Although Patient Safety (PS) is a fundamental principle of health care (WHO, 2018), evidence suggests that a significant number of patients are often unintentionally injured whilst receiving health care, resulting in permanent injury, disability, increased length of hospital stay or even death. Nurses as the largest group of healthcare providers, have a central role in patient care with unique perspective in assessing and promoting PS in care settings (Aiken et al, 2013, 2017). In order to manage these challenges, nurse managers (NM) need a broad range of knowledge regarding human resource planning and development, leadership approaches, teamwork techniques, and change management. The NM4SAFETY project aims to improve the quality of nursing working environment as the key factor capable of ensuring PS by strengthening the knowledge and competences of NMs as regards the strategies to minimise missed nursing care, errors of omission, or inappropriate rationing of nursing care. The consortium of the project consists of 4 partners Institutions from 3 Erasmus Programme countries and 1 partner country with complementary knowledge and backgrounds, that will ensure the success of the project activities following a 4 axis methodology: project management, evaluation, dissemination and exploitation activities. The project activities will be delivered mainly through 4 Intellectual outputs: IO1) development of a professional toolkit including a set of tools that learners will be able to use in their daily practice to review the concepts learnt, to strengthen the skills acquired during the training course and evaluate the best practices to be used in their daily practice. IO2) the development of the curriculum and contents that will be used in the blended learning activities IO3) the development of the online platform including networking opportunities and access to the elearning course and the live teaching course. IO4) the implementation and evaluation of the blended learning that will be tested in 20 NM in each country. Multiplier events with 30 local participants and 5 international will be organised per partner to disseminate the event apart from other dissemination activities.
The “Nurse Managers for Safety” (NM4SAFETY) project was aimed at improving the quality of nursing work environment by strengthening the knowledge and the competences of Nurse Managers regarding how to reduce Missed Nursing Care, errors of omission, or inappropriate Rationing of Nursing Care, and improve patients’ safety. To reach this main aim, there was developed a Massive Open Online Course (MOOC), internationally piloted and validated, freely accessible and delivered in different languages, targeting Nurse Managers, on the topics related to nursing care and nursing work environment as well as patient safety. The absence of fees or time limitations, as well as the online access, were all established as facilitating the participation and engagement of Nurse Managers that are often overwhelmed from the workloads and organizational constraints, especially in the last here years characterized by unprecedent working conditions due to the pandemic. In order to develop the MOOC, we set a series of specific aims, interrelated each other: (a) Firstly, we aimed at reviewing the literature on the causes of Missed Nursing Care and on the main pedagogical and technical characteristics of Massive Open Online courses capable of ensuring effectiveness of the training. (b) Secondly, we aimed at identifying the best practices used transnationally by Nurse Managers in the daily practice to prevent Missed and Rationed Nursing Care and shared them on a large scale to enhance the knowledge of a large number of Nurse Managers regarding this topic. (c) Thirdly, we aimed at developing the MOOC according to the need analysis and the emerged evidence: in fact, with the gained knowledge, we had the purpose of developing the MOOC curriculum and contents as the main expected result and objective of the project. The contents of the curriculum developed addressed the goal of the project of give impulses to change nursing environments threatening patient safety and provide the knowledge to be translated into their practice. (d) Fourthly, we aimed at developing a digital toolkit to summarize strategies, references, useful links, and assessment tools to be used in the daily practice by the Nurse Managers. (e) Fifth, we aimed at evaluating the MOOC with a pilot phase, with the double intent of increasing the knowledge and skills of several Nurse Managers and collecting from them suggestions to improve the final version of the MOOC to disseminate a valid, piloted, high quality and effective MOOC. Therefore, at the overall level, with the project aims, we would have reached the intent to promote the exchange of evidence-based best practices, experiences, and expertise both at the national and international levels among peers to increase the knowledge of Nurse Managers on strategies to improve the work environment and overcome barriers, difficulties and organizational constraints that often hinder the translation of the theory and the evidence into practices. The finalized MOOC was aimed at allowing – in long-terms and sustainable manner, to achieve the target of developing an intervention package that the Nurse Managers might use for their continuing education, self-directed strategies, and interventions to improve in their settings the quality of the nursing work environment and patient safety.
We applied to this project with the aim to promote one of the first training initiatives devoted to Nurse Managers (Nurse Managers) on nursing work environment and on the concept of Missed Nursing Care and Rationing of Nursing Care as they have direct and indirect impacts on patient safety. Although patient safety is a fundamental principle of health care (World Health Organization, 2017), evidence suggests that a relevant number of patients are unintentionally injured while receiving care, that could turn in permanent injury, disability, increased length of hospital stay or even death. Diagnostic errors, surgical complications as major bleeding, health care-associated infections, adverse transfusion reactions and consequences of medication errors have been identified as the most frequent and avoidable injuries in which nurses and other health care professionals are involved (World Health Organization, 2019). Unsafe care is considered one of the top 10 causes of disability and death globally with an estimated rate of adverse events of 10% in hospitalized patients (World Health Organization, 2017). Nurses represents the largest group of health care professionals, and as a result they have a crucial role in patient care and safety. However, despite their role, evidence shows that several patient safety issues are likely to arise through failures in nursing care (Recio-Saucedo et al., 2018): Rationing of Nursing Care (Schubert et al., 2007), Unfinished Nursing Care (Jones et al., 2015) or Missed Nursing Care (Kalisch, 2006) have been defined as underlying mechanisms affecting patient safety, such as missing mobilization or clinical assessments leading to pressure sores and unrecognized clinical deterioration (e.g. Recio-Saucedo et al., 2018). Nurse Managers have been recognized as being crucial in addressing patient issues considering their daily involvement in planning nursing care. Therefore, they might represent a fundamental vehicle in implementing strategies to prevent Missed Nursing Care and failures in nursing care, accounting for evidence suggesting leadership and other aspects of the professional and nursing work environment are factors that might prevent failures in nursing care (Smith et al., 2018). However, Nurse Managers are supported by limited evidence-based recommendations (Schubert et al., 2021; Patient Safety Network, 2019) in preventing Missed Nursing Care: to date, Missed Nursing Care has been researched intensively regarding prevalence, consequences, as well as regarding validating instruments to measure it, while less efforts have been directed towards interventions to prevent Missed Nursing Care or to understand its causes (Chiappinotto et al, 2022; Schubert et al., 2021). Therefore, based on these premises, there were addressed the following needs: (a) Improving patient safety, by promoting safe care and safe work environment to prevent and reduce adverse events and injuries. (b) Valorizing the role of nurses in providing safe care when working in safe conditions. (c) Emphasizing the role of Nurse Managers in prevent and reducing the occurrence of adverse events, including Missed Nursing Care, by acting on nursing work environment properly. (d) Offering a training opportunity embodying the best evidence and tailored on the needs of Nurse Managers capable of supporting them to ameliorate the nursing work environment, reduce and prevent Missed Nursing Care and failure in nursing care, and therefore improve patient safety. (e) Offering an evidence-based, accessible, internationally piloted, and free course to increase their knowledge and competences, supporting them in acting daily evidence-based practice.