An analysis of nursing error among licensed nurses working in North Carolina using the taxonomy of error root cause analysis and practice responsibility database

Healthcare error is a persistent challenge for clinicians, administrators, regulators, and policy makers. Researchers argue that the number of errors originally cited by Institute of Medicine’s (IOM) landmark report, To Err is Human: Building a Safer Health System (1999) were grossly underestimated and that despite concerted efforts aimed to mitigate error in healthcare settings, error remains a persistent and difficult problem to combat. Given the pervasiveness of this phenomenon, informed research is needed to discover why errors persist; informing interventions expressly created to reduce the incidence of error. Nurses are the largest provider of healthcare services in the United States (U.S. Bureau of Labor Statistics, 2013), and their surveillance across all healthcare settings is critical in efforts to improve patient safety by reducing errors. The purpose of this study was to examine the association of demographic and environmental factors on the prevalence of nursing errors resulting in patient harm among licensed nurses who violated the North Carolina Nursing Practice Act (NC NPA) between years 2011 and 2015. Exploration of nurse error through analysis of existing data from the Taxonomy of Error Root Cause Analysis and Practice Responsibility (TERCAP) database was important to identify patterns of error, risk factors, and systems issues that have contributed to practice breakdown. This cross-sectional study was guided by the Organizational Accident Causation Model. The model explains how latent and active failures contribute to the work conditions facilitating unsafe acts to occur. Nurse demographics (age, gender, educational preparation, and nursing tenure), organizational factors (shift worked, work environment, and history of prior employer discipline) and commission of a medication error (active failure) were assessed for their association with error resulting in patient harm through Chi-square tests and logistic regression (N=544). Findings revealed that error resulting in patient harm and commission of a medication error resulting in patient harm was significantly associated with the variables of age and work environment. Results also revealed that nurses = 50 years of age were found to be significantly associated with commission of a medication error that resulting in patient harm. Gender and work environment were found to be significant predictors of error resulting in patient harm with male nurses have lower odds of committing error resulting in patient harm than female nurses. Nurses who worked in ‘other’ work environments (non-traditional work settings) had lower odds of committing error resulting in patient harm when compared with nurses working in the hospital setting. Nurses working in ‘other’ work environments also had lower odds of committing medication errors resulting in patient harm when compared with nurses who worked in hospital settings. This study’s examination of relationships among organizational work environment factors, nurse demographics, and error resulting in patient harm among nurses practicing in North Carolina has implications for nursing regulation and clinical practice. Study findings provided nurses working in direct care roles information for consideration as they engage in their self-reflective activities to evaluate and enhance their personal practice while meeting continuing competence requirements of the state of North Carolina. Findings can serve as a catalyst for enhanced information sharing between nurse employers and the North Carolina Board of Nursing regarding remediation efforts for suspected violations of the Nursing Practice Act and nursing administrators can utilize findings to provide their staffs with focused education on contributing factors to nursing error while also evaluating work environments with a fuller appreciation of the needs of older nurses