Patient Safety Improves When Nurses Feel They Can Admit Errors

A new study suggests that when nurses feel safe admitting that they have made a mistake regarding a patient, they are more likely to report it, leading to a stronger commitment to safe practices and a reduction in the error rate.

Researchers at Katholieke Universiteit Leuven (Belgium), Pennsylvania State University (Penn State, PA, USA), and other institutions surveyed 54 nursing teams in four hospitals in Belgium to determine if the leadership actions of head nurses were aligned with the verbal expectations they had given to staff nurses, to examine the effect on nurse commitment to following safe work protocols and willingness to report a patient treatment error, and to examine the notion that care providers may experience a conflict between the strong enforcement of safety procedures on the one hand, and the reporting of safety/patient errors on the other hand.

The researchers found that when nurse managers' spoken expectations regarding safety aligned with their commitment to safety, their teams had a stronger commitment to acting safely while carrying out work duties, as well as a greater rate of reporting errors. In addition, this greater emphasis on safety resulted in a reduction in patient treatment errors. The findings suggest that by staying true to the safety values they espouse, leaders can start to solve the managerial dilemma of providing clear safety directives while encouraging employees to report errors. The study was published ahead of print on September 17, 2012, in the Journal of Applied Psychology.


“The study offers support for the efficacy of leaders' behavioral integrity -- walking the talk, if you will -- and it demonstrates the importance of leadership in promoting a work environment in which employees feel it is safe to reveal performance errors,” said study coauthor Deirdre McCaughey, PhD, an assistant professor of health policy and administration at Penn State. “This benefits patients because work environments in which error is identified offer employees the opportunity to learn from those errors and, ultimately, prevent similar errors from occurring.”

The surveys used examined the behavioral integrity of head nurses, the psychological safety felt by staff nurses, and team priority of safety using a variety of statements that participants ranked on an agreement scale. Such statements included “My head nurse always practices the safety protocols he/she preaches”; “If you make a mistake in this team, it is often held against you; and “In order to get the work done, one must ignore some safety aspects.”

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Katholieke Universiteit Leuven
Pennsylvania State University