Graduate nurse views on patient safety: Navigating challenging workplace interactions with senior clinical nurses

Abstract

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).

Speaking up about patient safety concerns: view of nursing students

“…On the other hand, a hierarchical system, which was already identified in previous studies is a common barrier for students to transform knowledge into practice [ 14 ]. Evidence exists that bullying in the workplace remains an issue [ 20 ]. The key to success is the importance of respectful interpersonal relationship between health professionals, mentorship between senior nurses and students or graduates [ 20 ].…”

“…Evidence exists that bullying in the workplace remains an issue [ 20 ]. The key to success is the importance of respectful interpersonal relationship between health professionals, mentorship between senior nurses and students or graduates [ 20 ].…”

“…Furthermore, teamwork and communication have an impact on problem-based and reflective learning and consequently, on critical thinking or problemsolving skills [17,19]. Lower levels of collegial support increase the likelihood of errors which has a negative impact on patient safety [20].…”

Nurse leader agency: Creating an environment conducive to support for graduate nurses

“…Of concern, GNs have been found to be largely uncomfortable in approaching senior nurse colleagues for support (Sahay & Willis, 2021). GNs have identified their need for support through effective mentorship (Laschinger et al, 2010) and rely on more experienced nursing colleagues for guidance (Sahay et al, 2015).…”

“…GNs have identified their need for support through effective mentorship (Laschinger et al, 2010) and rely on more experienced nursing colleagues for guidance (Sahay et al, 2015). Nevertheless, some studies indicate that GNs do not seek support from other nurses if the colleague's behaviour is not conducive to learning (Laschinger et al, 2010; Sahay & Willis, 2021). This is where the NL role becomes paramount in fostering a culture of support and collaboration.…”