Nurse and patient safety is the cornerstone of everything that we do.
WSNA — through research, education, legislation, regulation, collective bargaining,
and participation in various coalitions — is working to improve the delivery
of safe, effective, timely, equitable, efficient and patient-centered care. WSNA
actively participates in numerous safety initiatives and strengthens support for
these efforts by informing and engaging nurses in not only the dialogue, but also
the implementation of practice changes in the work environment.
WSNA advocates on behalf of all nurses, protecting nursing practice in a variety
of settings. Efforts over the past two years have included insulin delegation in
community based settings, ARNPs’ ability to dispense more than 72 hours of
medication, inclusion of ARNPs in the medical home pilot projects, requirement for
an RN circulator in every operating room, and ensuring adequate number of school
nurses in our schools.
Standardizing Safety
Through our partnerships, work in coalitions and participation in forums, WSNA ensures
that the unique perspectives and experiences of nurses are represented in the dialogue
about patient care. Over the past two years, our work has included planning the
upcoming “Carry and Share” campaign educating the public about carrying
and sharing their
The Washington State Hospital Association, Foundation for Health Care Quality, Department
of Health, and the Puget Sound Health Alliance are but a few of the organizations
WSNA engages with to improve the delivery of safe, effective, timely, equitable,
efficient and patient-centered care. In addition to advocating for patients and
nurses during the development and implementation of new safety initiatives, WSNA
also takes an active role in educating nurses about what changes are occurring,
why it’s important and how their practice will be affected.
Fatigue: Implications for Patient Safety and Nursing Practice
Fatigue has become a compelling and urgent issue with a significant impact on patient
and nurse safety. Nurse fatigue leads to decreased alertness, vigilance, concentration,
judgment, mood and performance. The result is an increase in medical and medication
errors as well as nurse burnout. WSNA has used our full strength and resources,
working across departments with a variety of strategies, to change the workplace
environment and decrease the incidence and impact of fatigue.
Education
WSNA prioritized the issue of fatigue as an area needing serious attention. Accordingly,
WSNA engaged Jan Ellis, PhD, RN, ANEF, to create a document on the issue. Dr. Ellis
developed Quality of Care, Nurses’ Work Schedules, and Fatigue: A White Paper,
a paper that summarizes research from not only the healthcare field, but other areas
of work. Recommendations are made for individual actions, employers, education,
practice, research and policy.
In 2008, WSNA, in collaboration with the Northwest Organization of Nurse Executives,
co-sponsored a workshop on the impact of fatigue on nurses and patients. The keynote
speaker for the program was Ann Rogers, PhD, RN, FAAN, Associate Professor at the
University of Pennsylvania. In addition to Dr. Rogers’ presentations and Dr.
Jan Ellis reviewing the White Paper, a panel of nurses presented a variety of fatigue
related issues faced in the practice environment from multiple perspectives.
All of these recommendations from the workshop as well as the White Paper, materials
from the workshop, sleep assessment tools, and additional references can be found
on our web page: http://www.wsna.org/Topics/Fatigue/
Legislative/Regulatory
Nurses’ ability to maintain the mental and physical alertness and focus required
to provide safe and quality patient care is dependent on their ability to take full,
uninterrupted rest breaks and refuse mandatory overtime.
WSNA has been aggressively pursuing the Washington State Department of Labor and
Industries to enforce the existing laws as well as pushing new regulations to ensure
uninterrupted rest breaks. At the same time, WSNA’s top legislative agenda
for 2008 and 2009 in Olympia have included the following:
Ensuring nurses have full, uninterrupted rest breaks
Current practice of claiming that brief interruptions in work activities provide
adequate intermittent breaks is detrimental to patient safety and nurse well-being.
Intermittent rest periods are not appropriate for nurses due to the intense nature
of their work and necessity for mental alertness and focus. WSNA spearheaded efforts
to bring about new legislation to assure uninterrupted rest breaks for nurses.
Closing loopholes in the mandatory overtime law
Due to the exemption of prescheduled on-call in the current law, many facilities
are using prescheduled on-call to attend to non-emergency cases or to fill chronic
staff shortages. WSNA again initiated legislation that improves patient safety by
closing loopholes in the current mandatory overtime law to ensure that exemptions
are not used inappropriately leading to longer hours for nurses and compromised
patient care.
Collective Bargaining
WSNA has filed and won numerous grievances forcing employers to provide the rest
and meal breaks guaranteed in nurses’ contracts. In some cases, we have been
forced into arbitration. These wins have resulted in hundreds of thousands of dollars
of back pay for these missed breaks.
Despite these victories, a number of employers still refuse to acknowledge their
contractual and legal obligation to provide sufficient staffing to ensure that nurses
are able to get adequate rest during their shifts. Other employers have recognized
their obligation and created “break nurses” and other creative ways
to provide the much needed breaks.
WSNA has filed a law suit in Superior Court to compel an employer to compensate
nurses for missed 15 minute rest breaks at the appropriate rate (which is time and
one half). The suit is still in process, as the employer continues to insist that
they are not obligated to compensate nurses when they work through their breaks.
WSNA Disaster and Emergency Preparedness Committee Formed
At the request of the WSNA Professional Nursing and Health Care Council (PNHCC),
the WSNA Board of Directors approved the appointment of a Disaster and Emergency
Preparedness Committee. Members of the Committee have a strong interest in issues
such as emergency preparedness, standards of care for altered conditions, collaborative
disaster management strategies, facilitating deployment of Registered Nurses to
care delivery sites, and developing as well as strengthening the roles for student
nurses during disaster situations.
Strategies of the Committee will include working to develop and recommend position
papers, prepare articles for publication, prepare and deliver testimony at Legislative
hearings, and speak at meetings and conferences within the area of their disaster
management/emergency preparedness interest and expertise.
