title: Operational Failures Detected by Frontline Acute Care Nurses.
abstract: Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Professor and Director, Improvement Science Research Network, MC 7949, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900.
authors.forename: Kathleen R
authors.identifier: http://orcid.org/0000-0001-7217-6847
authors.initials: KR
authors.lastname: Stevens
authors.affiliation: Nursing Research and Development Programs Manager, Children's National Health System, Washington, DC.
authors.forename: Eileen P
authors.initials: EP
authors.lastname: Engh
authors.affiliation: Assistant Professor, Research in Patient Services, Division of Nursing, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Heather
authors.initials: H
authors.lastname: Tubbs-Cooley
authors.affiliation: Gerontological Clinical Nurse Specialist, Nebraska Methodist Hospital, Omaha, NE.
authors.forename: Deborah Marks
authors.initials: DM
authors.lastname: Conley
authors.affiliation: Director of Nursing Research, University of Texas Medical Branch Health System, Galveston, TX.
authors.forename: Tammy
authors.initials: T
authors.lastname: Cupit
authors.affiliation: Associate Professor, Loma Linda University School of Nursing, Loma Linda, CA.
authors.forename: Ellen
authors.initials: E
authors.lastname: D'Errico
authors.affiliation: Associate Professor, University of New Hampshire College of Health and Human Services, Durham, NH.
authors.forename: Pam
authors.initials: P
authors.lastname: DiNapoli
authors.affiliation: Clinical Nurse Educator, Children's Hospital Colorado, Denver, CO.
authors.forename: Joleen Lynn
authors.initials: JL
authors.lastname: Fischer
authors.affiliation: Director, Clinical Alignment, Nebraska Methodist Health System, Omaha, NE.
authors.forename: Ruth
authors.initials: R
authors.lastname: Freed
authors.affiliation: Nurse Scientist, Children's Hospital Colorado, Associate Professor, University of Colorado Denver College of Nursing, Denver, CO.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Kotzer
authors.affiliation: Nurse Scientist, Baptist Hospital South Florida, Miami, FL.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Lindgren
authors.affiliation: Associate Dean and Associate Professor, Stony Brook University School of Nursing, Stony Brook, NY.
authors.forename: Marie Ann
authors.initials: MA
authors.lastname: Marino
authors.affiliation: Associate Administrator/Chief Nursing Officer, University of South Alabama Medical Center, Mobile, AL.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mestas
authors.affiliation: Clinical Nurse Educator, Children's Hospital Colorado, Aurora, CO.
authors.forename: Jessica
authors.initials: J
authors.lastname: Perdue
authors.affiliation: Patient Safety Manager, Midland Memorial Hospital, Midland, TX.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Powers
authors.affiliation: Loma Linda University School of Nursing, Loma Linda, CA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Radovich
authors.affiliation: Program Director, Center for Nursing Research, Ochsner Health System, New Orleans, LA.
authors.forename: Karen
authors.initials: K
authors.lastname: Rice
authors.affiliation: Director of Nursing/Evidence Research, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Linda P
authors.initials: LP
authors.lastname: Riley
authors.affiliation: Director of Outcomes Research and Program Evaluation and Center for Innovations in Advancement of Care, NYU Langone Medical Center, New York, NY.
authors.forename: Peri
authors.initials: P
authors.lastname: Rosenfeld
authors.affiliation: Professor and DNP Program Director, University of Alabama Birmingham, Birmingham, AL.
authors.forename: Linda
authors.initials: L
authors.lastname: Roussel
authors.affiliation: Nurse Scientist, Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Ryan-Wenger
authors.affiliation: Director of Nursing Research and Innovation, Huntington Hospital, Pasadena, CA.
authors.forename: Linda
authors.initials: L
authors.lastname: Searle-Leach
authors.affiliation: Professional Development Specialist, Children's Hospital Colorado, Denver, CO.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Shonka
authors.affiliation: Advanced Practice Care Coordinator, Reading Health System, Reading, PA.
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Smith
authors.affiliation: Director of Magnet Program, Methodist Mansfield Medical Center, Baptist Hospitals of Southeast Texas.
authors.forename: Laura
authors.initials: L
authors.lastname: Sweatt
authors.affiliation: Chief Nursing Officer, Baptist Memorial Hospital, Desoto, MS.
authors.forename: Mary
authors.initials: M
authors.lastname: Townsend-Gervis
authors.affiliation: Coordinator, Evidence-based Practice and Nursing Research, Deaconess Hospital Inc., Evansville, IN.
authors.forename: Ellen
authors.initials: E
authors.lastname: Wathen
authors.affiliation: Assistant Professor, Emory University, Atlanta GA, Palmetto Health, Columbia, SC.
authors.forename: Janice S
authors.initials: JS
authors.lastname: Withycombe
mesh_terms: D003422:Critical Care; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D004868:Equipment Failure / Q000706:statistics & numerical data*; D006801:Humans; D000069469:Medical-Surgical Nursing / Q000458:organization & administration; D009726:Nurses; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration*; D061214:Patient Safety; D011446:Prospective Studies; D058996:Quality Improvement
keywords: medical-surgical nursing; operational failures; organizational learning; patient safety; process improvement; quality improvement