Exerting Capacity: How Bedside RNs Approach Patient Safety

The numbers of patients in U.S. hospitals experiencing unfavorable, avoidable clinical outcomes continue at an alarming rate despite the development and implementation of patient safety initiatives. Until now, the majority of research into the concept of patient safety employed quantitative method approaches to investigate the possible causes of preventable adverse patient outcomes. There are several possible factors identified from research findings that might impact patient safety: an organization’s safety culture, the practice environment of the nurse, and nurse staffing. To date, qualitative exploration of the perspectives of those closest to the patient – bedside nurses – has been overlooked. This study incorporated Glaser’s Classical Grounded Theory (CGT) to explore bedside registered nurses' (RNs) perspectives of patient safety to generate a substantive theory that explained or described patient safety from the view point of bedside RNs. In addition to the substantive theory, Exerting Capacity, additional concepts that emerged from the data were two mindsets bedside nurses use to exert their capacity in order to keep their patients safe: 'me-centric' and 'patient centric'.

This study is the first of its kind to use CGT as a qualitative methodological approach into the concept of patient safety through the perspectives of bedside RNs in the adult acute hospital setting. CGT is a well-established, rigorous, inductive methodological approach to explore areas of life in which a group of people define their reality through their social interactions (Glaser, 1992), including how they resolve their main concern (Glaser, 1998). Data revealed that the main concern of bedside RNs is indemnifying duty: the RNs’ self-ascribed obligation to their patients through guarding or securing against anticipated loss or harm while in their care. From either a 'me-centric' or 'patient-centric' approach, the bedside nurses resolve the main concern of indemnifying duty through their ability to exert their capacity. Exerting capacity describes how the bedside nurses balance their own capacity against the demands of a given situation to fulfill their duty to keep their patients safe.

Understanding patient safety from the perspective of bedside RNs helps researchers to better define the RNs' thought processes and actions with respect to keeping their patients safe. Further, this knowledge adds to what is currently known about the concept of patient safety. It is imperative for the leaders of healthcare organizations, including nursing leaders from all levels, to recognize the value of the perspective of patient safety from the viewpoint of the bedside nurse. In addition, the bedside nurse needs to understand the implications of this study’s findings and how the approach to keeping patients safe, either from a' me-centric' or 'patient-centric' mindset, may not be suited for the current work environment. These findings establish the groundwork for future research into the evolving concept of patient safety.