Patient Safety and the Integration of Graduate Nurses Into Effective Organizational Clinical Risk Management Systems and Processes: An Australian Study

Factors influencing newly graduated registered nurses' voice behavior: An interview study

AIM

To gain insight into the factors that affect newly graduated registered nurses' voice behavior.

BACKGROUND

Employees with little work experience may experience difficulties with speaking up. Given that a lack of voice can negatively affect the delivery of safe client care and lower nurses' job satisfaction, it is important to understand which factors facilitate and hinder newly graduated nurses' voice behavior.

METHODS

A qualitative descriptive study was conducted using semi-structured interviews with 17 newly graduated registered nurses working in inpatient hospital settings.

RESULTS

In total, seven factors emerged from our data, which were grouped in four, overarching themes. Whether newly graduated nurses speak up depends on (1) their levels of self-confidence; (2) whether they feel encouraged and welcome to speak up; (3) their relationship with the voice target; and (4) the content of their voice message.

CONCLUSION

Factors that affect newly graduated nurses' voice behavior are multifaceted, but mostly center around time spent in and relationships at the workplace.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers and colleagues can build an environment that fosters newly graduated nurses' voice behavior. Specifically, induction programs, assigning mentors and offering additional training can support newly graduated nurses in developing voice behavior.

Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature

OBJECTIVES

The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting.

DESIGN

To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers.

RESULTS

The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators).

CONCLUSION

A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement.

Exploring the influence of workplace supports and relationships on safe medication practice: A pilot study of Australian graduate nurses

BACKGROUND

Despite the growing awareness of the benefits of positive workplace climates, unsupportive and disruptive workplace behaviours are widespread in health care organisations. Recent graduate nurses, who are often new to a workplace, are particularly vulnerable in unsupportive climates, and are also recognised to be at higher risk for medication errors.

OBJECTIVES

Investigate the association between workplace supports and relationships and safe medication practice among graduate nurses.

DESIGN AND PARTICIPANTS

Exploratory study using quantitative survey with a convenience sample of 58 nursing graduates in two Australian States.

METHODS

Online survey focused on graduates' self-reported medication errors, safe medication practice and the nature of workplace supports and relationships.

RESULTS

Spearman's correlations identified that unsupportive workplace relationships were inversely related to graduate nurse medication errors and erosion of safe medication practices, while supportive Nurse Unit Manager and supportive work team relationships positively influenced safe medication practice among graduates.

CONCLUSIONS

Workplace supports and relationships are potentially both the cause and solution to graduate nurse medication errors and safe medication practices. The findings develop further understanding about the impact of unsupportive and disruptive behaviours on patient safety and draw attention to the importance of undergraduate and continuing education strategies that promote positive workplace behaviours and graduate resilience.

Clinical Governance Infrastructures and Relational Mechanisms of Control in Healthcare Organizations

This review paper aims to identify and discuss the dominant themes surrounding the governance initiatives in the context of medical markets relying on the two most common search strategies, namely the keyword search technique and the ancestry approach. In an in-depth examination of the recently published research in the field we uncover an emergent decoupling between the governance initiatives formulated at the macro- and micro-levels in today’s institutions of healthcare provision. The macro-level initiatives are associated with clinical governance infrastructures directed towards the attainment of medical performance targets, whereas the micro-level endeavors refer to relational governance mechanisms for overseeing the relationship between the patient and the physician. Acknowledging the importance of monitoring micro-level interactions that may contribute to the achievement of macro-level objectives, a more comprehensive integration of relational governance devices under the broader system of clinical governance is advocated in this paper with the purpose of enhancing the effectiveness of healthcare organizations.

Turning mental health nursing problems into quality or research projects

Developing a researchable question or quality improvement project from a broad clinical problem is a key challenge for mental health nurses. In this paper, we provide an overview of some of the steps involved in proceeding from an initial ?problem? within a clinical setting to determining a research question with clear conceptual components that leads to appropriate methods to explore the topic or answer the question. The focus of the proposed quality or research study must be clear to clinicians and potential participants and meet professional responsibilities. Conducting high quality research and quality initiatives will likely improve care and outcomes for mental health consumers as well as providing a reliable evidence-based foundation for further improvements.

Social capital and risk management in nursing

The purpose of the study was to examine the relationship between social capital and clinical risk management in hospitals from nurses' perspective. The results of our investigation suggest that higher values of social capital are associated with better ratings in clinical risk management behavior. An established atmosphere of trust and a feeling of common values and convictions can help nurses integrate clinical risk management into their daily work.