Examining the relationship between work climate and patient safety among nurses in acute care settings

Registered Nurses' workplace climate has a significant impact on patient outcomes. While nurses are recognized as central to achieving safe and cost-effective healthcare, they have been historically reluctant to verbalize concerns about workplace issues. Nurses' perceptions of the safety of their workplace climate and the extent to which these perceptions affected their perceptions of patient safety and willingness to report medical events/errors were examined in this cross-sectional explanatory study. A secondary analysis of data from the Agency for Healthcare Research and Quality's (AHRQ) 2010 Hospital Survey on Patient Safety Culture was used to examine the relationships between five independent variables (teamwork within units, management support for patient safety, communication openness, staffing, and non-punitive response to error) with two dependent variables (overall safety grade and number of reported events). The sample was a subset of respondents who listed their staff position as 'Registered Nurse' (n= 107,271). Critical social theory provided the framework drawing heavily upon nursing studies utilizing the model of oppressed group behavior. Descriptive statistics were used to summarize the characteristics of the nurse respondents; bivariate and multivariate analyses were used to answer the research questions. Findings indicated that the demographics (except for patient interaction) were not meaningfully related to the study variables. The multivariate analyses for patient safety grades showed that four of the five independent variables: teamwork, management support, communication, and staffing were significantly positively associated with perceived patient safety grades after controlling for other independent variables and demographic variables; non-punitive response was not significantly associated with patient safety grades. Nurses reported higher patient safety grades associated with better perceptions of teamwork, management support, communication, and staffing. The four significant independent variables and one demographic variable (patient contact) accounted for 50 % of the variance in the dependent variable of patient safety grade. Results for the number of reported events indicated that relationships were too small to draw definitive conclusions. These findings suggested that the study variables are important indicators of factors that contribute to a workplace climate that is supportive of hospital 'safety culture'. The findings did not support the hypothesis that improvements in the hospital workplace climate would lead Registered Nurses to report more safety events/errors. Implications for managers and nursing leaders are that support of patient safety influences patient outcomes and Registered Nurses' perceptions of their workplace climate are accurate reflections of patient safety. Future research is needed to understand nurses' interpretations of 'safety culture' and this may be best accomplished through triangulation of research methods.