The impact of workplace relationships on nurse-reported quality of care and patient safety in the North West Province

Abstract

Aim and objectives: This study aims to investigate the impact of workplace relationships on nurse-reported quality of care and patient safety. Background: There is a direct link between workplace relationships between nurses and physicians, their managers and nurse colleagues, and improved patient outcomes. However, there is a dearth of literature on this in developing countries. Design: This study applied a cross-sectional survey design. Method: A multilevel sampling method was applied. Purposive sampling was applied to the selection of the province, health sector and hospitals (n=3). All-inclusive sampling was applied to in-patient units of the selected hospitals and nursing staff in those units (n=236). Data was collected in April 2021 using validated instruments. Findings: Nurse managers’ ability, leadership, and support were not experienced as positively contributing to the practice environment and had most impact on quality of care and patient safety. Collegial nurse physician relationships were experienced as contributing positively to the practice environment, and had most impact on adverse events, namely medication errors, patient falls after admission and healthcare-associated infections. Increased exposure to COVID-19 patients resulted in more positive perceptions of nurses regarding collegial nurse-physician relationships. The most common perpetrators of workplace violence (WPV) were supervisors/managers, followed by nursing colleagues. On average participants experience more personal WPV than physical WPV. Personal WPV had more effect on quality of care and patient safety, and adverse events than physical WPV. Conclusions: Positive workplace relationships or collegiality, especially nurse-manager relationships, appear to have the most impact on nurse-perceived quality of care and patient safety, followed by nurse-physician relationships, and then workplace violence. Relevance to clinical practice: The focus of education interventions should be on developing leadership, and recruiting and retaining relationship-focused leaders, as leaders have the greatest impact on nurse-reported quality of care and patient safety.