Organizational Safety Climate, Nurse Staffing, and Work-Related Nurse Injury

We sought to augment previous studies by exploring the relationship between nurse injury, nurse perceptions of organizational patient safety culture, and selected characteristics of the nursing unit. This study used the Safety Attitudes Questionnaire (SAQ), a survey which elicits frontline healthcare workers' perceptions of their organization's safety culture at their unit level.

The SAQ was used in this study because, of nine surveys measuring the patient safety climate of an organization, only the SAQ has been used to explore the relationship between safety climate scores, patient outcomes, and nurse turnover.

The study defined nurse injury to include a needle stick, splash, slip, trip, or fall occurring during 2005. Seventy-eight of 737 nurses experienced an injury of this type. The outcome was expressed as an odds ratio comparing nurses with injuries to those without.

For each nursing unit, the main explanatory variables consisted of turnover, nursing hours per patient day, and the SAQ domains of Stress, Safety, and Morale.

A two-fold increase in the odds of nurse injury with each 10% increase in the turnover rate was observed (OR: 1.92, p<0.05). The odds of nurse injury also increased with increasing Stress Recognition as assessed through the SAQ (OR: 3.47, p<0.001). Conversely, the odds of nurse injury decreased with increasing agreement on the Safety (OR: 0.61, p<0.05) and Morale (OR: 0.73, p<0.05) scales of the SAQ.

The SAQ traditionally has demonstrated associations between organizational safety climate and patient injuries. This study extends the utility of the SAQ to nurse injury.