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BackgroundMedication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already‐strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs.ObjectiveExamine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings.MethodArksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue.ResultsThirty‐eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies.Relevance to clinical practiceFatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re‐evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care.

Aim and objective: To explore and understand the negative experiences of graduate nurses' interaction with senior nurses and the implications for safe patient care.Background: Patient safety is dependent on the nursing care they receive. Working in environments where there is reduced collegial support and increased emotional distress, increases the likelihood of nurses making errors that may negatively impact on patient outcomes. Insights drawn from graduate nurses' negative interactions with senior nurses may provide an understanding of the impact of nurse-to-nurse interactions on patient safety outcomes.Methods: A qualitative exploratory descriptive design was used. A purposive sample of 18 graduate registered nurses participated in this study. Semi-structured interviews were conducted, audio-recorded and transcribed verbatim. Data were thematically analysed. The COREQ checklist was followed. Results:The overarching theme, 'Navigating workplace challenges' was identified with two sub-themes: Processing unsupportive nurse behaviour and responding to nurse deviations from best practice. Common deviations in practice included erosion of safe medication practice, wound care and non-compliance with universal precautions. Graduate nurses also observed unsafe workplace practice, however, were hesitant to speak up due to fear of retribution. Unsupportive behaviours impacted on their critical thinking ability, follow-up interactions with other nurses and subsequent delivery of patient care. Conclusion:Quality and safety strategies should not ignore and/or overlook the impact of interpersonal relationships on patient safety and risk. Strategies for delivering evidence-based, safe and quality care to patients go beyond the establishment of standards and technically focussed management strategies.Relevance to clinical practice: It is vital to examine the quality of working relationships between all levels of healthcare professionals including graduate nurses and their supervisors to ensure supportive behaviours prevail in advancing delivery of quality care within the practice environment. The study alludes to the fact that disruptive workplace behaviours are more hierarchical than horizontal (i.e., graduate nurse-to-graduate nurse).

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