some depth charges into the murky waters of the workforce and its relationship with patient safety. Fortunately, we are not starting with a blank slate.
My area of interest is nursing and nurse staffing in particular and its impact on patient outcomes and experience. Nurse staffing levels are associated with the safety grade of hospitals; that is not surprising since nurses are often credited with providing the ‘human touch’ in care and conversely condemned when they do not. Some of those measures are self-report by nurses but ‘feeling safe’ or having a sense of psychological safety and security is a vital part of what it means to be human and have confidence in the system. More than that staffing levels also predict patient mortality so have very real consequences for patients’ survival. One of the reasons nursing is so important is because it provides the surveillance system for patient safety and care including safety critical practices such as monitoring patients’ vital signs and picking up signals of patient deterioration.
I also trained as a historian and studied the symbiotic relationship between the rise of the hospital, scientific medical and nurse training. Nurses became necessary not only because they were the ‘stand-ins’ for doctors, their eyes and ears due to doctors who were only ever intermittently present on the wards. Not surprisingly, therefore, the early reform and training literature (late 19th Century), emphasised the need for a reliable witness to patient care and strict adherence to doctors’ orders. Training was the means of socialising nurses into conformity. This was no blind obedience or conformity. Doctors and Miss Nightingale appreciated ‘intelligent obedience’. In the case of doctors, the better-educated nurse was perceived as an asset in the sick room to translate the new therapeutics of medicine into practice, thus enabling the rise of the hospital from a place of dread to a place of relative safety.
Workforce and nursing especially is a facilitator both of ‘translation’ and ‘safety’; it is the ‘glue’ that connects patients to safety, translation and research. But it hinges on ‘safe’ staffing, having enough staff of the right grade mix in place to ensure a system can perform in a resilient manner. Easy to say difficult to do but building safe systems is a first important step.
One comment for “May the force be with you: The role of the workforce in patient safety”
Thank you for this timely articulation of the role of nursing and the workforce more generally. In our work with research improvement teams including patients and carers at NIHR CLAHRC NWL, we notice the essential but often overlooked and undervalued skills of facilitation and translation held and shared by individuals in teams. In the desire to reduce variation and increase standardisation through protocol and standards -driven care, something about the overall ‘glue’ has become unstuck. The focus on patient flow risks diminishing further the rapport that is required to enable, patients, carers and staff to have conversations about concerns, hunches and ultimately safety.