Title: Nurse recognition and response to unsafe practice by their peers
Abstract:
Introduction: Internationally, nursing regulatory bodies have introduced practice standards in an attempt to manage unsafe practice. Despite this, unsafe practices still occur and the identification and management of them remains an issue for the nursing profession. Few studies have sought to identify how unsafe practice is recognised and responded to by nurses. Nurses’ recognition and response to unsafe practice by their peers is crucial to the improvement of patient outcomes and safety. Nurses need to be aware of behaviours, cues and factors that indicate unsafe practice so that they can prevent harm to patients by implementing interventions that stop practices that breach the safety boundary.
Aim: This study aimed to identify the behaviours and cues that registered nurses recognised as indicating unsafe practice, the factors perceived to influence the occurrence of unsafe practice, and the actions and responses made by nurses when they encountered unsafe practice. Organisational policies and processes for reporting and prevention of unsafe practice, and the prevalence of unsafe practice amongst New Zealand Registered Nurses were explored.
Methodology: This study used a sequential explanatory mixed method design underpinned by Critical Realism. The study consisted of three phases, in phase one qualitative interviews were used to gather preliminary data to develop the Phase two cross-sectional survey instrument and interview questions for phase three. A qualitative descriptive approach was used to analyse qualitative data. Quantitative data were analysed using SAS v9.4.
Results: Sixty-six percent of nurses in this study reported working with a colleague they felt was practicing unsafely in the previous 12 months. Nurses in this study identified a range of behaviours, cues, contributing factors and responses to unsafe practice. Organisational issues perceived to contribute to the occurrence of unsafe practice were also identified. Themes of uncertainty, sensing unsafe practice and disrupted professionalism emerged from the qualitative data.
Conclusion: Recognising and responding to unsafe practice was described by participants to be fraught with uncertainty. Participants reported being uncertain about what constituted unsafe practice and what level of evidence was required before they could take action. The reported rate of unsafe practice was higher in this study than in other international research. Understanding the challenges faced by nurses is key to understanding how unsafe practice can be further addressed in clinical practice. This presentation outlines key findings and learning from this study.
Audience Take Away Notes:
• Behaviours and cues identified in this study should alert clinicians and managers to the potential for unsafe practice
• The perceived contributing factors identified are areas that clinicians and managers could focus on to support safe practice
• Early recognition and intervention should aim to intervene to support the nurse to improve their standard of practice and reduce the risk of harm to patients
