Effects of Learning Climate and Registered Nurse Staffing on Medication Errors

The Journal of nursing administration (Impact Factor: 1.27). 07/2011; 41(7-8 Suppl):S6-13. DOI: 10.1097/NNA.0b013e318221c213
Source: PubMed


Despite increasing recognition of the significance of learning from errors, little is known about how learning climate contributes to error reduction.
The purpose of this study was to investigate whether learning climate moderates the relationship between error-producing conditions and medication errors.
A cross-sectional descriptive study was done using data from 279 nursing units in 146 randomly selected hospitals in the United States. Error-producing conditions included work environment factors (work dynamics and nurse mix), team factors (communication with physicians and nurses' expertise), personal factors (nurses' education and experience), patient factors (age, health status, and previous hospitalization), and medication-related support services. Poisson models with random effects were used with the nursing unit as the unit of analysis.
A significant negative relationship was found between learning climate and medication errors. It also moderated the relationship between nurse mix and medication errors: When learning climate was negative, having more registered nurses was associated with fewer medication errors. However, no relationship was found between nurse mix and medication errors at either positive or average levels of learning climate. Learning climate did not moderate the relationship between work dynamics and medication errors.
The way nurse mix affects medication errors depends on the level of learning climate. Nursing units with fewer registered nurses and frequent medication errors should examine their learning climate. Future research should be focused on the role of learning climate as related to the relationships between nurse mix and medication errors.

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    • "A 'richer' skill mix, with higher proportions of care provided by registered nurses, is associated with improved outcomes for medical patients; observational studies show lower failure to rescue rates [23], in-patient mortality [24] and 30-day mortality [25] [26], and improved patient satisfaction [27]. Improving skill mix may be the least expensive of the options available to improve nurse staffing [28], although a good learning climate on the ward may also mitigate the impact of a poor skill mix [29]. Although a detailed discussion of nurse training lies outside the scope of this review, it is important to note that nurse education may also impact on patient outcomes. "
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