I was invited to write this as part of a Pennsylvania Nurse Special Issue on safe nursing staffing.

1. Code Blue 2016 Pennsylvania Nurse 7
SAFE STAFFING VOICE
Physicians
A most fundamental element of
patient safety is having adequate
numbers of qualified, knowledge-
able, skilled and empowered reg-
istered nurses to care for patients.
Physicians committed to safe,
quality care know that we cannot
be successful without adequate
nursing support. The data clearly
show that better nurse staffing
leads to improved outcomes and
fewer complications in hospital-
ized patients.
We recognize that RNs usually
have far more contact with any
given patient than the physician.
We know that no treatment plans
or orders get carried out without
our professional nursing partners.
Nurses’ observations are key;
their input and suggestions often
lead to adjustments and changes
in the physician orders.
In the emergency department,
patients’ underlying conditions
are often unclear and evolving.
With simultaneous patients in
progress, we depend on RNs to
alert us to individual changes and
deterioration that require priority
intervention. On the in-patient
unit, RNs are the constant “eyes
and ears” that keep us informed
of patients’ changing physical
parameters, emotional needs and
family dynamics. When emergen-
cies arise, it is usually the bedside
RN who responds first, initiates
care and activates the team. The
bedside RN also has the biggest
impact on the “personal” aspects
of hospital care. When RNs are
stretched too thin, both the tech-
nical and personal elements of
care suffer.
For the sake of the patients
whom we all care for, it is key
that hospitals recruit, develop
and retain adequate numbers
of RNs, and provide them with
adequate support staff. A culture
of safety is more than words on
paper. Physicians, hospital and
nursing executives, and nurse
administrators must each do their
part to build a supportive envi-
ronment where RNs feel valued
for their skills and contributions.
To promote patient safety, RNs
must feel safe to offer input into
care processes, and into adminis-
trative procedures and manage-
ment practices affecting nursing
care. All members of the health-
care team must be participants
in improving patient safety and
quality of care through reporting
and learning from mistakes and
errors. More importantly, each
must feel empowered to identify,
report and help correct unsafe
practices or situations affecting
patients, including inadequate
nursing staffing.
Adequate nurse staffing in hos-
pitals is not an expense — it’s an
investment. That investment pays
off in shorter stays, fewer compli-
cations, improved patient satis-
faction and better community
relations. Safe staffing improves
both patient safety and the bot-
tom line.
Building a Culture of Safety
By Cloyd Gatrell, MD, FACEP and Michael Daniels, MD, MBA
Dr. Gatrell is a practicing
emergency physician who has
been board certified in emer-
gency medicine for more than
30 years.
Dr. Daniels is a practicing
family physician who has been
board certified in family medi-
cine for 35 years, with addi-
tional certification in geriatric
medicine.