The Courage of One's Conviction: When Do Nurse Practitioners Report Unsafe Practices?

Abstract

When and why do nurses report unsafe patient practices when they see them? This paper adds to our understanding of the characteristics of health care practitioners who report errors and their environment by introducing role identity as an important concept for understanding this communication behavior. We analyzed the results of a national survey of 330 nurses to address three questions: (1) What factors are associated with nurses stating that they have observed tolerance for unsafe practices; (2) what fosters reporting of unsafe practices; and (3) what is the impact on nurses' commitment to the organization and the profession as a result of observing unsafe practices? Results suggest that the probability of reporting unsafe practices increases as the frequency of unsafe practices increases; this relationship is moderated by nurse role identity and supervisory support for reporting. The probability of reporting of unsafe practices also increases when nurses have a strong role identity and strong organizational role identity. Surprisingly, the highest probability for reporting occurs when both organization and nurse role identities are low. Finally, we examine how risk propensity influences reporting and discuss potential strategies for improving reporting of unsafe practices.