Workforce Management Key to Nurse Mental Health, Patient Safety

Critical care nurses (CCNs) in poor physical and mental health report significantly more medical errors than nurses in better health, according to a study out of The Ohio State University College of Nursing that draws workforce management and patient safety concerns.

The study, published in the American Journal of Critical Care, is based on survey responses from close to 800 members of the American Association of Critical-Care Nurses (AACN).  

More than half of the critical care nurses surveyed reported suboptimal physical and mental health (61 percent and 51 percent, respectively). What’s more, approximately 40 percent of nurses screened positive for depressive symptoms and over half screened positive for anxiety.

The researchers found that those who reported worse health and well-being had anywhere from 31 to 62 percent higher chances of making medical errors, drawing concern for patient safety.

Bernadette Melnyk, FAANP, AANP’s vice president for health promotion and chief wellness officer, called for targeted workforce management to tackle this issue in a press release.

"It's critically important that we understand some of the root causes that lead to those errors and do everything we can to prevent them,” Melnyk, lead author of the study and dean of the College of Nursing at Ohio State, said. “It's clear that critical care nurses, like so many other clinicians, cannot continue to pour from an empty cup. System problems that contribute to burnout and poor health need to be fixed.”

The study revealed that nurses who believed that their workplace was very supportive of their well-being were twice as likely to have better physical health and professional quality of life compared to those who reported that their workplace provided little or no support.

Even nurses who reported their workplaces as somewhat supportive of wellness were more likely to have better health and professional quality of life than those reporting no support.

“Nurses need support and investment in evidence-based programming and resources that enhance their well-being and equip them with resiliency so they can take optimal care of patients,” said Melnyk.

The researchers noted that the study was conducted prior to the COVID-19 outbreak in America. Therefore, depression, anxiety, and stress levels among CCNs are likely to be higher than indicated by this study’s findings.

“The major implication of this study’s findings for hospital leaders and policy makers is that CCNs whose well-being is supported by their organizations are more likely to be fully engaged in patient care and make fewer medical errors, resulting in better patient outcomes and more lives saved,” the study authors wrote.

“Critical care nurses’ ability to provide optimal care during these extraordinary times is linked to hospitals’ ability to build and sustain wellness cultures and provide solutions to long-standing systemic problems that contribute to burnout, stress, and depression, such as short staffing, electronic health record issues, and 12-hour shifts,” they concluded. 

The Ohio State researchers referenced an AHA survey which found that 90 percent of hospitals implement employee wellness programs. However, most hospitals do not invest in a chief wellness officer role or provide resources to build comprehensive wellness cultures.

“Evidence-based interventions known to be effective need to be rapidly translated into clinical settings in order to improve outcomes for nurses and other clinicians,” they wrote.

A systematic review of 29 randomized controlled trials found that deep breathing, mindfulness, cognitive-behavioral therapy–based programs, and gratitude practices are effective strategies to improve mental health, well-being, and lifestyle behaviors among physicians and nurses.

The same study found that visual triggers, pedometers, and health coaching via texting were effective strategies for increasing physical activity among healthcare providers.

The study authors also noted a recent randomized controlled trial with new nurse residents that found that a cognitive-behavioral skills building program resulted in reduced depression, anxiety, and stress levels, as well as increased job satisfaction.