Understanding nurses’ and physicians’ fear of repercussions for reporting errors: clinician characteristics, organization demographics, or leadership factors?

Abstract

BackgroundIdentifying and understanding factors influencing fear of repercussions for reporting and discussing medical errors in nurses and physicians remains an important area of inquiry. Work is needed to disentangle the role of clinician characteristics from those of the organization-level and unit-level safety environments in which these clinicians work and learn, as well as probing the differing reporting behaviours of nurses and physicians. This study examines the influence of clinician demographics (age, gender, and tenure), organization demographics (teaching status, location of care, and province) and leadership factors (organization and unit leadership support for safety) on fear of repercussions, and does so for nurses and physicians separately.MethodsA cross-sectional analysis of 2319 nurse and 386 physician responders from three Canadian provinces to the Modified Stanford patient safety climate survey (MSI-06). Data were analyzed using exploratory factor analysis, multiple linear regression, and hierarchical linear regression.ResultsAge, gender, tenure, teaching status, and province were not significantly associated with fear of repercussions for nurses or physicians. Mental health nurses had poorer fear responses than their peers outside of these areas, as did community physicians. Strong organization and unit leadership support for safety explained the most variance in fear for both nurses and physicians.ConclusionsThe absence of associations between several plausible factors including age, tenure and teaching status suggests that fear is a complex construct requiring more study. Substantially differing fear responses across locations of care indicate areas where interventions may be needed. In addition, since factors affecting fear of repercussions appear to be different for nurses and physicians, tailoring patient safety initiatives to each group may, in some instances, be fruitful. Although further investigation is needed to examine these and other factors in detail, supportive safety leadership appears to be central to reducing fear of reporting errors for both nurses and physicians.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0987-9) contains supplementary material, which is available to authorized users.

Nursing students’ perception of safety in clinical settings: From the quality and safety officer

“…[10] Fear of failing, blame, embarrassment, and guilt are all identified in this study. Another issue that affects only the student is the occasional pressure of not reporting errors from the clinical nurse, as reported in this study.…”

“…Research has documented that leadership support, for the health care providers, including the nursing students, can positively affect safe patient care issues. [10] The clinical instructor can help to bridge the gap between the nursing student and clinical nurse, in order to increase communication.…”

Exploring behavioural determinants relating to health professional reporting of medication errors: a qualitative study using the Theoretical Domains Framework

“…The research was conducted within three major hospitals of the UAE and the findings may not necessarily be transferable to other settings in the UAE, and beyond. Nevertheless, it is likely that the findings will resonate widely, given the acknowledged and demonstrated scale of under-reporting [6][7][8][9][10][11][12][13][14]. Although there were attempts to promote the credibility (i.e.…”

“…A number of studies have employed quantitative approaches (mainly cross-sectional surveys) to research the perspectives of health professionals around medication error reporting [6][7][8][9][10][11][12][13][14]. Key findings are that many factors appear to influence sub-optimal reporting including: lack of awareness of reporting policies; lack of visibility of the reporting processes; disagreement on what constitutes an error worthy of reporting; the effort required to report; lack of any senior role models; and poor communication following reporting.…”

Nurses' experiences with errors in nursing

“…Although nurses are the healthcare professionals who most frequently report errors, many continue to harbor fears about reporting them (Bayazidi, Zraezadeh, Zamanzadeh, & Parvan, 2012;Cook, Hoas, Guttmannova, & Joyner, 2004;Espin, Lingard, Baker, & Regehr, 2006;Hartnell MacKinnon, Sketris, & Fleming, 2012;Osmon et al, 2004;Rowin et al, 2008;Prang & Jelsness-Jorgensen, 2014;Uribe, Schweikhart, Pathak, Dow, & Marsh, 2002). In many institutions, the workplace culture regarding error reporting remains one of blame, and nurses are often concerned about personal repercussions associated with reporting errors (Blair, Kable, Courtney-Pratt, & Doran,2015;Castel, Ginsburg, Zaheer, & Tamin, 2015;Cook et al, 2004;Espin et al, 2006;Jeffe et al, 2004;Stratton, Blegen, Pepper, & Vaughn, 2004;Taylor et al, 2004;Uribe et al, 2002). A better understanding of nurses' decision-making regarding error reporting and workplace factors that influence their decisions can inform the development of strategies to improve the frequency and accuracy of error reporting by nurses.…”