Patient safety: a literative review on the impact of nursing empowerment, leadership and collaboration

Background: Nurses are ideally placed to drive the safety and quality agenda within health care because of their unique proximity to patients. There have been some attempts to look at the links between nursing care and quality outcomes, but relatively little on the connection between nursing and patient safety. Therefore, exploring the evidence on this issue was indicated, excluding links to nurse staffing and environment. Aims: The aim of this study was to identify to what extent and in what way nursing leadership, collaboration and empowerment can have a demonstrable impact on patient safety. Methods: A search of electronic databases was undertaken from 1998 to 2008. One thousand seven hundred eighty-eight titles and abstracts were retrieved, and the full text of 65 relevant papers was obtained and reviewed. Data extraction was undertaken if papers met the following inclusion criteria: a measure of impact from a study or audit, patient safety and nursing focused, and identified one of the following issues (leadership, advocacy, interdisciplinary working, empowerment and collaboration). Eleven papers were selected and critically reviewed. Finding: Of the 11 papers, 7 were undertaken in the USA, 2 in Canada, 1 in the UK and 1 in Iceland. Selected papers comprised of one systematic review, one cohort study, four qualitative studies, three cross-sectional studies, one survey and an evaluation. The quality of papers was variable and provided limited evidence of impact or effectiveness in terms of nurses directly influencing patient safety. Conclusion: Gaps currently exist in relation to knowledge on the extent and nature of the role of nurses in patient safety improvement. Considerable work is required before comprehensive solutions can be further developed. Huge potential exists for improvement through nursing empowerment, leadership and the development of tools to strengthen and support nurses' influential role in the quality and safety movement; therefore, the need for investment into well-designed research studies to address these gaps is obvious, required and timely.