Patient Safety Culture and Barriers to Adverse Event Reporting: A National Survey of Nurse Executives


      Although boards of nursing (BONs) ensure nurse competency and fitness to practice through the regulatory process, it is nurse executives who enforce the Nurse Practice Act and standards of care in the clinical setting. As such, it is a nurse executive’s responsibility to uphold the culture of safety.


      To better understand nursing executives’ current protocols for reporting serious adverse events to state BONs and to identify potential reporting barriers.


      A national survey was administered to members of the American Organization of Nurse Executives and the National Association of Directors of Nursing Administration in January 2018. The study collected demographic and professional data, as well as health facility information and practice related to serious adverse event reporting. Analysis included a descriptive summary and univariable and multivariable ordinal logistic regression models to examine drivers of and barriers to serious adverse event reporting.


      A total of 441 participants completed the survey. Respondents included directors of nursing (35.6%), chief nursing officers (21.5%), chief nursing executives (17.2%), and nurse managers (9.1%). There was broad coverage across U.S. Census regions: South (33.9%), Midwest (30.8%), Northeast (19.1%), and West (16.2%). Executives who are aware of state BON guidelines ( OR = 2.52, 95% CI: 1.56 – 4.09, p < .001), have a policy in place ( OR = 1.73, 95% CI: 1.10 – 2.72, p = .02), and express satisfaction with said policy ( OR = 1.39, 95% CI: 1.11 – 1.74, p = .004) are significantly more likely to report a violation of the Nurse Practice Act to their state BON. Difficulty knowing what is reportable ( OR = 0.30, 95% CI: 0.19 – 0.49, p < .001), how to file a report ( OR = 0.39, 95% CI: 0.22 – 0.69, p < .001), concern over legal ramifications ( OR = 0.48, 95% CI: 0.28 – 0.84, p = .01), and facility culture ( OR = 0.26, 95% CI: 0.13 – 0.52, p < .001) are significant barriers to BON reporting.


      Nurse executives encounter barriers to BON reporting. Additional resources to align facility practice related to nurse discipline are needed. Ongoing BON education and outreach will help facilitate serious adverse event reporting, which can enhance patient safety.


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      Brendan Martin, PhD, is a Research Scientist, Nursing Regulation, National Council of State Boards of Nursing (NCSBN), Chicago, Illinois.


      Kyrani Reneau, MA, is a Research Coordinator, Nursing Regulation, NCSBN.


      Laura Jarosz is an Associate, Nursing Regulation, NCSBN.