Past research indicates that error reporting is a multifaceted phenomenon in hospitals, with multiple diverse and complicated reasons for error-reporting process breakdowns. While much of the past research on error reporting has sought to identify facilitators and barriers to error reporting, these studies have not fully explained how more complex factors in organizations may affect error reporting by clinicians. In this study, we used the model of work-team learning (Edmondson, 1999) to examine factors that affect error reporting by nurses, namely work environment and teamwork dynamics on nursing units. Specifically, the safety climate on the nursing unit, nurses’ perceptions of nurse managers’ leadership qualities, and the psychological safety of nurses on the unit were examined.
This study used a cross-sectional descriptive design. Self-administered surveys were used to collect data from nurses and nurse managers in an 805-bed academic medical center in the southeastern United States. There were 1,922 RNs employed on 50 nursing units at the study site who were recruited to participate in this study. Of those nurses, 924 completed the survey, for a response rate of 48.1%. Data analysis was conducted using linear mixed models with random effects to account for within unit correlations. Bootstrap confidence intervals with bias correction were used for mediation analysis.
The results of the study demonstrated that the safety climate of the nursing unit, the leader inclusiveness of the nurse manager, and the degree to which nurses felt psychologically safe positively affected error reporting. Furthermore, the results showed that psychological safety mediated the relationship between aspects of safety climate and error reporting as well as the relationship between leader inclusiveness of the nurse manager and error reporting.
For organizational learning to occur in response to errors and near misses, awareness of those events is essential. Organizational awareness of errors and near misses can only happen if nurses, physicians, or other clinicians report that an error or near miss happened. The findings of this study emphasize the important relationship between the work environment and error reporting. The safety climate of the nursing unit, leadership behaviors demonstrated by the nurse manager, and nurses’ perceptions of psychological safety are all significant factors that influence nurses’ reporting of errors. The study findings also emphasize the importance of healthy work environments to the psychological safety of nurses. As hospital leaders seek to improve the quality and safety of care for patients by learning from errors, the findings from this study can help guide the development and implementation of strategies that foster a positive safety climate of nursing units, build leader inclusiveness of nurse managers, and promote positive perceptions of psychological safety among nurses.