Date of Graduation
School of Nursing
Purpose: The purpose of this research study was to 1) compare differences in perceptions of the influence of organizational safety and 2) the nurses' practice environment on medication error occurrence and barriers to reporting among nurses working in Magnet, Magnet-aspiring, and non-Magnet hospitals using an Internet survey method.;Background: Over the last several years, there have been many publications that cite organizational variables that are potentially important in addressing medical errors and patient safety. Unfortunately, it is unclear which specific organizational factors contribute to errors and safety in health care organizations. Empiric support of the effects of the nurses' work environment and perceived safety culture within an organization on reasons nurses make medication errors and the barriers to report those errors would provide nursing leaders with data that would be useful in prioritizing interventions to improve patient safety.;Design and method: This descriptive correlational study used a cross sectional design. Additionally, for several of the research questions, a between-participants design was used to evaluate differences among acute care nurses in Magnet, Magnet-aspiring, and non-Magnet hospitals in perceptions of medication error occurrence and reporting, work environment, and safety culture. The study population included 447 nurses working in acute care Magnet, Magnet-aspiring, and non-Magnet designated hospitals. Data were collected online using Qualtrics web-based software. An advertisement for participation was placed on professional organizations' websites. Participants clicked on the link if interested in learning more about the study. A cover letter explaining the research was available to the potential participants.;Instruments: All of the instruments used in this study had validity and reliability demonstrated in prior studies. The Medication Administration Error (MAE) Reporting Survey contains 45 questions in 2 general content areas; (a) reasons why medication errors occur (29 items) and (b) reasons why medication errors are not reported (16 items) The instrument has five subscales for "why MAEs occur" and four subscales for "why MAEs are not reported." Internal consistency of each subscale was acceptable, with Cronbach's alpha ranging from .74--.97. Safety culture was measured using the Hospital Survey on Patient Safety Culture (HSPSC). The survey consists of 79 items measuring 12 dimensions: 2 outcome dimensions and 10 safety culture dimensions with Cronbach's alpha ranging from .72--.91. Nurses' work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI) instrument. The PES-NWI consists of 31 items in five subscales that characterized professional practice in the original Magnet hospitals with Cronbach's alpha ranging from .88--.92.;Results: Differences were found among nurses working in Magnet, Magnet-aspiring, and non-Magnet hospitals regarding reasons why medication errors occur and reasons why medication errors are not reported. Safety culture variables (hospital handoffs, nonpunitive response, staffing and resources, collegial nurse-physician relations) and type of work unit were predictors of reasons medication errors occur. Safety culture variables (nonpunitive response and hospital management) and years as a nurse were predictors of reasons medication errors are not reported. Work environment variables (nursing foundation for quality of care, staffing and resources, and nurse manager ability) were predictors of reasons medication errors are not reported. The relationships between the perceived work environment and reasons medication errors are not reported and the perceived safety culture and perceived work environment were as theorized but not in the anticipated direction, most likely due to participant fatigue causing participants to not notice that the response scale options were in the opposite direction as the rest of the questionnaires.;Conclusions: This study revealed there are a number of person and system attributes that influence the reasons why medication errors occur and the reasons why medication errors are not reported, confirming the complexity of hospital systems and the influence of organizational variables on medication error occurrence and reporting and providing support for the Conceptual Model of Medication Safety. This study also revealed that reasons medication errors occur and nurses' willingness to report those errors are influenced by the key environmental attributes of Magnet hospital settings.
Shanty, Joyce A., "The Influence of Perceived Safety Culture and Nurses' Work Environment on Medication Error Occurrence and Reporting" (2011). Graduate Theses, Dissertations, and Problem Reports. 4787.