Creating safety culture on nursing units: Human performance and organizational system factors that make a difference

OBJECTIVE: To report evidence of relationships among selected human performance factors and perceptions of safety culture on medical/surgical nursing units in relation to nurses' productivity, frequency of error reporting, and reported medication administration errors. BACKGROUND: Creating safety culture in health care institutions is critical to patient safety and quality care. Most patient care in acute health care settings takes place on nursing units. Clarity about relationships among human performance and system factors that may influence nursing care delivery in relation to patient safety on nursing units is needed to better understand and support the development of safety culture on nursing units. METHODS: Descriptive cross-sectional, correlational survey of medical/surgical staff nurses (158/186) in 2 hospitals in metropolitan health care system. Survey items measured nurses' motivation, cognitive decision-making style, and safety culture perceptions. Dependent measures included retrospective data collection on nurses' productivity, reported medication administration errors, and frequency of error reporting. RESULTS: Lower unit monthly direct care nursing hours per patient care day (productivity) correlate with higher number of nurses' reported medication errors. Positive nursing unit leadership correlates with nurses' increased willingness to report error. Variables that influence reporting of medication administration error are nurses' cognitive decision-making style, motivational inhibition, communication in relation to authority gradient, and nursing unit leadership. Variables associated with nurse productivity are motivational drive, unit teamwork, and perceptions of patient safety. CONCLUSIONS: Behavioral motivation, cognitive decision making, and open communication, in conjunction with perceptions of nursing unit leadership and levels of nurses' direct care hours, influence nurses' safety culture perceptions and behaviors.