Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses

The effect of organizational silence on the relationship between workplace ostracism and nurses' procrastination behavior: A structural equation modeling

AIM

This study aims to assess the relationship between workplace ostracism and the procrastination behavior of nurses, as well as examine the effect of organizational silence on this relationship.

BACKGROUND

Controlling workplace ostracism and eradicating time wasters, especially procrastination behavior among nurses, are key strategies that add value to organizational effectiveness. In addition, remaining silent about significant issues facing nurses is a devastating approach to the success of both healthcare organizations and the nursing profession.

METHOD

A cross-sectional descriptive correlational exploratory research design was used to conduct the study. Data were collected from 352 nurses recruited from three large university hospitals in Alexandria, Egypt. Four instruments, namely, the Workplace Ostracism Questionnaire, the Organizational Silence Scale, the Active Procrastination Scale, and the Unintentional Procrastination Scale, were used. Structural equation modeling was used to test the hypothesized relationships among the variables.

RESULTS

The findings demonstrated a significant positive and moderate association between workplace ostracism and both active and passive procrastination behaviors among nurses. Moreover, there was a strong positive and significant correlation between organizational silence and workplace ostracism. The results of mediation revealed that the indirect effect of workplace ostracism on both active and passive procrastination behavior through organizational silence was statistically significant, suggesting that organizational silence partially mediated this relationship.

CONCLUSION

The study highlighted the ongoing challenges posed by toxic workplace issues, such as organizational ostracism and silence, as significant factors contributing to nurses' procrastination behaviors. Not only do these factors directly impact nurses' productivity, but they also interact to exacerbate negative outcomes in nursing care. Addressing these toxic dynamics is critical to improving nurse performance and ensuring quality care in healthcare settings.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study offers new insights for navigating toxicity and upgrading nursing productivity in healthcare organizations through fostering a more inclusive and communicative work environment. Promoting team cohesion and ensuring that all staff members feel valued and included can reduce feelings of isolation that may lead to procrastination. Also, creating safe spaces for nurses to voice concerns without fear of reprisal could significantly diminish passive procrastination, which ultimately enhances overall patient care quality and organizational efficiency.

Assessing employee silence about patient safety and its association with environmental factors among nurses in Ardabil: a cross-sectional study

BACKGROUND

Nurses have a crucial role in recognizing potential dangers to patient safety during direct patient care. However, there are occasions when they opt to stay quiet instead of voicing their concerns, ultimately endangering patients. The underlying reasons for this silence pose a significant challenge in the nursing industry. While it's known that workplace conditions contribute to this silence, the specific ways in which this occurs need to be clarified. This research aimed to investigate the factors that lead nurses to remain silent about patient safety, specifically focusing on environmental influences in Ardabil City.

METHODS

This descriptive and analytical study examined 630 nurses, including head nurses, from five medical training centers in Ardabil, northwest Iran. The primary instruments used in the research included the Employee Silence about Patient Safety Questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of psychological safety, leader-member exchange (LMX) assessments, and evaluations of professional discrimination. Data analysis was performed using SPSS version 16.0, applying descriptive statistics, t-tests, ANOVA, Pearson's correlation coefficient, and hierarchical regression analysis.

RESULTS

The average score for employee silence regarding patient safety was 2.62, with a standard deviation of 0.98. Several factors were found to be significant predictors of employees' silence about patient safety, including nurse participation in hospital affairs (ß = 0.196, p = 0.002), nurse's role in the quality of care (ß = -0.352, p < 0.001), staff and facility adequacy (ß = 0.156, p = 0.001), communication with the physician (ß = -0.105, p = 0.015), LMX (ß = -0.284, p < 0.001), and job position (ß = -0.093, p = 0.018).

CONCLUSION

This study has identified several critical factors influencing employee silence regarding patient safety, including nurse involvement in hospital decision-making, the quality of care, communication with physicians, and job positions. To address these challenges, healthcare organizations must implement standardized protocols, improved communication channels, regular safety training, and the integration of advanced technologies. Increasing nurse participation in decision-making processes and strengthening communication between nursing staff and physicians can foster a culture of openness that encourages employees to voice their safety concerns. By creating an environment where staff feel supported and empowered to speak up, healthcare facilities can enhance patient safety and improve overall care quality, ultimately leading to a safer working environment for healthcare professionals.

Subtypes of Job Satisfaction and Health-Related Quality of Life in Chinese Male Nurses: A Latent Profile Analysis

In this cross-sectional study, we aimed to identify subgroups of job satisfaction and health-related quality of life (HRQoL) in Chinese male nurses and examine the factors associated with subgroup profiles. A convenience sample of 626 Chinese male nurses were enrolled from January to October 2021. Latent profile analysis was performed to identify profiles based on self-esteem, psychological resilience, social support, neuroticism, perceived prejudice, occupational stress, job satisfaction, and HRQoL. Chi-squared tests were used to examine predictors of profiles. Results indicated that a three-profile model provided the best fit: low job satisfaction and health (9.90%), moderate job satisfaction and health (64.06%), and high job satisfaction and health (26.04%). The average number of monthly night shifts was negatively correlated with the male nurses' subgroups. Psychological resilience, social support, and neuroticism were the key factors associated with the HRQoL of male nurses, while perceived prejudice, occupational stress, and self-esteem were the key factors associated with job satisfaction. Nurse administrators could improve their job satisfaction and health by reducing perceived prejudice, and job stress, increasing organizational support and resilience.

Perceived overqualification and service behavior: a moderated mediation model of nurses' silence toward patient safety and praise from patients

PURPOSE

Using conservation of resources (COR) theory as our theoretical basis, we investigate how nurses' perceived overqualification influences their service behavior. In doing so, we highlight nurses' silence toward patient safety and praise from patients as a mediator and moderator, respectively.

DESIGN/METHODOLOGY/APPROACH

Data were collected from 201 nurses employed in a Greek public hospital. To examine the present hypotheses, we used the PROCESS macro.

FINDINGS

We found that nurses' perceived overqualification affects their silence toward patient safety, which in turn leads to reduced levels of service behavior. Furthermore, praise from patients attenuated the relationship of perceived overqualification with nurses' silence toward patient safety, such that this association was significant only when praise from patients was low. Similarly, the indirect linkage of perceived overqualification with service behavior through nurses' silence toward patient safety was significant only for nurses who had low levels of praise from patients.

ORIGINALITY/VALUE

This is one of the few studies that examine the phenomenon of perceived overqualification in nursing. Specifically, the potential effect of nurses' perceived overqualification on their service behavior has been neglected. In addition, less is known about how nurse-patient interaction mitigates or boosts nurses' experience of overqualification. By investigating the mediating and moderating mechanisms, this study extends the existing literature regarding why and how perceived overqualification affects nurses' service behavior. Based on our findings, we discuss implications for theory and practice.

The relationship between compulsory citizenship behavior and nurses' silence: a cross-sectional study

AIM

This study aimed to assess the relationship between compulsory citizenship behavior and nurses' silence.

METHODS

A descriptive cross-sectional online study was conducted in October 2023, targeting 402 nurses working in Yichang Central People's Hospital, Hubei Province, China. Data were collected through a structured questionnaire comprising demographic details, the Compulsory Citizenship Behavior Scale, and the Nurses' Silence Scale. Statistical analyses were conducted using SPSS 25.0, including descriptive statistics, t-tests, one-way ANOVA, Pearson correlation, and hierarchical regression analyses.

RESULTS

The study revealed that the overall mean score for nurses' compulsory citizenship behavior was 14.63 (3.99), while the overall mean score for nurses' silence was 32.78 (8.28). Significant differences in compulsory citizenship behavior scores were observed among nurses with varying levels of work experience (P < 0.05). Similarly, significant variations in silence scores were identified according to work experience and employment type (P < 0.05). After adjusting for work experience and employment type, a significant correlation was identified between compulsory citizenship behavior and nurses' silence (P < 0.05).

CONCLUSIONS

Nurses exhibited moderate levels of compulsory citizenship behavior and silence. Additionally, a significant positive correlation was revealed between compulsory citizenship behavior and nurses' silence.

RECOMMENDATION

Nursing administrators should implement targeted measures to lower compulsory citizenship behavior, thereby fostering a more open and communicative environment within the organization, and encouraging nurses to express their opinions more freely.

Nurses' attitudes towards safety and their association with nurses' perceptions of adverse events and quality of care: a cross-sectional study

Aims

To explore nurses' attitudes towards safety and their association with nurses' perceptions of adverse events and quality of care in Saudi Arabian hospitals.

Design

A cross-sectional study using a web-based survey.

Methods

A web-based survey was administered to nurses working in five hospitals in Saudi Arabia. Nurses' attitudes regarding safety, nurses' perceptions of the frequency of seven adverse events, and nurses' views on quality of care were collected. Descriptive and predictive analyses were performed.

Results

Nurses' attitudes regarding safety (n = 653) were classified as less than positive, with an overall score of 68.96%. The highest subscale mean score was for safety behaviour (73.1%), which was followed by job satisfaction (72.6%); the lowest subscale mean score was for working conditions (61.7%). Positive attitudes towards safety were associated with a lower frequency of pressure injuries, patient falls, healthcare-associated infections and unexpected deaths due to deterioration; positive attitudes towards safety were also associated with higher quality of care.

Conclusion

Nurses' attitudes towards safety contribute to preventing avoidable adverse events and to improving quality of care. This study builds on the growing body of evidence that demonstrates fostering a strong safety culture is essential for improving patient outcomes.

"You should have addressed it directly": the ideals and ideologies of managing interaction problems in healthcare work

PURPOSE

An "open communication culture" in the workplace is considered a key contributor to high-quality interaction and providing means to address problems at work. We study how the ideals of "open communication" operate in healthcare.

DESIGN/METHODOLOGY/APPROACH

We use discourse analysis to investigate the audio-recorded data from 14 workshop team discussions in older people services.

FINDINGS

We found four imperatives concerning the interactional conduct of their colleagues in problematic situations that nursing professionals prefer: (1) Engage in direct communication and avoid making assumptions, (2) Address problems immediately, (3) Deal directly with the person involved in the matter and (4) Summon the courage to speak up. Through these imperatives, the nursing professionals invoke and draw upon the "open communication" discourse. Although these ideals were acknowledged as difficult to realize in practice and as leading to experiences of frustration, the need to comply with them was constructed as beyond doubt.

PRACTICAL IMPLICATIONS

Workplace communication should be enhanced at a communal level, allowing those with less power to express their perspectives on shaping shared ideals of workplace interaction.

ORIGINALITY/VALUE

The expectation that an individual will simply "speak up" when they experience mistreatment by a colleague might be too much if the individual is already in a precarious position.

The moderating role of just culture between nursing practice environment and oncology nurses' silent behaviors toward patient safety: A multicentered study

BACKGROUND

Patient safety is a critical part of healthcare delivery that must be prioritized to guarantee optimal patient outcomes. Oncology nursing is a specialized area of nursing that demands great focus on patient safety because of the high-risk nature of this patient group. Nurses play an important role in ensuring that patients receive safe and effective care. However, the nursing practice environment can have a substantial impact on how nurses respond to patient safety problems. A just culture can promote open communication and identify potential safety issues, whereas a culture of silence can have a negative impact on patient outcomes.

OBJECTIVE

Firstly, assess the relationship between the nursing practice environment and oncology nurses' silent behavior towards patient safety. Secondly, the interaction effect of just culture as a moderator in this relationship.

METHOD

A cross-sectional, correctional research design was employed. Data was collected from 303 nurses working at the oncology departments of five hospitals in Egypt using three questionnaires. Data was analyzed using SPSS-PROCESS Macro (v4.2).

RESULTS

There was a moderate, negative, and significant correlation between the nurse practice environment and silent behavior of nurses towards patient safety. The interaction effect of just culture with nurse practice environment strengthens this relationship, thus enhancing errors reporting.

CONCLUSIONS

This study emphasized on the importance of creating a just culture that facilitates open communication and eliminating the potential hazards result from nurses' silence. Thus, oncology nurses must be encouraged to report issues related to patient safety.

Structural equation modeling for associated factors with patient safety behaviors among nursing interns: A cross-sectional study based on the capability opportunity motivation-behavior model

BACKGROUND

Nursing interns are one of the most crucial providers of nursing services. Their safety behaviors are closely associated with adverse events. Therefore, it is vital to explore the factors influencing nursing intern safety behavior to improve patient safety.

OBJECTIVE

To evaluate patient safety behavior among nursing interns and explore latent influencing mechanisms based on the capability opportunity motivation-behavior (COMB) model.

DESIGN

A cross-sectional study SETTINGS AND PARTICIPANTS: The participants were 422 nursing interns recruited through convenience sampling from a comprehensive teaching hospital.

METHODS

Data on general information, nursing interns' patient safety behavior, metacognitive ability, clinical internship environment, and moral sensitivity were collected. Nursing interns' patient safety behavior was described with means and standard deviations. The independent sample t-test, ANOVA, Pearson's correlation, and SEM were used to determine contributing factors to nursing interns' patient safety behavior.

RESULTS

The mean total score for patient safety behavior was 53.08 ± 6.22. The results indicated that metacognitive ability not only directly affects the patient safety behavior of nursing interns (β = 0.554, P < 0.001, 95 % CI = [0.446, 0.637]) but indirectly affects interns' safety behavior through professional identity (β = 0.009, P = 0.031, 95 % CI = [0.001, 0.019]). The clinical internship environment also has both direct (β = 0.258, P = 0.001, 95 % CI = [0.166, 0.349]) and indirect (β = 0.007, P = 0.029, 95 % CI = [0.001, 0.015]) effects on the patient safety behavior of nursing interns.

CONCLUSION

There are some specific areas where nursing interns' safety behaviors need to be improved. This study reveals that strong metacognitive ability and a clinical internship environment with rich opportunities might be essential for the development of patient safety behaviors. To promote nursing interns' patient safety behaviors, clinical teachers could use reflective teaching methods and provide a supportive clinical environment to nurture nursing interns' professional identities and patient safety behaviors.

Preventing Future Harm: Identifying the Drivers of an Unsafe Discharge to Improve Safety on an Inpatient Oncology Service

Cancer Morbidity, Mortality, and Improvement Rounds is a series of articles intended to explore the unique safety risks experienced by oncology patients through the lens of quality improvement, systems and human factors engineering, and cognitive psychology. For purposes of clarity, each case focuses on a single theme, although, as is true for all medical incidents, there are almost always multiple, overlapping, contributing factors. The quality improvement paradigm used here, which focuses on root cause analyses and opportunities to improve care delivery systems, was previously outlined in this journal.This article describes the care of a young patient with aggressive breast cancer, declining performance status, and multiple hospital admissions who died shortly after being discharged home without essential medications or an adequate plan for follow-up. The patient's death due to her malignancy was unavoidable, but she had inadequate resources before her death, leading to avoidable suffering. This outcome resulted from a series of minor errors attributable to inadequate handoffs, challenges establishing realistic goals of care, and hierarchy within and between medical teams that resulted in major lapses at the time of discharge. We explore these issues and discuss how this case led to the establishment of programs designed to empower health care providers and increase engagement of outpatient oncologists at critical points of patients' disease courses.

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

The need for a nursing specific patient safety definition, a viewpoint paper

Purpose

This viewpoint article discusses and analyses the need and benefits of a patient safety definition within the context of nursing.

Design/methodology/approach

This viewpoint article is supported by literature review, statutory documents and expert knowledge evidence. All these sources provided a unified narrative of the background, current aspects and future needs of patient safety.

Findings

The need for strengthening patient safety and the nurses' role within healthcare's actions towards patient safety are discussed. The predominant role of nurses due to the proportionate size and significant role along with the need for clarification of patient safety in nursing terms is recognised. Research evidence of nursing areas with safety issues and relevant nursing interventions are presented. Based on all findings, a research-based nursing specific patient safety definition is proposed. This definition includes three axes: what is patient harm, how this harm can be eliminated or reduced and which are the areas of nursing practice that are identified to provide opportunity for patient harm. These axes include nursing specifications of the patient safety definition.

Originality/value

It is the first time that a nurse specific patient safety definition is proposed. This definition strives to enhance nurse practitioners' understanding and engagement with patient safety by clarifying aspects of patient safety within everyday nursing practice.

A Systematic review protocol on workplace equality and inclusion practices in the healthcare sector

INTRODUCTION

While equality and inclusion practices in healthcare have been advanced from a service user perspective, little is known about the application of workplace equality and inclusion practices in healthcare on upper-middle-income and high-income countries. In the developed world, the composition of the healthcare workforce is changing, with nationals and non-nationals working 'side-by-side' suggesting that healthcare organisations must have robust and meaningful workplace equality and inclusion practices. Healthcare organisations who welcome and value all their employees are more creative and productive, which can lead to better quality of care. Additionally, staff retention is maximised, and workforce integration will succeed. In view of this, this study aims to identify and synthesise current best evidence relating to workplace equality and inclusion practices in the healthcare sector in middle-income and high-income economies.

METHODS AND ANALYSIS

Using the Population, Intervention, Comparison and Outcome (PICO) framework, a search of the following databases will be made-MEDLINE, CINAHL, EMBASE, SCOPUS, PsycInfo, Business Source Complete and Google Scholar-using Boolean terms to identify peer-reviewed literatures concerning workplace equality and inclusion in healthcare from January 2010 to 2022. A thematic approach will be employed to appraise and analyse the extracted data with the view to assessing what is workplace equality and inclusion; why it is important to promote workplace equality and inclusion in healthcare; how can workplace equality and inclusion practices be measured in healthcare; and how can workplace equality and inclusion be advanced in health systems.

ETHICS AND DISSEMINATION

Ethical approval is not required. Both a protocol and a systematic review paper are to be published concerning workplace equality and inclusion practices in the healthcare sector.

Impact of Obstetric Communication on Decision-to-Delivery Time

OBJECTIVE

In obstetric emergencies, care coordination is critical in achieving a "decision-to-delivery" time of 30 minutes. Reliable communication is essential to optimize coordinated care of mother and baby. Clinical mobility (CM) platforms have been shown to improve communication during medical emergencies; however, their impact on improving decision-to-delivery times has not been shown. This study aimed to determine the impact of a new CM platform on decision-to-delivery time.

STUDY DESIGN

A multidisciplinary team designed a CM platform that employs a wall-mounted panel paired with mobile technology to alert all relevant clinical staff. This new platform uses in-room preprogrammed messages that alert predetermined responders matching the emergency. For example, the "STAT section" button summons doctors (obstetrics, anesthesiology, and neonatology), obstetric nurses, and newborn resuscitation staff via smartphones. Impact of this platform was assessed with process and outcome data: cord artery pH, 5-minute Apgar's score; and decision for cesarean section to time of: skin incision, uterine incision, and delivery. This pre- and postimplementation study (October-September 2018 vs. January-December 2019) centered on the opening of our new Obstetric Care Unit. Data were analyzed with Chi-square and Mann-Whitney U-test.

RESULTS

Emergent cesarean delivery was performed in 172 women pre- and 124 postimplementation of the new CM platform. In postimplementation, we observed a 7.4-minute reduction in time from decision-to-delivery (26 pre- vs. 18.6 minutes postimplementation, p = 0.001). Delivery within 30 minutes improved by 15.2% (p = 0.018). Times to skin and uterine incision were also significantly reduced. The two groups had similar neonatal outcomes: birth weight, Apgar's score at 5 minutes, and cord artery pH did not differ, but the study was underpowered to compare these outcomes.

CONCLUSION

This new CM platform significantly reduced decision-to-delivery time, in turn improving compliance with the "30-minute rule." All relevant personnel were contacted specifically, while avoiding overhead paging and other unnecessary messages.

KEY POINTS

· Obstetric communication via a clinical mobility platform shortens the delivery to delivery interval. · Obstetric communication systems via an information technology (IT)-system results in a higher frequency of deliveries within 30 minutes.. · Communication systems may be a useful tools to synchronously call multiple services to respond..

The TARGET Nurses' health cohort study protocol: Towards a revolution in getting nurses' health ticked

AIM

To evaluate the health status of nurses in China and explore the impact of work-related stress, work environment and lifestyle factors on their health outcomes.

DESIGN

The Chinese Nurses' Health Study is a multicentred, prospective cohort study.

METHODS

We plan to recruit approximately 80,000 registered nurses aged between 18 and 65 years. Eligible nurses will be introduced to complete a series of web-based questionnaires after obtaining their informed consent. Follow-up questionnaires will be completed at 2-year interval to continuously track subsequent exposures. Health-related indicators will be obtained through self-reporting by nurses and the provincial and national registry platforms such as National Central Cancer Registry. The funding was approved in July 2020 and Research Ethics Committee approval was granted in February 2021.

DISCUSSION

The study is the first multicentred prospective cohort study that aims to assess the impact of work-related stress, work environment and lifestyle factors on the health of Chinese nurses. The results of the Chinese Nurses' Health Cohort Study will potentially draw a picture of the current situation of general health and well-being among nurses in China and their health risks. This will be critical in recommending locally tailored strategic preventive measures and policies to reduce health and well-being threats for nurses and potentially general public, thereby promoting the quality of healthcare in China and globally.

IMPACT

This study will help to understand the health status and working environment characteristics of Chinese nurses, and provide valuable epidemiological evidence for improving working environment and promoting well-being. The results of this study are potentially of great significance for formulating targeted nursing strategies to promote the nurses' health, nursing quality and patient safety in China and even around the world.

CLINICAL TRIAL REGISTRATION NUMBER AND NAME OF TRIAL REGISTER

ChiCTR.org (ID:ChiCTR2100043202), The Nurses' Health Cohort Study of Shandong.