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Nurses' perspectives of recognising and responding to unsafe practice by their peers: a national cross-sectional survey.

AIMS
This study aimed to identify behaviours and cues that nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and actions nurses take in response.


DESIGN
Cross-sectional survey.


METHODS
National cross-sectional survey of a random sample of Registered Nurses (n = 231) in New Zealand, in 2017-2018. The STROBE Checklist was used to report this study.


RESULTS
Nurses reported a high rate of episodes of unsafe practices and recognised a range of behaviours and cues that alerted them to the potential for unsafe practice. Several organizational issues were perceived to contribute to unsafe practice occurring. The reporting of episodes of unsafe practice and perceived organisational support was low for nurses compared to managers.


CONCLUSION
Failure to recognise and respond to unsafe practice may indicate a tolerance for substandard practice by individual nurses, or by the organisation. Nurses who recognise unsafe practice must be supported by the organisation.


IMPACT
What problem did the study address? This study measured practicing nurses' recognition of, and response to unsafe practice by their peers. What are the main findings? Sixty-six percent of participants reported working with a colleague they felt was practicing unsafely. High workloads, poor teamwork, poor skill mix, and poor organisational culture were identified as contributing to unsafe practice. The reporting rate of unsafe practice was low. Where and on whom will the research have an impact. Creating awareness of the prevalence of unsafe practice informs the profession about the magnitude of the problem and associated issues. Study results can be used by regulatory authorities and health care organisations to develop policies about recognising and responding to unsafe practice. Organisational responses should be non-punitive and should include an investigation and action to prevent further occurrences.