A total of 1,825 nurses (1,762 females, 97.5%) participated in the study, 0.8% of professionally active Polish nurse. Nurses’ average age was 44.15 years (SD=10.27). The youngest participant of the survey was 22 years old, and the oldest 69 years old. Participants had worked as nurses for 21.89 years on average (SD=11.39), ranging from 0.5 years to 50 years. The average length of service on the nursing position in the hospital where a nurse was employed at the time of the research was 17.85 years (SD=11.76). Among responding nurses, 498 (27.3%) assessed patients' safety in the ward where they worked at a high level, 926 (50.7%) at a medium level, while 401 (22.0%) at a low level.
During their most recent shift in the ward there were 30.68 patients on average (SD=13.01), nurses were directly responsible for 18.37 patients on average (SD=11.28), 9.98 patients on average required assistance in all daily activities (SD=7.6), and 5.97 patients on average required monitoring or treatments every hour or more frequently (SD=5.64). The characteristic of work load based on the number of patients under care during the most recent shift is presented in Figure 1.
Patient safety and working conditions
Amongst the respondents, 65.4% of the surveyed group rated working conditions as excellent, 32.1% of as good, and 12.4% in the group declaring an unsatisfactory grade. The analysis of the research showed that there was an association between overall assessment of working conditions and overall assessment of safety (p<0.001). In the opinion of nurses, higher positive ratings of working conditions in the hospital corresponded to higher ratings of overall patient safety.
Overall assessment of patient safety in the ward was related to changes in the quality of care in the last year (p<0.001). Nurses reporting an improvement of care quality in the hospital in the year reported higher levels of patient safety. Ratings indicating an improvement in patient safety during the last year were received from 58.7% of nurses. Simultaneously, 25.5% indicated no improvement and 8.1% who reported a decrease of patient safety.
The analysis of The Practice Environment Scale of the Nursing Work Index (PES-NWI) characteristics showed that the higher nurses rated patient safety, the higher they rated adequacy of human and material resources, cooperation between nurses and doctors, support for nurses from the managing staff, possibility for nurses' participation in managing the hospital, and support for providing high standards of nursing care quality (p<0.001); Table 1.
Patient safety and nurses' satisfaction with autonomy and professional development
The lower the nurses assessed the patient's safety in the ward, the lower they assessed their satisfaction with autonomy and professional development. It was shown that 71.2% of the low-safety group were unsatisfied with the possibility of promotion, compared to the medium - 56.3% and high-safety group - 46.0%. Moreover, 59.2% of the respondents who rated safety as low reported unsatisfaction with independence at work (autonomous practice) compared to the group with medium - 38.4% and high safety level - 20.2.0%; Table 2.
Patients' safety and nurses' sense of safety
Multiple relationships were revealed between a nurse’s assessment of patient safety in the ward and nurses' opinion on safe working conditions. Notable relationships included good flow of information between providers and culture of awareness that when errors occur, preventable event discussions happen to determine how to prevent them in the future. Organizations with non-punitive environments also received higher ratings by nurses on patient safety overall (p<0.001).
By contrast, nurses who perceived themselves as working in punitive environments were less likely to rate patient safety well. Approximately 27% of nurses reported that they are severely punished for their errors without forgiveness. The analysis further showed that the more frequently nurses declared that they are allowed to question the decisions or actions of their supervisors, the higher they rated patient safety. The analysis further showed that the nurses assessed the patient's safety lower, the more they declared that they were unable to question the decisions or actions of their superiors. Table 3 illustrates how across all measures, ratings were statistically significantly different.
Patients' safety and nurses' work load
Workload, including time spent working beyond scheduled shift hours, also affected patient safety ratings. Nurses who were working during their most recent shift beyond their contractual time of work assessed safety lower than other nurses who were working according to their contracted hours; low assessment was provided respectively by 19.9% vs. 32.5%; p<0.001.
Nurse-to-patient ratios also affected their perception of patient safety. The higher the nurses assessed overall patients' safety, the lower the number of patients per nurse, the (medians of the indicator of patients per nurse were respectively: 1.71, 1.62 and 1.55 in the subsequently higher assessment groups for safety (p = 0.041).
The surveyed nurses who during their most recent shift declared that they cared for a higher number of patients than usual more frequently assessed safety lower than other nurses; low assessment was declared respectively by: 28.1% of nurses who cared for a larger number of patients, 19.0% of those caring for the same number of patients, and 20.9% of those caring for a smaller number of patients during their most recent shift, p<0.001.
Nurses' assessment of patient safety in the ward was also connected with the number and health condition of the patients for whom they cared during their most recent shift. Nurses who cared on average for a smaller number of patients requiring assistance in all routine daily activities as well as frequent monitoring of their health condition assessed safety in the ward higher; p<0.001; Table 4.
Patients' safety and occurrence of adverse events, failure to perform necessary activities and care quality
Ward safety assessments were associated with the occurrence of adverse events associated with the quality of nursing care, namely administration of a wrong medication, at a wrong time or in an incorrect dosage, bedsores, falls, and infections. Higher assessment of safety in the ward were associated with less frequent declaration of such events (p <0.001).
Patient safety assessment in the ward was related to nurses performing activities related to direct patient care (p <0.001), performance of activity was more often declared by those who assessed safety as high, especially in the range of delivered services such as monitoring of a patient according to the rules (respectively 85.2.% vs. 62.0%), care over the patient's skin (respectively 80.9% vs. 48.1%), relieving the patient's pain (respectively 95.1% vs. 81.8%), administering medication on time (respectively 85.4% vs. 65.3%), proper recording of nursing care (respectively 88.4% vs. 58.2%); Table 5.