Structural Model of Medication Errors in Clinical Nursing: A Structural Equation Model Based on the Ecological...

Medication errors remain a critical patient safety issue. Although prior research has examined individual and environmental determinants, few studies have investigated their complex interrelationships within an integrated theoretical framework, particularly in clinical nursing practice.

To examine the structural relationships among the nursing work environment, communication with health professionals, fatigue, and medication errors among clinical nurses, grounded in Bronfenbrenner's ecological systems theory.

A cross-sectional study was conducted involving 230 clinical nurses from four tertiary hospitals in South Korea. Data were collected using validated self-report questionnaires measuring the nursing work environment, communication with health professionals, fatigue, and medication errors. Structural equation modeling, supported by confirmatory factor analysis, was used to evaluate direct and indirect pathways and to assess overall model fit.

The proposed model demonstrated acceptable fit (χ²/df = 2.98, RMSEA = 0.08, CFI = 0.93). The nursing work environment exerted a significant direct effect on communication (β = 0.80, p < 0.001), and communication was significantly associated with reduced fatigue (β = -0.78, p = 0.005). Fatigue had a direct effect on medication errors (β = 0.32, p = 0.003), while communication showed both direct and indirect effects on medication errors. The model explained 64.3% of the variance in communication, 45.4% in fatigue, and 29.8% in medication errors.

A supportive nursing work environment facilitates effective interprofessional communication, which in turn mitigates fatigue and reduces medication errors. Communication functions as a key mediating mechanism within this structural pathway.

To reduce medication errors, nurse managers should prioritize fostering positive work environments, implementing structured communication protocols, and establishing systematic fatigue management strategies. Such organizational initiatives may enhance communication efficiency and strengthen patient safety outcomes.