Table 1

Interview guide and observation protocol

Interview-guide-selected questions
“What does “keeping patients safe” mean to you?”
“Tell me about a time when something was going wrong for a patient and you needed to do something about it”.
“Tell me about a time when you felt care was unsafe.”
“What do you think makes a nurse really good at managing complicated patients or rapidly changing patient status?”
“What do you think makes complicated situations easier or harder to manage?”
“Have you ever been in a situation where you knew something was wrong but were hesitant or afraid to speak up or do something about it? Tell me about that”.
“What do you think makes a nurse really good at getting their message across to the team?”
“What haven't I asked you about that I should have?”
Participant observation protocol
Enrolled RNs were asked at the close of interviews if they were willing to host an observation.
Observations lasted 2 to 8 h. Most observations sessions lasted 4 h.
Investigator shadowed the RN performing clinical duties:

  • Investigator asked participants to “think out loud” and to explain actions, so as to avoid making assumptions about the meaning of events. Probes such as “Tell me about why this piece of equipment is important” or “What will happen if this is not done?” were used to uncover taken-for-granted meanings of RNs' actions.

  • Focus of observations was safety-promoting and safety-challenging actions, interactions and environmental conditions.

  • Investigator gave limited non-technical assistance to RNs such as obtaining supplies, providing comfort measures to labouring women and changing linens.

Field notes were taken openly throughout the observation sessions.