Positive

Practice
Environment
s (PPE)

Workplace Health,
Safety and Well-
being of the nurse
Safe staffing in
nursing practice

Meeting 3
By Romiko
 What is PPE ?
Lingkungan kerja/praktek yang positif/PPE
adalah pengaturan yang mendukung
peningkatan mutu da dan kelayakan kerja.
Secara khusus yaitu berusaha untuk menjamin
kesehatan, keselamatan dan kesejahteraan
staf, mendukung kualitas perawatan pasien dan
meningkatkan motivasi, meningkatkan
produktivitas dan kinerja individu dan
organisasi (Rondeau & Francescutti, 2005)
Elements of Positive Practice Environments (ICN,
2007)
Occupational health, safety and wellness policies that address workplace
hazards, discrimination, physical and psychological violence and issues
pertaining to personal security;
Fair and manageable workloads and job demands/stress;
An organisational climate reflective of effective management and leadership
practices, good peer support, worker participation in decision- making, shared
values;
Work schedules and workloads that permit healthy work-life balance;
Equal opportunity and treatment;
Opportunities for professional development and career advancement;
Professional identity, autonomy and control over practice;
Job security;
Decent pay and benefits;
Safe staffing levels;
Support, supervision and mentorship;
Open communication and transparency;
Recognition programmes; and
Access to adequate equipment, supplies and support staff2
Workplace Health, Safety and
Well-being of the Nurse
What we would like to do for
today ???
Workplace Health, Safety and Well-
being of the Nurse (Tempat kerja
yang sehat, aman, dan sejahtera
bagi perawat)
Safe staffing (Keamanan staf dalam
pelayanan keperawatan)
How important the Workplace Health,
Safety and Well-being of the Nurse
Health care reform is currently focused on three primary goals
(Registered Nurses Association, 2008)
Penyediaan akses yang tepat terhadap pelayanan kesehatan atas dasar
kebutuhan;
Pelayanan kesehatan yang berkualitas tinggi, efektif, berpusat pada
kesehatan klien dan aman
Sistem perawatan kesehatan yang berkelanjutan dan terjangkau.

Nurses are a vital component in achieving these goals. Achievement of

healthy work environments for nurses is critical to the safety,
recruitment and retention of nurses.

Numerous studies have shown a growing understanding of the

relationship between nurses work environments, patient/client outcomes
and organizational and system performance (Dugan et al,, 1996 &
Lundstrom, 2002)
HEALTHY WORK
ENVIRONMENT

A healthy work environment is

a practice setting that maximizes the
health and well-being of nurses, quality
patient/client outcomes, organizational
performance and societal outcomes (RNA,
2008)
Organizing Framework for the
Healthy Work Environments
Physical/Structural Policy Components

At the individual level, the Physical Work Demand Factors

Included workload, changing schedules and shifts, heavy lifting,
exposure to hazardous and infectious substances, and threats
to personal safety.
At the organizational level, the Organizational Physical Factors
included among these factors are staffing practices, flexible and
self-scheduling, access to functioning lifting equipment,
occupational health and safety polices, and security
At the system or external level, the External Policy Factors
include health care delivery models, funding, and legislative,
trade, economic and political frameworks
Cognitive/Psycho/Socio/Cultural
Components
At the individual level, the Cognitive and Psycho-social Work
Demand Factors included clinical complexity, job security, team
relationships, emotional demands, role clarity, and role strain.
At the organizational level, the Organizational Social Factors are
related to organizational climate, culture, and values. Included
among these factors are organizational stability, communication
practices and structures, labour/management relations, and a
culture of continuous learning and support.
At the system level, the External Socio-cultural Factors include
consumer trends, changing care preferences, changing roles of
the family, diversity of the population and providers, and
changing demographics
Professional/Occupational
Components
At the individual level, the Individual Nurse Factors included
commitment to patient/client care, the organization and the
profession; personal values and ethics; reflective practice;
resilience, adaptability and self confidence; and familywork/life
balance.
At the organizational level, the Organizational
Professional/Occupational Factors included the scope of practice,
level of autonomy and control over practice, and intradisciplinary
relationships.
At the system or external level, the External
Professional/Occupational Factors include policies and regulations
at the provincial/territorial, national and international level which
influence health and social policy and role socializations within
and across disciplines and domains.
Healthy work environments for
nurses
lingkungan kerja yang sehat bagi perawat
didefinisikan sebagai pengaturan praktek yang
memaksimalkan kesehatan dan kesejahteraan
perawat, kualitas pasien/klien, kinerja
organisasi dan dampak sosial.
Three themes for ensuring the health,
safety and well-being of the current and
future nursing workforce (RNA, 2008):
1. Comprehensive Definition of the Terms
Health and Well-Being
Health is a vehicle that enables and facilitates
meaningful living.
Well-being is defined as the extent to which
a person is able to experience physical,
mental and psychosocial health.
Next...
2. Legislation Regarding Workplace Health and Safety.
The concept of workplace health and safety includes:
Occupational health and safety initiatives that focus on
prevention of injuries and illnesses and elimination or
control of hazards.
Health promotion/wellness activities.
Supportive organizational cultureG and leadership
practices.
Employee assistance programs to assist employees with
personal issues.
Ability management programs including early intervention
and return to work initiatives.
Next...
3. Nurses Connectedness with their Work
All aspects of healthy work environments are
connected, related and interdependent.
Connectedness is the feeling of being fully
engaged and a part of the whole organization
or workplace setting.
Connection at all levels of individual and
organizational practice is needed to achieve
health not only for patients/clients, but also for
nurses as well.
Safe Staffing
Safe Staffing in Nursing Practice
Nursing care is considered essential to providing health
care in a variety of settings.
The North Carolina Nurses Association (NCNA 2005)
stated Safe staffing reflects the maintenance of quality
patient care, nurses work lives and organisational
outcomes. Safe staffing practices incorporate the
complexity of nursing activities and intensities; varying
levels of nurse preparation, competency and
experience; development of health care personnel;
support of nursing management at the operational and
executive levels; contextual and technological
environment of the facility; available support services;
and the provision of whistleblower protection.
Why is Safe Staffing Important?
1. The Patient Safety Movement
The patient safety movement is important because it focuses on a
variety of care indicators.
Reduce medical errors and improve patient safety and centre
around:
Leadership and knowledge for patient safety;
Error reporting systems;
Protection for nurses reporting adverse events and staffing issues;
Setting performance standards and expectations for patient
safety; and
Creating safety systems in health care organisations.
In order to accomplish the above, there has to be adequate
staffing. A number of research articles have described a direct
relationship between safe staffing and patient outcomes (e.g.
mortality and morbidity).
Next...
2. The Role of Competition

Organizations with an adequate number of

nurses and physicians are using the size of their
staff to increase their competitive edge against
other hospitals.
The attractive work environments of these
organisations, sometimes referred to as
magnet hospitals, allow them to recruit and
retain staff.
Next...
3. Occupational Health: The Health of Nurses
It is recognised that having adequate staff is
important because it affects the health of nurses.
According to Baumann et al. (2001), safe staffing is
essential for the demands of contemporary work
environments. These environments include increased
work pressure and stress resulting from concerns
about job security, workplace safety, support from
managers and colleagues, control over practice,
scheduling, leadership and inadequate staffing.
Next...
4. Professional Liability

Nurses often feel compromised in patient care

situations when there is not adequate staff.
There have been cases of individual nurses who
have been found liable in the provision of care.
Opportunities

Skill Mix: Clarification of Roles

Safe or adequate nurse staffing is

influenced by other health care
providers. It is important to establish the
guidelines for certain health roles and
determine their effective mix.
Obstacles
Supply and Demand
The overall supply of nurses has recently
been impacted by shortages in the more
industrialised nations
Financial Constraints
Safe staffing may not receive adequate
attention.
Lack of Effective Workload Measurement
Tools
Existing tools are unable to capture more
than 40% of nursing work.
How Is It Done?
Safe staffing initiatives can be encouraged in a variety
of ways:
Legislation
An approach to ensuring safe staffing for nursing is
the legislation of safe staffing ratios (ICN n.d.).
Professional Judgement
Instead of legislating safe staffing ratios, organisations
should identify their own definition of safe staffing.
Professional Frameworks
Organisations such as the ICN do provide frameworks
for the provision of care (ICN 2004). These documents
encourage healthy work environments and adequate
numbers of nurses to provide care (ICN 2000).
Role of National Nurses Associations
Research
National nurses associations (NNAs) are influential in setting local,
national and international research agendas.
Policy-making
NNAs have introduced accreditation processes for health care
organisations with safe staffing as a criterion.
Advocacy
NNAs play a key role in the advocacy for healthy working
environments and safe staffing practices.
Representation
NNAs have a responsibility to represent and defend their members
whether in court or the regulatory body.
Negotiation
NNAs have a critical role to play in speaking for nurses and nursing,
negotiating an adequate supply of nurses entering active practice
Thanks.....