Evaluating the Adverse Event Decision Pathway: A Survey of Canadian Nursing Leaders

Background: Worldwide, nursing regulatory bodies (NRBs) use the regulatory process to ensure the competency and fitness of nurses to practice; however, it is nurse executives who ensure the standard of care in clinical settings and promote cultures of safety. Purpose: The purpose of this study is to identify barriers to adverse event reporting and to evaluate the National Council of State Boards of Nursing's new Adverse Event Decision Pathway (AEDP) tool, which was developed in collaboration with the American Organization for Nursing Leadership. Methods: Nursing leaders in British Columbia and Ontario, Canada, were surveyed between May and November 2019 before and after receiving the AEDP tool. Generalized estimating equation models were used to assess changes in adverse event reporting frequency. Results: The pre- and postsurvey response rates were 21% (663/3,155) and 34% (125/369), respectively. At baseline, director of nursing (30.6%) and nurse manager (22.1%) were the most common professional titles reported. Concern over possible legal ramifications (23.8%), knowing what constitutes a reportable offense (21.0%), knowing how to make a report (19.8%), and facility culture/policy (15.1%) emerged as reporting barriers. After the introduction of the AEDP tool, participants were 2.29 times (95% CI = 1.27-4.11) more likely to report that a nurse was terminated due to their role in a serious adverse event (p = .01). Conclusion: Nurse executives regularly encounter barriers to adverse event reporting. The AEDP is an evidence-based tool that can be used to support facility decision-making and facilitate adverse event reporting to NRBs, which enhances patient safety globally.