Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions
- Jennifer A Taylor1,
- Francesca Dominici2,
- Jacqueline Agnew3,
- Daniel Gerwin1,
- Laura Morlock4,
- Marlene R Miller4,5
- 1Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- 2Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
- 3Department of Environmental Health Sciences, Division of Occupational and Environmental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- 5Department of Pediatrics, Johns Hopkins Children's Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Correspondence to Jennifer A Taylor, Assistant Professor, Department of Environmental and Occupational Health, Drexel University School of Public Health, 1505 Race Street, MS 1034, Philadelphia, PA 19102;
Contributors JAT: conception and design, data collection and management, analysis and interpretation, writing manuscript, guarantor of the paper; FD: design, statistical methods and analysis of data, contribution to manuscript; JA: design, interpretation, and writing manuscript; DG: conception and design, writing manuscript; LM: conception and design, data analysis and interpretation, writing manuscript; MRM: conception and design, data collection and management, analysis and interpretation, writing manuscript.
- Accepted 27 September 2011
- Published Online First 19 October 2011
Background Safety climate and nurses' working conditions may have an impact on both patient outcomes and nurse occupational health, but these outcomes have rarely been examined concurrently.
Objective To examine the association of unit-level safety climate and specific nurse working conditions with injury outcomes for both nurses and patients in a single hospital.
Research design A cross-sectional study was conducted using nursing-unit level and individual-level data at an urban, level-one trauma centre in the USA. Multilevel logistic regressions were used to examine associations among injury outcomes, safety climate and working conditions on 29 nursing units, including a total of 723 nurses and 28 876 discharges.
Measures Safety climate was measured in 2004 using the Safety Attitudes Questionnaire (SAQ). Working conditions included registered nursing hours per patient day (RNHPPD) and unit turnover. Patient injuries included 290 falls, 167 pulmonary embolism/deep vein thrombosis (PE/DVT), and 105 decubitus ulcers. Nurse injury was defined as a reported needle-stick, splash, slip, trip, or fall (n=78). Working conditions and outcomes were measured in 2005.
Results The study found a negative association between two SAQ domains, Safety and Teamwork, with the odds of both decubitus ulcers and nurse injury. RNHPPD showed a negative association with patient falls and decubitus ulcers. Unit turnover was positively associated with nurse injury and PE/DVT, but negatively associated with falls and decubitus ulcers.
Conclusions Safety climate was associated with both patient and nurse injuries, suggesting that patient and nurse safety may actually be linked outcomes. The findings also indicate that increased unit turnover should be considered a risk factor for nurse and patient injuries.
- Organisational culture
- medical errors
- occupational safety
- administrative nursing research
- adverse events, epidemiology and detection
- patient safety
- safety culture
- healthcare quality improvement
- near miss
Funding This research was supported (in part) by funding from the NIOSH Education and Research Center for Occupational Safety and Health at the Johns Hopkins Bloomberg School of Public Health—a doctoral training program (#T42OH00842428). Dr Taylor was a trainee in this program from 2003 to 2007.
Competing interests None.
Ethics approval Johns Hopkins Bloomberg School of Public Health.
Provenance and peer review Not commissioned; externally peer reviewed.