UCLA

Objective. Healthcare’s efforts to prevent adverse events include initiatives to encourage adverse event reporting so it becomes possible to explore causes and prevent recurrence. However, the current climate of significant underreporting of adverse events by healthcare providers curtails the opportunity to explore preventable medical errors, improve system care delivery processes, and achieve better patient outcomes. The purpose of this study was to investigate the relationship between structural and psychological empowerment elements and nurses’ reporting of adverse events including near-misses, event has no potential to harm the patient and event could harm the patient but does not. This study also examined nurses’ identification of different types of adverse events, their intention to report each type, and whether their professional characteristics (education level, work role, staff position, specialty nursing certification, and professional society membership) are related to nurses’ adverse event reporting. Methods. A cross-sectional survey study among nurses in a large academic, tertiary and quaternary referral medical system in the Southwest region of the United States of America. Kanter’s described elements of organizational empowerment (opportunity, information, support, resources, formal power and informal power), measured by the Condition of Work Effectiveness Questionnaire (CWEQ-II) were compared to adverse event reporting. Spreitzer’s Psychological Empowerment Instrument (PEQ), a 12-item scale with three items for each of the four dimensions (meaning, competence, self-determination and impact) was used to compare psychological empowerment to nurses’ reporting of adverse events. Specific questions from the Hospital Survey of Patient Safety Culture (HSOPSC) developed by the Agency for Healthcare Research and Quality (AHRQ) were used to measure nurses’ reporting of adverse events. The variables analyzed from the HSOPSC survey included: 1) the overall number of events reported by participants in the past 12 months, and 2) three questions measuring nurses’ perception of how frequently (never/rarely, sometimes, most of the time, and always) three types of events (near-missed, event with no potential for harm, and event that could harm the patient but does not) are reported on their units. Results. Study findings indicate no statistically significant association between the number of incidents that participants reported and any of the CWEQ-II and PEQ subscales. All CWEQ-II outcomes with the exception of access to opportunity showed an overall significant difference between categories of frequencies of the three types of adverse event reported (near-missed incident, events with no potential harm, and events with potential harm but did not). Among the four elements of psychological empowerment measured with the PEQ, “impact” consistently shows a significant difference in nurses’ perception of how frequently the three types of adverse events are reported. When provided clinical scenarios with five levels of harm (omission, near miss, no harm, reversible harm, and irreversible harm), participants indicated they would report the event when they were in “strong agreement” with their determination that the scenario was viewed as an adverse event. Nurses’ professional characteristics, level of education, work role, level of nursing practice and certification status play a role in nurses’ reporting of adverse events. Implications and Conclusion. Organizational and nursing leaders should construct a supportive environment that fosters adverse event reporting among nurses. Nurse leaders should cultivate a work environment that improves nurses’ empowerment and autonomy, such as shared-governance, which could promote creating evidence-based strategies for delivering safe patient care. Nurse educators can provide a curriculum that emphasizes quality improvement to build a foundation of knowledge and skills needed to implement quality improvement methodologies. Unit directors can encourage nurses to participate in process improvement projects to champion the drive for better patient outcomes. Nursing professional education should emphasize that errors of omission and near-missed events are indeed adverse events and should be reported as opportunities for system improvement. Our findings provide a glance into the needed elements, tailored to special professional characteristics to be taken into consideration when constructing such programs.