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Supported nurses boost the health of healthcare

Alexandra Wilson Pecci, for HealthLeaders Media, September 4, 2012

Reading about the perks of working at the Internet search giant Google might cause a serious case of workplace envy. Google employees enjoy onsite healthcare, free gourmet meals, reimbursement for education, napping pods, laundry services, travel insurance, and amazing maternity benefits. They'll even take care of you when you're dead.

All of this adds up to some of the most satisfied and productive workers in the world, who've helped Google grow to the multibillion company that it is today.

Supporting nurses should be a top priority for hospitals as well. If engagement and productivity isn't enough incentive for managers to strengthen their nurses' working environment, a new study shows that supporting nurses also reduces medication errors and improves a hospital's bottom line.

Nursing managers could take a few cues from Google about how to reach those goals. But Google is swimming in cash, hospital leaders might argue huffily, and we can't afford to lavish nurses with free haircuts and organic breakfasts. And they'd be right. It's all many organizations can do to provide decent healthcare benefits.

But free stuff isn't the only reason that Google employees are productive and engaged. In fact, in an article titled "Passion, Not Perks," Laszlo Bock, Google's senior vice president of people operations, wrote that "the bulk of what we do to cultivate this creative, passionate workforce costs nothing." Bock says that Google operates on three pillars: mission, transparency, and voice. It's a bottom-up approach that translates into every employee, no matter how junior, being listened to, having a say in big decisions, and having access to high-level information about the company and its operations.

"People look for meaning in their work. People want to know what's happening in their environment. People want to have some ability to shape that environment," Bock writes. "These three components of our culture create a virtuous cycle of attraction, community, engagement, and innovation."

These principles of that "virtuous cycle" can be applied to the culture of nursing, too, the new research shows. The recent study, "Nurses' Practice Environments, Error Interception Practices, and Inpatient Medication Errors," published in the Journal of Nursing Scholarship, finds that "when supported by their practice environments, nurses employ practices that can assist in interrupting medication errors before they reach the patients."

A supportive practice environment was positively associated with error interception practices, and interception practices were, in turn, associated with lower medication error rates. A virtuous cycle if there ever was one. More frequent engagement by nurses in interception practices was associated with fewer documented medication errors per 1,000 patient days. For example, for 100 units of interception practice for 1,000 patient days, medication errors decreased by an average of 19.

Since medication errors often result in longer stays and an estimated $4 million per hospital in additional annual patient care costs, the authors note that good practice environments are good for hospitals financially, too.

"Health care administrators should carefully consider available strategies to ensure supportive work environments for nurses," writes Linda Flynn, PhD, RN, FAAN, professor and associate dean at Rutgers University's College of Nursing and one of the study's principal investigators.

It doesn't take expensive perks to achieve supportive work environments and the financial and patient safety benefits that result from them. Instead, the researchers say supportive work environments come from factors such as "teamwork between physicians and nurses; nurses' opportunities to participate in hospital- and unit-level decisions; continuity of patient care assignments; continuing education opportunities; and the retention of nurse administrators who are visible and accessible, who listen to nurses' concerns, and who have high expectations of their nurses."

Which sounds a lot like what Google advocates for. No napping pods required.

Source: HealthLeaders Media