Transforming the Work Environment of Nurses through an Analysis of Practice Variance

Tuesday, July 12, 2011: 2:25 PM

Judy Ong Ho, MSN, RN, ACNS-BC, CPHQ
Nursing and Patient Education, St. Luke's Episcopal Hospital, Houston, TX
Cheryl Novak Lindy, PhD, RN-BC, NEA-BC
Nursing & Patient Education & Research, St. Luke's Episcopal Hospital, Houston, TX

Learning Objective 1: Describe the key practice variances identified in the study.

Learning Objective 2: Discuss actions plans that can transform the nursesí work environment

Purpose:  The Texas Board of Nursing (TBON) requires when practice standards are violated, a nursing peer review (NPR) must be initiated by the employing agency. The nursing peer review committee (NPRC) conducts an investigation reviewing the practice of the nurse. The NPRC responsibilities include identifying practice variances, system barriers and external factors. The committee makes recommendations to the chief nursing officer regarding barriers for patient safety improvement.  Although NPR has been in place at the study site, no systematic analysis of the activities and findings had been conducted.  Few studies have examined practice variances that have resulted in disciplinary actions. The purpose of the study was to identify themes of practice variances and recommendations for system improvement.

Methods: A systematic retrospective record review of the NPR investigations was conducted to quantify nursing practice variances. Data was collected based on the taxonomy of error incorporating environmental factors contributing to practice variances developed by National Council of State Boards of Nursing (NCSBN) and the unprofessional conduct developed by the TBON.

Results: Seventy eight records were reviewed from 2005 to 2009 using the eight components of patient safety that are central to the nursing role. The components include safe medication administration, documentation, attentiveness/surveillance, clinical reasoning, prevention, intervention, interpretation of authorized provider orders, and professional responsibility/patient advocacy. Analysis of the records showed the most frequent variance was in professional responsibility.

System barriers and external factors were not found not to be a factor in 41% of the records reviewed. In the remaining records, organizational and work environment were identified as the leading systems barriers.

Conclusion: One limitation is that there was only one study site. Consistency of documentation may also limit study findings.

This presentation will detail the findings of the research study and its implications to transforming the work environment of nurses.