It’s also a way to quickly improve patient care. Researchers have proven that patient-to-nurse ratios directly affect patient mortality; medical errors and adverse events; patients’ length of stay; risk of heart attack, hospital acquired pneumonia, or infections; failure-to-rescue rates; patient falls; readmissions; nurse retention; and patient satisfaction. Lightening patient loads reduces nurse stress, burnout, bullying, and exhaustion.

The bottom line is that hospitals could save money, patients, and nurses by investing in staffing. Policymakers could help by providing grants, fellowships, and other subsidies for additional nurse hires.

Before hospitals implemented the checklist mentioned in Chapter 5, medical professionals couldn’t imagine reminding physicians to wash their hands. When infection rates dropped to zero, the checklist ably demonstrated that small changes can have big payoffs. Here are additional tips to help people receive—and staff provide—better healthcare.

For hospitals and managers

Involve nurses in decision making.

Directly involving nurses in decision-making processes is a good strategy for developing efficient policies, making nurses feel like valued workplace contributors, decreasing occupational burnout, and increasing morale. As frontline healthcare providers, nurses have important insights and day-to-day perspectives that can inform everything from patient-care procedures to workplace policies. Currently, many workplaces do not include nurses in these strategic meetings.

Appoint a contact person to objectively handle nurses’ concerns.

Inter-office politics affects patient care, as evidenced by Dr. Bitch’s and other doctor bullies’ power plays over nurses. One strategy to curb bullying is to establish a contact person or inter-staff committee to whom nurses can report disruptive behavior without risking retaliation, according to the Online Journal of Issues in Nursing. This point-person could also handle reports of assaults by patients and visitors as well as concerns about physician mistakes. Nurses will be far more effective at checking doctors and caring for patients if they are expected to speak up. They must feel empowered to protect their patients. Hospitals can develop protocols for nurses to report urgent concerns to an administrator who can and will intervene. As the Institute for Safe Medication Practices suggests, workplaces should have a no-retribution policy for employees who report worrisome or disrespectful behavior.

Provide debriefing/counseling resources.

It’s unrealistic to expect even seasoned nurses to recover immediately from handling trauma victims or unexpected patient deaths or complications. A range of resources could help nurses cope with tragedies and/or manage burnout, second-victim syndrome, and other longer-term work-related emotional issues. Accessible on-site counseling would be ideal. Debriefing sessions can help to find lessons, meaning, or closure after certain patient cases.

Some hospitals have trained colleagues across departments to provide support, comfort, resources, and counseling referrals to any staff member dealing with a difficult situation; a liaison is on call at all times. At the least, hospitals could provide a quiet room in which nurses can relax and compose themselves. Ohio nurse practitioner Barbara Lombardo has suggested soothingly colored walls, comfortable chairs, and relaxing music to relieve stress. Advocate Lutheran General Hospital in Illinois gave nurses a small budget to furnish a retreat in a break room; the nurses purchased a massage chair and some puzzles, if only to refocus coworkers’ thoughts with a brief distraction.

Compassion fatigue, stress, burnout, and other mental health issues not only wear nurses down but also drive them out of the field. Administrators’ efforts to prevent these issues could demonstrate care for their employees and save money in absenteeism and job attrition.

Use first names.

In many workplaces, nurses are called by their first names, while doctors are not. Requiring doctors, nurses, administrators, and other staff members to call each other by their first names is a no-cost strategy to reduce the appearance of hierarchies among the professions. One of the reasons Pines Memorial nurses liked working with Dr. Preston was because they could call him Clark, which blurred the doctor–nurse tiers. “Using a colleague’s first name can help break down artificial barriers that may impede effective communication,” the ISMP recommends. This simple way to help equalize the playing field could help to decrease disrespectful and disruptive behaviors and lessen the “us versus them” attitude.

Prioritize security.

Getting assaulted by patients and visitors should not be tolerated as “part of the job.” Hospitals have had success by assigning uniformed security personnel to make frequent rounds in patient care areas. The Joint Commission recommends wand-screening visitors for weapons or conducting bag checks. Some hospitals also might consider installing metal detectors. Within six months after Detroit’s Henry Ford Hospital began using metal detectors, staff had confiscated thirty-three handguns, ninety-seven chemical sprays, and more than 1,300 knives.

By requiring staff to report all violent acts and threats, administrators can track the events, deduce patterns, identify frequent aggressors, and better prevent future incidents. As mentioned in Chapter 3, the computer database identifying violent patients at the VA Medical Center in Portland, Oregon, reduced attacks by 91.6 percent. If other hospitals implemented this successful program, countless nurses could be spared injury and suffering.

OSHA states that “at a minimum, workplaces should ensure that no employee who reports violence faces reprisals . . . [and] place as much importance on employee safety and health as on serving the client.” Separately, all states should make it a felony to assault any healthcare professional on the job.

Talk about substance abuse.

The most important step employers can take to reduce narcotics addiction among their staff is to make sure that addicts can easily get the help they need. “A lot of nurses get caught and no complaint is filed. Whatever was driving them to use comes back at their next job and they steal drugs again,” said Douglas McLellan, RN Coordinator for Massachusetts’ Nursing Substance Abuse Rehabilitation Program. “The best thing is for nurse managers to file the complaint, get the nurse into a program, and let her be monitored.”

Prevention strategies could include more vigilant monitoring of medication disposal and placing posters in staff areas that list signs of possibly impaired colleagues and ways to help them. All nursing schools should teach a unit on chemical dependency and intervention strategies. This type of instruction would help to prevent addiction and lessen the stigma associated with chemical dependency. Addiction is an illness, not willful misconduct. If healthcare providers view nurses with chemical dependency issues as patients with a treatable problem, they may be more likely to assist them rather than stigmatize them.

Don’t automatically or exclusively fault nurses for medical errors.

Nurses are blamed for medical errors too often when doctors or hospital policies are at the root. If a medical error occurs because of a nurse whose unit was short-staffed at the time, the hospital should accept some responsibility. Even when nurses do make a mistake, as in the case of Kimberly Hiatt, the nurse who committed suicide after her hospital blamed her for an infant’s death, rather than scapegoating and/or firing them, administrators could tap them to help devise a system that would prevent similar errors. As an American Association of Critical Care Nurses study points out, “A mistake does not mean a bad practitioner . . . not correcting a mistake does.” When Montreal’s Jewish General Hospital launched a “no shame, no blame” campaign to track errors, staff was able to reduce bed sores (which can develop quickly when a patient can’t change positions on his own) from 25 to 6 percent.