Patient Safety Culture and Barriers to Adverse Event Reporting: A National Survey of Nurse Executives

Introduction Although boards of nursing (BONs) ensure nurse competency and fitness to practice through the regulatory process, it is nurse executives who enforce the Nurse Practice Act and standards of care in the clinical setting. As such, it is a nurse executiveu0027s responsibility to uphold the culture of safety. Aims To better understand nursing executivesu0027 current protocols for reporting serious adverse events to state BONs and to identify potential reporting barriers. Methods A national survey was administered to members of the American Organization of Nurse Executives and the National Association of Directors of Nursing Administration in January 2018. The study collected demographic and professional data, as well as health facility information and practice related to serious adverse event reporting. Analysis included a descriptive summary and univariable and multivariable ordinal logistic regression models to examine drivers of and barriers to serious adverse event reporting. Results A total of 441 participants completed the survey. Respondents included directors of nursing (35.6%), chief nursing officers (21.5%), chief nursing executives (17.2%), and nurse managers (9.1%). There was broad coverage across U.S. Census regions: South (33.9%), Midwest (30.8%), Northeast (19.1%), and West (16.2%). Executives who are aware of state BON guidelines ( OR = 2.52, 95% CI: 1.56 – 4.09, p OR = 1.73, 95% CI: 1.10 – 2.72, p = .02), and express satisfaction with said policy ( OR = 1.39, 95% CI: 1.11 – 1.74, p = .004) are significantly more likely to report a violation of the Nurse Practice Act to their state BON. Difficulty knowing what is reportable ( OR = 0.30, 95% CI: 0.19 – 0.49, p OR = 0.39, 95% CI: 0.22 – 0.69, p OR = 0.48, 95% CI: 0.28 – 0.84, p = .01), and facility culture ( OR = 0.26, 95% CI: 0.13 – 0.52, p Conclusion Nurse executives encounter barriers to BON reporting. Additional resources to align facility practice related to nurse discipline are needed. Ongoing BON education and outreach will help facilitate serious adverse event reporting, which can enhance patient safety.