Determining managerial implications from the relationship between nurse outcomes and medication safety

Abstract

Background: Previous research has been conducted on the relationships between nurse outcomes and patient safety outcomes, mostly focussing on the influence of negative nurse outcomes on patient safety aspects such as medication errors. However, there is no summary of evidence to comprehensively describe the interrelatedness of negative nurse outcomes and medication safety, from which managerial implications for betterment of these outcomes could be derived. Objectives: The primary objective of this study was to derive managerial implications for the improvement of nurse outcomes and medication safety by exploring and describing the relationship between negative nurse outcomes and medication errors. Design: A systematic review was chosen as study design. Search strategy: The following databases were used as information sources: EbscoHost (Including Academic Search Premier; CAB Abstracts; CINAHL; E-journals; Health Source Premium; International Pharmaceutical Abstracts; MasterFILE Premier; MEDLINE; PsycARTICLES and PsycINFO); PubMed; Scopus; and Web of Science. Peer-reviewed English studies published between 2013 and 2017 addressing the relationship between negative nurse outcomes (bullying and incivility, compassion fatigue, burnout, lack of job satisfaction and intent to leave) and medication errors were searched. These studies were critically appraised using the Johns Hopkins Research Evidence Appraisal Tool and the Critical Appraisal Skills Programme Tool for Qualitative Studies. Data extraction: Both quantitative and qualitative data pertaining to the research question were extracted from included studies. Data synthesis: Mixed methods analysis was incorporated. Quantitative data was firstly converted to qualitative data to be able to conduct thematic content analysis. After themes, based on negative nurse outcomes, were finalised, statistical support for relationships between nurse outcome themes and medication safety was provided. A forest plot was derived from odds ratios describing the correlation between burnout and medication safety. Furthermore, histograms were presented to compare the beta coefficients and effect sizes related to other nurse outcome themes as extracted from studies. Results: Thirteen (13) articles were included for data extraction. Themes for relationships between medication safety and all mentioned nurse outcomes were derived, including bullying and incivility, compassion fatigue, burnout, job satisfaction, and intent to leave. The two-directional relationship between medication safety and all nurse outcomes except for compassion fatigue was supported by the findings. Results of this study showed that medication errors contribute to causing symptoms of compassion fatigue while the causative impact of compassion fatigue on medication errors was not confirmed from included studies’ data. In determining managerial implications from these results, three mega-themes for the manager to focus on in mitigating the effects of medication errors and negative nurse outcomes were identified, namely nurses’ inner conflict, nurses’ relational conflict and nurses’ conflict with systems. Conclusion: Five elements should be addressed by managers to better both medication safety and nurse outcomes, viz. resolution efforts, affirmation, teamwork, social support and training. A focus on the nurses’ practice environment might assist managers in mitigating both medication errors and negative nurse outcomes, which will respectively positively impact on each other as well