Proactive RN Behavior - A determinant in improving patient safety

Purpose:
The purpose of this research study was to examine the determinants that influence a RN to take action within their scope of practice in situations that pose an imminent safety risk for patients.

Background/Significance:
The IOM Reports challenge health care facilities to adopt practices developed by High Reliability Organizations (HROs).Employees in HROs are empowered to take action when a safety risk is detected. While the value that RNs play in detecting safety issues is undisputed, the determinants that allow an RN to take action and mitigate risk in the clinical environment is unknown. The aim of this research is to describe the determinants that influence an RNs ability to act in these high risk events.

Methods:
Using a model of employee decision making by James Thompson, an internet based questionnaire was developed assessing the independent variables - education level, propensity for proactive behavior (proactive behavior scale), and perceptions of transformational leadership (MLQ scale). The dependent variable, decision to act when a safety issue is detected, was measured using three clinical vignettes developed in conjunction with two clinical nurse specialists. Participant recruitment was conducted at a 500+ bed academic hospital amongst RNs employed on adult medical surgical units. A total of 111 RNs completed the questionnaire. Logistic regression was used to analyze the data.

Results:
Of the 111 RNs who responded to the questionnaire, when faced with an imminent patient safety risk all would notify the MD and 73 (65.8%) of the participants indicated they would take action within their scope of practice. The research model examining the determinants that would influence the RN to take action was significant at the 95% confidence level (p = .05). The only significant independent variable was propensity for proactive behavior (p = .05). The odds ratio was 1.91 indicating a positive correlation. The Cox and Snell R Square was .723 indicating a strong predictive relationship between these two variables.

Conclusions and Implications for Practice:
Propensity for proactive behavior can be encouraged in the work environment by promoting competency, co-worker trust and demonstrating leadership support. This study suggests that developing the propensity for proactive behavior in RN staff is necessary for cultivating safety environments.