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Objective: The aim of this article is to describe the associations of nurses' hand hygiene (HH) attitudes, subjective norms, and perceived behavioral control with observed and self-reported HH behavior., Background: Hand hygiene is an essential strategy to prevent healthcare-associated infections. Despite tremendous efforts, nurses' HH adherence rates remain suboptimal., Methods: This quantitative descriptive study of ICU nurses in the southeastern United States was guided by the theory of planned behavior. The self-administered Patient Safety Opinion Survey and iScrub application, which facilitates observation, comprised the data set., Results: Nurses' observed HH median was 55%; tendency to self-report was a much higher 90%. Subjective norm and perceived control scores were associated with observed and self-reported HH (P < .05) but not attitude scores or reports of intention., Conclusions: Nurses' subjective norm and perceived control are associated with observed and self-reported HH performance. Healthcare workers overestimate their HH performance. Findings suggest future research to explore manipulators of these variables to change nurses' HH behavior.

Context: Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety organizing and other contextual factors that help foster safety., Objectives: Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors., Subjects: A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004., Research Design: Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing., Results: Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways., Conclusions: Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.