Implicit as compared with explicit safety procedures: the experiences of Israeli nurses

Area of Science:

• Healthcare Management
• Occupational Safety
• Nursing Practice

Background:

• Traditional approaches to enhancing nurse safety through rule compliance and training yield limited success.
• Effective implementation of safety guidelines, rather than their mere existence, is crucial for reducing injuries.

Purpose of the Study:

• To investigate nurses' implicit safety theories regarding compliance with safety rules.
• To understand the underlying reasons for nurses' adherence or non-adherence to safety protocols.

Main Methods:

• A multimethod approach was employed, combining semistructured interviews, direct observations, and analysis of documentary evidence.
• Data were collected from 15 nursing units, involving 90 nurses.

Main Results:

• Nurses develop implicit rules for self-protection, such as prioritizing patient care over personal safety.
• These implicit rules include not disturbing colleagues, underestimating personal risk, and being influenced by recent accidents or the presence of others.
• Personal, social, and unit-level contextual factors reinforce these implicit rules, obscuring their potential flaws.

Conclusions:

• Nurses' implicit safety theories significantly impact their safety behaviors, often overriding formal guidelines.
• Understanding and addressing these implicit theories is essential for improving the implementation of safety practices in nursing.
• Healthcare organizations must consider these unwritten rules to effectively enhance nurse safety and reduce workplace injuries.