Work stress and patient safety: Observer-rated work stressors as predictors of characteristics of safety-related events reported by young nurses

Abstract

This study investigates the link between workplace stress and the 'non-singularity' of patient safety-related incidents in the hospital setting. Over a period of 2 working weeks 23 young nurses from 19 hospitals in Switzerland documented 314 daily stressful events using a self-observation method (pocket diaries); 62 events were related to patient safety. Familiarity of safety-related events and probability of recurrence, as indicators of non-singularity, were the dependent variables in multilevel regression analyses. Predictor variables were both situational (self-reported situational control, safety compliance) and chronic variables (job stressors such as time pressure, or concentration demands and job control). Chronic work characteristics were rated by trained observers. The most frequent safety-related stressful events included incomplete or incorrect documentation (40.3%), medication errors (near misses 21%), delays in delivery of patient care (9.7%), and violent patients (9.7%). Familiarity of events and probability of recurrence were significantly predicted by chronic job stressors and low job control in multilevel regression analyses. Job stressors and low job control were shown to be risk factors for patient safety. The results suggest that job redesign to enhance job control and decrease job stressors may be an important intervention to increase patient safety.

A Daily Diary Approach to the Examination of Chronic Stress, Daily Hassles and Safety Perceptions in Hospital Nursing

“…By demonstrating associations between nurse perceptions of chronic stress, daily hassles and safety perceptions, our findings support previous research reporting relationships between stress and error, and quality and safety issues within hospital nursing [e.g., 28,31,34]. However, much of the previous research which has examined associations between stress (and burnout) and patient safety, has adopted a between-person approach, so we know little about these relationships at the individual level.…”

“…Nonetheless, a small number of studies have utilised a within-person approach, for example, one such study found work stressors (e.g., time pressure) which were observer-rated, to predict safety-related event characteristics [34].…”

Patient safety and job-related stress: A focus group study

“…A stressful milieu in addition to enormous work pressures can also result in decreased patient safety (Carayon and Gurses, 2005). This has been confirmed in a study by Elfering et al (2006) that shows a direct correlation between stressful work situations and the safety of patients.…”

“…This type of working environment, which is demanding and which the nurses feel they have little control over, is perceived as stressful. A recent study has shown that minimal control over a work situation can increase the risk factors for patient safety (Elfering et al, 2006).…”

“…We have found that a work environment consisting of high demands combined with a lack of individual control was perceived as stressful to nurses. Work situations such as this could also effect patient safety (Elfering et al, 2006).…”