Transforming Nurses’ Work Environments to Improve Patient Safety: The Institute of Medicine Recommendations

In early 2004, the Institute of Medicine released the report Keeping Patients Safe— Transforming the Work Environment of Nurses, commissioned by the Agency for Healthcare Research and Quality as part of its initiative to determine the causes of medical errors and develop models to decrease their occurrence and severity. The study’s analysis of evidence from health services research, behavioral and organizational research on work and workforce effectiveness, human factors analysis and engineering, studies of organizational disasters and their evolutions, and studies of high-risk industries with low accident rates identified mechanisms for improving patient safety within all health care organizations that employ nurses. This article presents the report’s recommendations and conceptual framework, which together provide a blueprint that all nurses—clinicians, educators, managers, researchers, and policy experts—can use to create and follow a patient safety agenda throughout the U.S. health care system.