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Introduction Hospital nurses may experience substantial fatigue, yet there is limited empirical evidence about fatigue management strategies. Aim: The aim of this study was to describe how hospital nurses manage fatigue at home and at work. Methods This descriptive third-phase study of nurses in eight Midwestern hospitals used a maximum variation sampling strategy based on fatigue scores and self-reported medication error and near misses. Participant data from semi-structured interviews were thematically analyzed. Results Barriers to fatigue management included workload, pace, schedule, shift, and nutrition at work, as well as inadequate sleep and competing demands at home. Strategies for fatigue management at work included moving, drinking caffeine, keeping busy, eating, and taking breaks, whereas strategies at home included sleeping, performing activities, and relaxing. Participants suggested organizational approaches to support fatigue management related to staffing and workload, such as breaks, naps, and schedule and shift. Every nurse interviewed reported some degree of fatigue and could describe barriers to fatigue management they encountered. All nurses also could describe attempts to manage fatigue. Conclusions Fatigue management should be part of organizational policy review and nursing education and training to keep nurses and their patients safe and to enable a positive work-life balance.

Medication near-misses occur at higher rates than medication errors and are usually underreported. Reporting a medication near-miss is crucial, as it highlights areas of human and system failures. Identifying these incidents is particularly important in nursing home (NH) settings to help managers plan and initiate proactive measures to contain the errors. However, scarce evidence exists about predictors of nurses' willingness to report near-misses. Therefore, the purpose of this study was to test a proposed model for NH nurses' willingness to report medication near-misses. Data for this cross-sectional study were collected using a random sample of RNs working in NHs across one Midwestern state. The proposed model predicted a 19% variance in nurses' willingness to report medication near-misses, with the strongest predicators being non-punitive responses to errors ( β = 0.33, p < 0.001). According to the study results, system and social factors are needed to improve nurses' voluntary reporting of medication near-misses. [ Journal of Gerontological Nursing, 46 (4), 21–30.]

BackgroundLittle is known about how team processes impact providers’ abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams’ organised understanding of individual member’s roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients.MethodsThis mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams’ teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs.ResultsThe sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation.ConclusionsExamining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.

Background Past studies have reported nurses working day shifts engage in high amounts of light and moderate-intensity occupational physical activity. However, little is known regarding how occupational physical activity and sedentary behavior is accumulated within shifts and/or over consecutive shifts. Objective This study compared occupational physical activity and sedentary behavior patterns of nurses working 12-h. day vs. 12 -h. night shifts. We hypothesized nurses working day shifts would be more active and less sedentary while at work compared to nurses working night shifts and that within shift and between shift differences would emerge. Design Prospective-cohort study design Setting(s) Midwestern trauma one academic medical center medical units (medical surgical, critical care, pediatrics, mother and baby, and other) Participants A total of 56 registered nurses working 12-h. day and night shifts participated in this study. Methods Occupational physical activity and sedentary behaviors (e.g., step count, time spent sitting, standing, and walking) were measured for 14 continuous days using the ActivPAL 3 micro activity monitor. Repeated measures mixed-effects regression models were used to examine the effects of shift type, consecutive shifts, and time within a shift on occupational physical activity and sedentary behaviors. Results Nurses spent more time standing and walking, and less time sitting overall during day shifts compared to night shifts. Nurses walked less during the third consecutive night shift and stood less and sat more during the second and third consecutive night shifts, compared to day shifts. Nurses tended to walk less and sit more during the middle portion of each night shift compared to day shifts. Conclusions Our findings suggest nurses spend more than half of each shift either standing or walking and that differential patterns of occupational physical activity and sedentary behavior exist between day and night shifts. These findings should be used to inform future interventions designed to advance the health and work performance of nurses.

Medication errors are common in health care settings. Safety motivation, such as willingness to report error, is needed to contain medication errors. Limited evidence exists about measures to enforce nurses’ safety motivation. The purpose of this study was to test a proposed model explaining the mechanism by which organizational and social factors influence nurses’ safety motivation. Survey for this cross-sectional study was mailed to a random sample of 500 acute care nurses. Data collection started in January 2014 and lasted 6 months. Path analysis results showed a good fitting final model with 15% of explained variance on nurses’ safety motivation. Safety climate dimensions of error feedback (β = .38, p ⩽ .00) and nonpunitive response to errors (β = .22, p = .01) significantly predicted the outcome. There is a need for both organizational and social factors to motivate nurses to report errors. Leadership practices emphasizing safety as a priority is needed to enhance nurses’ safety motivation.

Nurses function at the point of care and assume a significant role in intercepting errors. They work in a mentally and physically demanding profession that is comprised of shift-work, subjecting nurses to considerable fatigue. Yet, few studies constructed a comprehensive model that integrates personal and occupational factors to explore their relationship with various types of fatigue (acute, chronic, physical, mental, and total). Here, we examine this type of comprehensive fatigue-model, in a report that represents one aim of a larger, mixed-methods study. The study sample comprised of 1137 registered nurses working in eight hospitals in a Midwestern state. Nurses reported higher levels of acute and total fatigue than chronic and physical fatigue. Staffing and resource adequacy, exercise, and sleep were among the strongest predictors. Since fatigue is a multi-faceted construct, a comprehensive fatigue-management strategy that targets both day and night-shift nurses is the optimal way to manage nurse fatigue.

This paper presents a novel methodology to analyze nursing surveys. It is based on ELM and SOM. The goal is to identify which variables lead to the likelihood to report the medication errors. ELM are accurate by extremely fast prediction models. SOM are performing nonlinear dimensionality reduction to get an accurate visualization of the data. Combining both techniques reduces the curse of dimensionality and improves furthermore the interpretability of the visualization. The methodology is tested on a nursing survey datasets.

Introduction Medication errors are one of the most frequently occurring errors in health care settings. The complexity of the ED work environment places patients at risk for medication errors. Most hospitals rely on nurses' voluntary medication error reporting, but these errors are under-reported. The purpose of this study was to examine the relationship among work environment (nurse manager leadership style and safety climate), social capital (warmth and belonging relationships and organizational trust), and nurses' willingness to report medication errors. Methods A cross-sectional descriptive design using a questionnaire with a convenience sample of emergency nurses was used. Data were analyzed using descriptive, correlation, Mann-Whitney U, and Kruskal-Wallis statistics. Results A total of 71 emergency nurses were included in the study. Emergency nurses' willingness to report errors decreased as the nurses' years of experience increased ( r = –0.25, P = .03). Their willingness to report errors increased when they received more feedback about errors ( r = 0.25, P = .03) and when their managers used a transactional leadership style ( r = 0.28, P = .01). Discussion ED nurse managers can modify their leadership style to encourage error reporting. Timely feedback after an error report is particularly important. Engaging experienced nurses to understand error root causes could increase voluntary error reporting.

Purpose To describe work environment characteristics (leadership style and safety climate) of ambulatory surgical settings and to examine the relationship between work environment and nurses' willingness to report medication errors in ambulatory surgical settings. Design Descriptive correlational design using survey methodology. Methods The sample of this study consisted of 40 unit-based registered nurses, working as full time, part time, or as needed in four ambulatory surgical settings affiliated with one health care system located in Northeast Ohio. Findings The results of two separate regression analyses, one with three nurse manager's leadership styles and another with five safety climate dimensions as independent variables, explained 44% and 50%, respectively, on variance of nurses' willingness to report medication errors. Conclusion To increase nurses' willingness to report medication errors, ambulatory surgical settings administrators should invest in nurse manager leadership training programs and focus on enhancing safety climate aspects, particularly errors feedback and organizational learning.

Medication order discrepancies pose safety risks when nursing home residents transition between health care settings. In nursing homes, both registered nurses (RNs) and licensed practical nurses (LPNs) frequently are assigned to detect medication order discrepancies, using the process of medication reconciliation. This study was undertaken to examine the extent to which licensure (RN, LPN), years of experience performing medication reconciliation, and the perceived Need for Closure were related to differences in the detection of medication order discrepancies. The Multiple Segment Factorial Vignette design was used to explore and compare nursing home nurses’ detection of such discrepancies. RNs ( n = 32) and LPNs ( n = 70) from 12 Missouri nursing homes responded to four resident transfer vignettes embedded with medication order discrepancies. The study found that years of experience and the Need for Closure were not related to reports of discrepancies. However, RNs detected discrepancies involving orders for high-risk medications significantly more often than LPNs. No significant differences existed between RNs and LPNs when identifying discrepancies in orders for low-risk medications. These findings regarding the discrepancies detected in orders for high-risk medications and those detected in orders for low-risk medications have implications for resident safety.

Background Medication reconciliation is a safety practice to identify medication order discrepancies when patients’ transitions between settings. In nursing homes, registered nurses (RNs) and licensed practical nurses (LPNs), each group with different education preparation and scope of practice responsibilities, perform medication reconciliation. However, little is known about how they differ in practice when making sense of medication orders to detect discrepancies. Therefore, the purpose of this study was to describe differences in RN and LPN sensemaking when detecting discrepancies. Method We used a qualitative methodology in a study of 13 RNs and 13 LPNs working in 12 Midwestern United States nursing homes. We used both conventional content analysis and directed content analysis methods to analyze semi-structured interviews. Four resident transfer vignettes embedded with medication order discrepancies guided the interviews. Participants were asked to describe their roles with medication reconciliation and their rationale for identifying medication order discrepancies within the vignettes as well as to share their experiences of performing medication reconciliation. The analysis approach was guided by Weick’s Sensemaking theory. Results RNs provided explicit stories of identifying medication order discrepancies as well as examples of clinical reasoning to assure medication order appropriateness whereas LPNs described comparing medication lists. RNs and LPNs both acknowledged competing demands, but when performing medication reconciliation, RNs were more concerned about accuracy and safety, whereas LPNs were more concerned about time. Conclusions Nursing home nurses, particularly RNs, are in an important position to identify discrepancies that could cause resident harm. Both RNs and LPNs are valuable assets to nursing home care and keeping residents safe, yet RNs offer a unique contribution to complex processes such as medication reconciliation. Nursing home leaders must acknowledge the differences in RN and LPN contributions and make certain nurses in the most qualified role are assigned to ensure residents remain safe.

This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices.The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices.This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital.Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices.Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

Understanding how safety culture mechanisms affect nursing safety-oriented behavior and thus patient outcomes is critical to developing hospital safety programs. Safety priming refers to communicating safety values intended to activate patient safety goals. Safety priming through nursing handoff communication was tested as a means by which cultural safety values may affect nursing practice. The mixed-methods pilot study setting was an academic medical center’s high-fidelity simulation lab. Twenty nurses were randomized into intervention and control groups. The intervention group received a safety priming intervention; all participants were observed for completing appropriate actions in response to patient safety risks embedded in a scenario. Stimulated recall interviews were conducted following simulation completion. Nurses receiving the safety priming intervention performed slightly but non-significantly more safety actions than nurses who did not (60.5% vs. 57.9% of 43 actions). Implications for both research and practice are discussed for interventions targeting routine versus safety goal-directed nursing actions.

This concurrent mixed-method study examines the nurse work environment of high-quality Medicare-certified home health agencies. High-quality ( n = 6) and low-quality ( n = 6) home health agencies were recruited using agency-level publicly reported patient outcomes. Direct care registered nurses (RNs) from each agency participated in a focus group and completed the Practice Environment Scale of the Nurse Work Index (PES-NWI). No significant differences were found in the PES-NWI results between nurses working in high- and low-quality agencies, though nurses in high-quality agencies scored higher on all subscales. Nurses working in all the high-quality agencies identified themes of adequate staffing, supportive managers, and team work. These themes were not consistently identified in low-quality agencies. Themes of supportive managers and team work are reflective of effective leadership at the manager level. Agencies struggling to improve quality of care might consider developing their managers’ leadership skills.

Aim To describe and compare how nurses representing four age cohorts perceive their manager’s leadership style and unit climate. Background The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers’ leadership style and unit climate. Method This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. Results and conclusion Only nurses from Boomer and Gen-Xers had sufficient representation to be included in the data analysis. Nurses from the two main age cohorts did not differ in their perceptions of their manager’s leadership style. Significant differences were found in two unit climate dimensions. The Gen-Xers had a less favourable perception of their unit climate related to warmth and belonging and administrative support. Implications for nursing management Nurse manager’s might reflect on how they interact with different age cohorts; and to involve nurses from various age cohorts in the development of policies to create a flexible work environment.