The Meaning of Safety in the Emergency Department: A Survey Study

A challenge to determining safe staffing levels in emergency departments lies in an inability to define and measure "safety" and thus to more clearly identify which interventions improve safety, including staffing patterns. This study aimed to more clearly identify emergency nurses' perception and understanding of elements of a work environment that is structured to be free from avoidable harm to both nurses and patients.

A quantitative descriptive exploratory design with cross-sectional survey methodology was used to address the study purpose. The Checklist for Reporting Results of Internet E-Surveys guideline was used to report results. A survey was developed from previous qualitative findings and available literature and presented 22 elements related to ED safety. Participants were asked to report whether each element was an indicator of safety, whether it was measurable, and whether it was measured in their department.

The survey was completed by 1051 emergency nurses (response rate of 3.4%). Of the 22 elements presented, 14 were identified by participants as "indicators of safety." Eight of those 14 indicators were identified as "measurable," and 3 of the "measurable" indicators were identified as "measured in my emergency department."

Emergency nurses identified a large number of elements as indicators of physical and psychological safety of both nurses and patients. However, nurses report that these elements were rarely or never measured in their ED environments, impeding the ability to determine "safe" levels of staffing as they pertain to nurse and patient outcomes. Emergency nurses and leaders must identify elements of safety applicable to their departments and measure outcomes related to these elements to facilitate effective staffing configurations.