Organizational factors: impact on administration violations in rural nursing

This paper reports a study investigating organizational factors contributing to procedural violations by nurses during medication administration.

Health care is not as safe as it could be, with research indicating that errors involving medications are a leading cause of unintended harm to patients. In the safety literature, strong claims are made about the connection between violation of procedures and adverse occurrences but, in the healthcare field in particular, there is limited empirical evidence that can serve as a basis for understanding why workers deviate from established procedures.

Quantitative and qualitative data were collected by questionnaire in 2002 to 627 nurses working in rural and remote areas in Queensland, Australia. The response rate was 31%. The data were used to build a model that shows how organizational variables can produce conditions that improve work practices that fall short of best practice standards.

The statistical model accounted for a reliable 19% of the variance in self-reported violations. A higher level of knowledge was found to be associated with lower levels of violations. Conversely, higher workloads and higher expectations by doctors were associated with a higher incidence of violations. Qualitative comments tended to support the conclusions drawn from the model and helped to explain the observed associations.

Attempts to deal with deviations from work procedures through interventions such as retraining or disciplinary action are likely to be ineffective unless they take a more holistic management approach aimed at the individual, the team, the task, the workplace, and the institution as a whole and are directed at the weaker points in the system. These interventions may take the form of training programmes, systems redesign, or the injection of resources. The costs of providing adequate resources to a healthcare system are likely to be offset by savings gained through worker productivity, and better patient outcomes.