Effects of Individual Nurse and Hospital Characteristics on Patient Safety and Quality of Care

Aim: The aim of the study was to investigate the effects of individual nurse and hospital characteristics and their interactions on patient adverse events and quality of care using a multilevel approach. Background: Because nurses constitute the major workforce in healthcare systems, they are key potential contributors to enhancement of patient safety and quality of care. Therefore, researchers have investigated factors affecting nursing care and have suggested that both individual nurse and organizational characteristics can play a significant role in patient safety and quality of care. However, the relative contribution of these characteristics remains unclear. Methods: Based on a multilevel conceptual framework, data for 1,053 Canadian nurses who provided direct care to patients in acute care hospitals were analyzed using multilevel modeling. Results: The study revealed that organizational safety culture was significantly associated with three types of patient adverse events as well as quality of care. Controlling for the effects of nurse and hospital characteristics, nurses in hospitals with stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections than nurses in hospitals with weaker safety culture. In addition, nurses who worked in hospitals with a stronger safety culture were significantly more likely to report higher levels of quality of care in their hospitals. Additional analyses showed that the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals. Among hospital characteristics, only hospital-level nurse education interacted with individual-level baccalaureate education. No significant interaction was found between individual-level nurse experience and hospital-level variables. Conclusions: This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. With the current healthcare emphasis on continuous quality improvement, healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers can trust each other, work collaboratively, and share accountability for patient safety and quality of care.