10 Most Common Examples Of Unsafe Nursing Conditions + How To Report
Written By:
Darby Faubion
Darby Faubion RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» RN, BSN, MBA
As nurses, we prioritize patient safety and implement measures to reduce or eliminate risks. What about nurse safety, though? Have you considered what factors contribute to safety issues for nurses? I have been asked by nurse leaders and administrators many times, “What are the common examples of unsafe nursing conditions, and what can we do about it?"
In my more than 20 years of experience as a nurse, I have seen several instances where I felt conditions were unsafe for myself or other nurses. Recognizing unsafe nursing conditions is important, but it is equally as important to know what to do when these situations arise. In this article, I will share with you 10 most common examples of unsafe nursing conditions + how to report them.
What are the Common Examples of Unsafe Nursing Conditions?
(The following are the 10 most common examples of unsafe nursing conditions + how to report them.)
EXAMPLE #1: Inadequate Nurse-Patient Staffing Ratios
About the Example:
A common example of unsafe nursing conditions occurs when nurse-patient ratios are inadequate, leading to nurses being assigned more patients than they can safely provide care for. When there are too few nurses to care for the number of patients, it results in slower response times, increased risk of medication errors,
higher rates of nurse burnout, and poor patient and organizational outcomes.
How to Report:
I must admit there have been more times than I care to count that I have worked with inadequate staff-to-patient ratios. There are some circumstances when staff shortages cannot be helped. However, when the issue becomes a common occurrence, it is crucial that management steps in to remedy the situation.
If you work in a situation where the nurse-patient ratio is inadequate, talk to your charge nurse or Director of Nursing. Depending on the size of your facility and who makes the schedule for each department, the main nursing leaders could be unaware of issues in smaller units. Nevertheless, it is their responsibility to know and handle these matters.
Often, the unsafe condition can be resolved by reassigning staff to accommodate areas where the patient census is higher. Also, hospitals and other healthcare facilities typically have a list of prn nurses or temp services they can call on to fill in when there is a need. Keep in mind that when you advocate for adequate staffing ratios, you advocate for everyone on your team, as well as your patients.
EXAMPLE #2: Lack of Adequate Personal Protective Equipment
About the Example:
One thing I always stress to my team members is that it is hard to do a good job taking care of others if we do not take care of ourselves. Personal protective equipment is designed to shield us from exposure to disease-causing pathogens. Therefore, lack of adequate PPE supplies can pose a significant risk to nurses, resulting in unsafe nursing conditions.
When the COVID-19 pandemic was in full force, one of my closest friends called me in tears. The hospital where she worked was filled to capacity with patients, and the nurses were scrambling for masks and other personal protective equipment. It was a scary time for nurses, other healthcare providers, and patients, as no one knew what to expect, and the mortality rate was so high. Things we took for granted before the pandemic suddenly seemed as precious as the air we breathe, and not having access to it was frightening.
How to Report:
How and who you report a PPE shortage to, depends on where you work and the reason for the shortage. Some hospitals or larger healthcare facilities have a central supply department that is responsible for restocking units each shift or at least every 24 hours. Others require someone from each unit to place an order with the central supply department and pick up supplies to restock their departments.
If your department experiences frequent shortages of personal protective equipment, the first step is to find out why the PPE is unavailable. For example, were replacement supplies not ordered, or are they not available at your facility for replacement? Talk to your shift supervisor and let them know your supplies are low and ask if they can arrange to get enough PPE for your team. If your shift supervisor is unable or unwilling to help, you may need to go to someone in a higher position. One thing I take seriously is personal protection. So, my advice is do not be intimidated or feel bad about asking for the things you need to help you do your job safely.
EXAMPLE #3: Working with Broken or Poorly Maintained Equipment
About the Example:
Although it may come as a surprise, one of the most common things that lead to unsafe working conditions is when healthcare facilities do not maintain equipment in good working order. A wheel on a cart that does not turn properly can result in a cart overturning, which could lead to falls and injuries. Equipment used for diagnostic purposes that is not in proper working order can malfunction while in use and lead to a nurse, patient, or both being injured.
How to Report:
Having worked in supervisory positions, I take the role of nursing leaders seriously. As such, I believe it is every nurse leader’s responsibility to ensure a safe work environment for their staff, including making sure staff have adequate amounts of properly working equipment.
If you encounter broken equipment or equipment that you feel is not in proper working order, bring it to your supervisor’s attention as soon as possible. Although nurse leaders are responsible for maintaining their unit’s safety, it is important to remember that their jobs involve many duties. They may not know there is an issue unless you bring it to their attention.
EXAMPLE #4: Working in High-Stress Areas Where Patients Are Prone to Violence
About the Example:
While there are risks for violence in any work setting, some healthcare environments have higher risks. For example, nurses who work in emergency rooms or psychiatric units are more likely to encounter patients with violent or uncontrollable outbursts.
I remember one of the scariest encounters I had in nursing, which occurred when I was working in an emergency room. A man walked into the ER requesting to be seen and stated he was in excruciating pain. While the clerk checked him in, the charge nurse told me that the man was a drug addict who frequently came to the emergency room seeking pain medications. The physician who saw him did not prescribe the medication the patient requested, and he became furious. The man started throwing IV poles and other equipment and tried to hit the doctor and nurses. Although security came to our assistance and got the situation under control, it was still a frightening experience, one that could have resulted in one or more people being seriously injured.
How to Report:
Unfortunately, there is a surge in violence toward nurses. According to
National Nurses United, 81.6 of nurses experienced some type of workplace violence between January 1 and December 31, 2023.
If you work in a high-stress area or in a setting where patients have a higher risk of violent or aggressive behavior, it is important to know your company's protocol for handling each situation. When you feel things may be getting out of control or that a threat of violence is imminent, go to your charge nurse immediately.
EXAMPLE #5: Colleagues Who Utilize Unsafe Practices
About the Example:
I would love to tell you that all nurses exemplify professionalism and follow great examples of safe practices. Unfortunately, not everyone does. Some of the worst examples of unsafe nursing conditions I have witnessed have been caused by careless nurses.
For example, I have seen nurses who draw blood and give injections without washing their hands or donning gloves, which is a risk to both them and their patients. Additionally, as nurses, it is our responsibility to ensure that we have adequate support when performing specific tasks. When moving heavy patients or equipment is necessary, it is important to have another person assist you or use the appropriate lift equipment.
How to Report:
I understand no one wants to be a snitch. However, when it comes to your safety and the safety of your patients, you have a responsibility to stand up for what is right. If you witness a colleague who uses unsafe practices, consider offering assistance to them. In cases where you feel your coworker is not receptive to your offer of help or seems unapproachable, it is essential that you report unsafe practices to your charge nurse.
Good nurse leaders know how to take the information you give them and follow up without divulging the source of the information. Remember, by speaking up, you could prevent serious harm or injury from happening to a patient or colleague.
EXAMPLE #6: Working with Inexperienced/Underqualified Leaders
About the Example:
While inexperience does not automatically mean a nurse leader is incapable of providing a safe working environment, some positions may require a more seasoned nurse to get the job done.
For example, working in critical care or high-risk areas requires having a leader with hands-on experience in these settings. Inexperienced or underqualified leaders may lack the knowledge and expertise needed to make crucial decisions when time is of the essence, which could jeopardize nurses' safety.
I remember working a prn shift in the emergency room one night, and it felt like everything that could go wrong did go wrong! Unfortunately, the charge nurse in the ER that night was recently promoted to that position, had little experience in management, and had never worked in emergency care. To say that it was like a train wreck waiting to happen is an understatement. As patients seemed to pour into the emergency room, you could feel the tension among staff.
Because the charge nurse had no experience, she quickly became overwhelmed. Thankfully, the house supervising nurse was called and came to assist us until things settled down. In this situation, patients were angry, some were combative, and people in the waiting room were arguing. Without safe intervention from someone with experience and authority, it could have led to serious problems, including the possibility of a nurse being harmed.
How to Report:
If you find yourself working in a situation with a manager or leader whose lack of experience seems to hinder safe practices within your unit, it is your duty as an advocate for yourself, your team, and the patients you serve to reach out to the administration for help.
I understand that it can be difficult to know what is right or wrong when it comes to reporting unsafe conditions, especially if you feel the need to go above your immediate supervisor. I can tell you, though, having been in leadership roles myself, I appreciate a nurse or other team member who is willing to look at the big picture and realize the ramifications of how unsafe conditions can impact not only patients but nursing teams and entire healthcare facilities, and stands up for what is right.
I would like to clarify that having leaders with less experience does not always lead to unsafe working conditions. However, having leaders in place with knowledge and experience in the fields where they are assigned as managers is critical to promote safer nurse working conditions.
EXAMPLE #7: Nurses Working While Experiencing Burnout
About the Example:
Nurse burnout is an occupational hazard that comes from being overworked, overstimulated, and, quite frankly, simply exhausted. Nurses experiencing burnout typically show symptoms of decreased concentration, emotional detachment, poor decision-making, and slow reaction times. All these things cause unsafe nursing conditions. Nurse burnout affects not only the individual nurse but their teams, patients, organizations, and the profession as a whole.
How to Report:
I believe all nurses should be educated on the signs and symptoms of nurse burnout and how to not only identify burnout in colleagues and coworkers but in ourselves as well. Education and self-awareness are key to preventing unsafe nursing conditions that result from nurse burnout.
If you feel burned out, do not feel embarrassed or ashamed. When this occurs, you should talk to your nursing supervisor. If you observe signs of burnout in your coworkers, offer to help when it is appropriate, but be keenly aware of when their situation may pose unsafe nursing conditions and report any concerns to your nursing supervisor. Remember, speaking up in situations where nurse work conditions are unsafe is every nurse’s responsibility.
EXAMPLE #8: The Effects of Moral Distress
About the Example:
When we think of examples of unsafe nursing conditions, moral distress is usually not at the top of the list of causes. However, moral distress in nursing can significantly impact nurses and lead to poor or unsafe nursing conditions.
Moral distress in nursing is the cognitive and emotional responses that occur when nurses feel forced to act against their best judgments or morals. Being forced to act in a way that contradicts a nurse's beliefs can lead to significant issues, including anxiety, depression, burnout, emotional detachment, and poor interprofessional relationships.
Patient and staff safety can be negatively impacted by the effects of moral distress, as nurses communicate less with one another, often have trouble concentrating, and struggle with important decisions for fear of their ideas being rejected.
How to Report:
Unfortunately, issues related to moral distress are one risk to the safety of nursing conditions that often go unreported. It is understandable as moral distress occurs due to feelings of being forced to do things that go against one's beliefs or morals. However, it is important to understand that anything that makes you feel your nursing conditions are unsafe or that your mental health is compromised at work should be reported.
Who you report the issue to depends on the source of your moral distress. First-term nursing students learn about following a chain of command in leadership, and it is important to do so... if it is possible. If the source of your problem is your immediate supervisor, though, you may need to go to the next person in leadership. I have learned in situations like this that it is best, to be honest about your thoughts and feelings. Explain why you feel distressed and ask if there is a way to compromise. Nursing management's job is to ensure that the team works cohesively and effectively, promoting positive patient, team, and organizational outcomes, which means alleviating any source of moral distress should be paramount to them.
EXAMPLE #9: Being Assigned to Unfamiliar Units
About the Example:
It is not uncommon for hospitals to reassign nurses to units they may not normally work in or be familiar with if there is a staff shortage. Even experienced nurses can feel like a fish out of water when working in unfamiliar units. Every assignment to a new unit may not result in unsafe nursing conditions. However, if you are unsure of your role in a new unit or how to use equipment, it is important to seek direction and clarification before safety becomes an issue.
How to Report:
I can tell you from experience that good nurse leaders do not want anyone on their team to feel out of place or unsure of their role. Also, no matter how short-staffed your hospital or facility is, you are allowed to have reasonable expectations to be properly educated and prepared for any assignments you have not performed previously.
If you find yourself in a situation where you are assigned to an unfamiliar unit and you feel your lack of experience or expertise in that area poses a risk to patient or staff safety, speak up! Go to the charge nurse and express your concerns. It could be that simple answers to your questions can give you clarity and help you feel at ease about your assignment.
On the other hand, after talking with your supervisor, you may come to an agreement that a different assignment is more fitting. Either way, by speaking up, you are advocating for yourself, your team, and the patients on the unit to which you are assigned.
EXAMPLE #10: Unsanitary Work Environments
About the Example:
Another example of unsafe nursing conditions is when work environments are unsanitary. Nursing is a profession filled with risks to health and safety, as nurses are exposed to illnesses and diseases daily. There is also the risk of accidental needle sticks or exposure to contaminated blood or body fluids. Other risks that lead to unsafe work conditions are when the work environment is unsanitary. It could be that you work in an understaffed facility where housekeeping tasks fall behind. On the other hand, some nurses or other staff may simply neglect the important things that must be done to keep their work environment sanitary and safe.
How to Report:
Whatever the reason for unsanitary work environments, it is an unacceptable example of how nursing conditions can be unsafe for work. Depending on the reason for the unsanitary conditions, a concentrated team effort could be enough to get things tidied up and back in safe order. However, if the situation is not easily resolved, it certainly warrants reporting the situation to management.
As with reporting anything to a manager or supervisor, there are times when you may feel like the “odd man out” or worry that others may resent you. I want to encourage you, though, to remember that unsanitary work environments put everyone at risk. That type of environment puts patients at great risk of hospital-acquired infections, prolonged hospital stays, and poor outcomes, and it puts nurses at risk of being injured or becoming ill.
My Final Thoughts
Nursing is a wonderful career with opportunities to make a significant impact on others’ lives. Unfortunately, there are times when circumstances lead to unsafe conditions for nurses, which makes doing our jobs challenging. Knowing what poses a risk to nurse safety and how to address it is crucial, which means you must answer the question, “What are the common examples of unsafe nursing conditions?”
In this article, I shared 10 most common examples of unsafe nursing conditions + how to report them. Sometimes, all it takes to improve nursing conditions is to lead by example. Other times, you may need to reach out to leaders and managers for help or guidance. Whatever situation you find yourself in, I encourage you to stand firm as an advocate for nurse safety by speaking up when needed.
List Of Sources Used For This Article
1.
“American Nurses Association Backs Nurse-Patient Staffing Ratios” (
nursejournal.org)
2.
“NNU Report Shows Increased Rate of Workplace Violence Experienced by Nurses” (
National Nurses United)
3.
“What is Moral Distress in Nursing? (with Examples, How to Address, & Negative Effects” (
nursingprocess.org)
Darby Faubion, RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Her work history includes clinical experience in pediatrics, mental health, addiction and behavioral disorders, geriatrics, wound management, and communicable disease. Darby has worked in hospitals, long-term care facilities, and home health and hospice agencies. Darby also has experience as a nursing and allied health educator at both community college and university levels. Her love for nursing and nursing education led to her becoming a test-taking strategist and NCLEX prep coach.