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Practice based evidence
by
Tom Bissonnette, MS, RN
Executive Director of Nursing Practice & Operations
We all have heard the phrase “evidence based practice.” Yet, what about “practice based evidence?” A simple change in the word order reflects the need to ensure that evidence which we use to improve nursing practice needs to be extrapolated from nursing practice and the nursing practice environment. And what about practice based evidence as it relates to nurses’ work environment? Let’s examine some such evidence.
Nurses providing direct care to patients make a significant, positive difference in patients’ outcomes. Some revealing evidence: one study of medication errors made by physicians, pharmacists, and others in two hospitals over a six month period found that nurses were responsible for intercepting 86 percent of the medication errors before the mistakes affected patients!
A growing body of practice based evidence documents a truth that nurses, as well as doctors, patients, and other health care workers have known for a long time: the quality of nursing care patients receive influences patient health and safety and is often a matter of life or death. Also, the increase
in nurses’ workloads and the concurrent decrease in direct care nurses has increased nurses’ burdens and fostered job dissatisfaction.
The Institute of Medicine report, “Keeping Patients Safe,” informs us about the outcomes of typical hospital restructuring initiatives intended to save money by increasing efficiency (at the expense of patient safety): they are often poorly managed, exclude direct care nurses’ input, increase ineffective communication, and increase nurses’ mistrust in hospital administration.
Study after study within the direct care nursing environment educates us about factors that improve that same environment, as summarized in the Robert Woods Johnson Foundation October 2007 edition of “Charting Nursing’s Future.” These factors include: increasing staff nurses’ authority; increasing trust between direct care nurses and management; and reorganizing nurses’ work (with nurses’ input). One study states nurses spend 34% of their time caring for patients and families and the rest in non-nursing activities.
Each of these factors remains secondary to having enough non-fatigued, healthy nurses to provide safe, high quality patient care. MNA will continue our fight to improve nurses’ working conditions at the collective bargaining table and in legislative arenas as informed by practice based evidence.
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