Safety Versus Social: Nurses Comfortable Intervening in Unsafe Practices Need Less Validation and Acceptance

Purpose: Worldwide, nurses struggle with assertiveness and assimilation into professional roles while patient safety issues and failure to rescue haunt rates of morbidity and mortality. Transitioning to registered nurse (RN) from nursing student can be an intimidating shift in roles as new nursing graduates identified vulnerability as the first stage of adaptation in this new position (Kelly, 1998). New nursing graduates (“new grads”) are often intimidated by more seasoned nurses and may lack the confidence to call out unsafe practices or correct others for fear of ostracism in their new work environment (Pfaff, Baxter, Jack, & Ploeg, 2014).

Methods: After institutional review board (IRB) approval, we recruited participants through social media and administered an electronic survey via QuestionPro. After informed consent, participants identified as RNs and selected their level of experience. Participants responded to demographic questions and those from psychometrically-sound instruments from the Psychological Vulnerability Scale (PVS) and the Big Five Questionnaire for Children (BFQ-C). The BQF-C has strong internal consistency with Cronbach’s α of .76; the PVS Cronbach’s α is .91. Case study questions detailing unsafe patient care situations followed instruments measuring personality and vulnerability. Case studies detailed scenarios of six common deviations from accepted nursing practices (e.g. nurse opioid diversion, delegation to unlicensed personnel, patient rights to autonomy, patient hygiene, restraint use, and timely nursing intervention). Participants rated their level of comfort intervening in these unsafe scenarios to prevent negative outcomes via Likert-type scales of agreement.

Results: For unequal group sizes (33% were associate degree nurses [ADN]; 66% were baccalaureate-prepared nurses [BSN]) we utilized nonparametric tests for differences and found willingness to intervene varied significantly with personality and vulnerability responses (p < .05). Namely, participants with less need for external validation were more likely to report and/or intervene in unsafe practices (p=.016) whereas those higher in extraversion, creativity, and openness felt the most uncomfortable intervening in unsafe situation (p=.006). Post-hoc analyses revealed significant differences between ADN and BSN participants (p=.009) in reported need for entertainment, prosocial personality traits, and professional conscientiousness.

Conclusion: Based on our review of the literature, we believe these findings are new to nursing science and fill crucial gaps in the body of knowledge on failure to rescue, patient safety, and provide new insights into nurse personality traits and willingness to intervene. Specifically, we found professional behaviors were reported more often in nurses who cared the least for popularity and external opinion, presenting new paradigms of thought for nurse civility, productive conflict, and possibly rejecting antiquated and matriarchal influences on nursing in favor of patient safety. Our results indicate personality differences may mediate or moderate nurses’ willingness to intervene in unsafe practices. Nurses in this study who reported being least concerned with social interactions were shown to be more concerned with safety, providing new information for managers and leaders in developing initiatives encouraging safety over popularity among nurse coworkers in practice.