Nurses’ Risk Perception of Adverse Events and Its Influencing Factors: A Cross-Sectional Study

Abstract

To investigate clinical nurses’ perception of adverse event risk and to analyze its influencing factors. A proportional stratified random sampling method was applied to recruit nurses from a hospital in Shiyan City, Hubei Province, China. The Nursing Adverse Event Risk Perception Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout scale was used to investigate 1084 nurses. Univariate analysis, Pearson correlation analysis, and multiple linear regression analysis were used to analyze the influencing factors. The scores of the Nurses’ Risk Perception of Adverse Nursing Event Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout Scale were 14.98 ± 5.39, 52.57 ± 10.00, 88.98 ± 21.08, 56.42 ± 5.03, 30.90 ± 21.49, respectively. According to the correlation analysis, nurses’ perception of adverse nursing events was positively correlated with the sense of organizational support (r = .457, P < .01), head nurses’ leadership behavior (r = .348, P < .01), and nurse safety behavior (r = .457, P < .01), and negatively correlated with the level of burnout (r = −.384, P < .01). According to the Regression analysis, nurses’ departments (β = .226, P < .001), daily working hours (β = 1.122, P < .001), adverse events experience (β = −1.505, P < .001), organizational support (β = .105, P < .001), head nurses’ leadership behavior (β = .072, P < .001), and burnout (β = −.052, P < .001) held an influence on nurses’ risk perception of adverse nursing event. These factors explained 42.5% of the total variation. Nurses’ risk perception of adverse nursing events needs to be improved. Nursing managers need to strengthen organizational support for nurses, change the leadership behavior of nurse managers, reduce nurses’ burnout, improve nurses’ risk perception of adverse nursing events, prevent adverse events, and ensure patient safety.

Keywords

nursing adverse events risk perception nurses factors

What do we already know about this topic?

Nurses’ competency in perceiving the risk of adverse nursing events early and preventing adverse events is vital to improving nursing safety. Existing studies have only conducted univariate analysis of general data and correlation analysis with work burnout and adverse event reporting habits on the influencing factors of adverse event risk perception among clinical nurses, and lack systematic multivariate analysis.

How does your research contribute to the field?

The results of this study can be informative for designing interventions to improve nurses’ risk perception of adverse events, preventing adverse nursing events, and ensuring patient safety.

What are your research’s implications toward theory, practice, or policy?

Based on the ternary interaction theory, considering the influence of environmental factors (head nurse leadership behavior, organizational support), personal factors (burnout, demographic factors), and the risk perception of clinical nurses, to supplement and improve the risk perception theory.

Introduction

Patient safety is a priority in the health field. Reducing adverse events and improving patient safety are urgent problems worldwide.¹ Previous studies showed that the incidence of adverse events in inpatients is about 3.5% to 16.6%.^2,3 Forty-five percent of the annual medical adverse events in the United States were caused by negligence in the work process of health care providers, and 82% of these human errors are preventable.⁴ In particular, nursing behavior errors have become one of the primary potential sources of accidents threatening patients’ life safety in medical services.⁵ As a significant part of adverse events, nursing adverse events increase the medical cost, prolong the length of hospital stay, lead to patient physical dysfunction and death, and threaten patient safety.⁶ Also, nursing adverse events harm the hospital’s reputation.⁷ Insufficient awareness of nursing risk is a significant direct factor in adverse events.⁸ Improving the risk perception of adverse events is fundamental to reducing the incidence of adverse events in care. Risk perception of nursing adverse events refers to the subjective psychological perception and feelings of the possibility and the severity of possible negative consequences in their clinical work.⁹ Nurses’ competency in perceiving the risk of adverse nursing events early and preventing adverse events is vital to improving nursing safety.¹⁰ This paper explores nurses’ risk perception of adverse events and its influencing factors. The results of this study can be informative for designing interventions to improve nurses’ risk perception of adverse events, preventing adverse nursing events, and ensuring patient safety.

Methods

Participants

According to the proportion of the number of nurses in each department, a proportional stratified random sampling method was applied to recruit 1084 nurses from different departments in a comprehensive tertiary hospital in Shiyan City which allows admission of patients with various diseases, Hubei Province, China, from July to August 2022. The departments include emergency, ICU, internal medicine, surgery, obstetrics, pediatrics, features, operating room, and rehabilitation division.

Inclusion criteria were: ① licensed registered nurses; ② nurses working frontline and engaging in direct patient care; ③ nurses signing the informed consent and voluntarily participating in this survey. Exclusion criteria were: ① nurses who are not currently on leave, or ② nurses from other health care settings who come to this hospital for study and training. All the respondents gave informed consent and volunteered to participate in this study.

Measures

Demographics

A self-designed questionnaire collected nurses’ demographics, including gender, age, educational background, marital status, working department, working years, and professional title.

Nurses’ risk perception of adverse events scale (NRPAES)

NRPAES was a Likert scale developed by Qiuyun et al¹¹ . It has 20 items divided into three dimensions: patient care risk, system process risk, and nurse operation risk. The three dimensions include 9,7, and 4 items, respectively. Each item assessed the possibility of adverse events and the severity of consequences. Each item assesses the likelihood of adverse events from “extremely unlikely = 1” to “very likely = 6” and measures the severity of results of adverse events from “very serious = 1” to “very serious = 5.” The higher the score is, the stronger the clinical nurse perceives the risk of adverse events. And a high score indicates that nurses hold a strong risk perception of adverse events. The scale has a Cronbach’α coefficient of 0.939 and a content validity index of 0.910l.¹¹

Perceived Organizational Support Questionnaire (POSQ)

The POSQ was developed by Hongmei and Hui.¹² The revised POSQ contains 13 items, including 2 dimensions: emotional support and instrumental support. The emotional support dimension includes 10 items, including caring for nurses’ welfare and solving work and family difficulties. The instrumental support dimension includes a good working environment, learning and training opportunities, etc. The questionnaire is a Likert scale; each item scored (1-5) from “very inconsistent” to “very consistent.” The higher the score, the higher the support the nurse felt in the hospital. The Cronbach’α coefficient of this questionnaire was .969.¹²

Nurses’ Perceived Leadership Behavior Questionnaire (NPLBQ)

The NPLBQ was developed by Avolio B J et al¹³ and revised by Pan.¹⁴ The Chinese NPLBQ is divided into transformational and transactional leadership styles, consisting of 7 dimensions and 32 items. The questionnaire is a Likert scale, from “never = 0” to “almost always = 4.” The higher the score, the more frequently the head nurse leads. The Cronbach’α coefficient of this questionnaire was .880.¹⁴

Nurse safety behavior questionaire (NSBQ)

The NSBQ was developed by Shih et al¹⁵ and adapted in Chinese by Yanfu and Zhengyi.¹⁶ The questionnaire is a 12-items Likert scale, from “never = 1” to “always = 5.” The higher the score, the better the nurses’ safety behavior. The Cronbach’α coefficient of this questionnaire was .915.¹⁶

Burnout scale (Maslach Burnout Inventory)

This scale was developed by Maslach et al¹⁷ and adapted in Chinese by Yueping and Mingzhi.¹⁸ The Burnout Scale includes 22 items and 3 dimensions: emotional exhaustion, depersonalization tendency, and personal accomplishment. The scale is a Likert scale; each item scored from “never” to “every day” (0-6). A higher score of emotional exhaustion and depersonalization dimension indicates a higher degree of work burnout, and a lower personal accomplishment score implies a higher degree of work burnout. The Cronbach’s α coefficient of the burnout scale and three dimensions were .823, .888, .770, and .839, respectively.¹⁸

Data Collection

The research team used Wen Juan Xing (an online survey platform used in China) to formulate an online survey including the abovementioned measures. After obtaining the consent of each hospital department, the research team distributed the online survey link to the WeChat working group. The survey cover introduces the research project and the research purpose, the time of filling out the survey, and explains that participation is voluntary. After the survey, the 2 researchers checked the questionnaires submitted by the respondents one by one and eliminated the invalid questionnaires.

Statistics

Statistical analysis was performed using SPSS 24.0. Nominal data were described by frequency and percentage, and numeric data were displayed by mean ± standard deviation. The correlation between the risk perception of nursing adverse events and the sense of organizational support, head nurse leadership behavior, nursing safety behavior, and job burnout was analyzed by Pearson correlation analysis. The Chi-square test or independent sample t-test was used for univariate analysis. Multivariate analysis was performed using multiple linear regression analysis. P < .05 was considered statistically significant.

Ethical Consideration

The Taihe Hospital Ethics Committee has granted consent for conducting this study (review number: 2022XM001). No personal identifying information was collected, and participants were afforded the freedom to withdraw from the study at any time, ensuring uniqueness and respect for their autonomy.

Results

Nurses’ Risk Perception of Nursing Adverse Events, Organizational Support, Head Nurse Leadership Behavior, Nurse Safety Behavior, and Job Burnout (Table 1)

Table 1.

The Score of Clinical Nurses’ Risk Perception of Nursing Adverse Events, Organizational Support, Head Nurse Leadership Behavior, Nurse Safety Behavior and Burnout.

Scale or questionnaire	Score
Nurses’ risk perception of adverse events scale	14.98 ± 5.39
1.Patient care risk	15.24 ± 5.69
2. System process risk	14.46 ± 5.66
3. Nurse operation risk	15.26 ± 5.61
Perceived organizational support questionnaire	52.57 ± 10.00
1.Emotional support	39.86 ± 8.10
2.Instrumental support	12.72 ± 2.19
Nurses’ perceived leadership behavior questionnaire	88.98 ± 21.08
1.Leadership charisma dimension	12.29 ± 3.59
2.Intelligent excitation dimension	13.18 ± 3.39
3.Appeal dimension	13.11 ± 3.57
4.Personalized care dimension	12.33 ± 3.59
5.Variable reward dimensions	12.92 ± 3.09
6.Active exception reward dimension	12.36 ± 3.51
7.Passive exception management dimensions	12.79 ± 3.28
Nurse safety behavior questionaire	56.42 ± 5.03
Burnout scale	30.90 ± 21.49
1.Emotional exhaustion	16.54 ± 11.41
2.Depersonalization tendency	4.10 ± 5.23
3.Personal accomplishment	10.27 ± 10.13

Nurses’ Risk Perception of Adverse Events, Organizational Support, Head Nurse Leadership Behavior, Nurse Safety Behavior, and Job Burnout

Different characteristics of clinical nurses’ risk perception of nursing adverse events, organizational support, head nurse leadership behavior, nurse safety behavior, and burnout scores were compared. The results showed the difference between clinical nurses’ risk perception of adverse nursing events and their departments, positions, daily working hours, and whether they had experienced nursing adverse events (P < .01) (Table 2).

Table 2.

The Score of Different Characteristics of Clinical Nurses’ Risk Perception of Nursing Adverse Events, Organizational Support, Head Nurse Leadership Behavior, Nurse Safety Behavior, and Burnout ( $\bar{x} \pm s$ ).

Project	Class	Number of people	Nurses’ risk perception of adverse events scale	Perceived organizational support questionnaire	Nurses’ perceived leadership behavior questionnaire	Nurse safety behavior questionnaire	Burnout scale
Department	Internal medicine	290	15.22 ± 5.12	52.81 ± 9.69	88.30 ± 21.59	56.40 ± 5.02	30.96 ± 21.38
	Surgery	308	14.61 ± 4.96	52.17 ± 10.57	88.63 ± 22.90	56.73 ± 4.16	30.49 ± 22.42
	Gynecology and obstetrics	59	13.88 ± 6.02	50.73 ± 9.55	86.14 ± 20.86	54.19 ± 6.01	34.00 ± 21.47
	Pediatrics	122	14.33 ± 5.14	51.84 ± 9.42	89.21 ± 19.59	56.28 ± 4.89	32.19 ± 19.31
	Facial features and dermatology	68	14.18 ± 5.98	54.10 ± 7.77	92.12 ± 16.50	56.60 ± 5.27	26.09 ± 16.97
	Traditional Chinese medicine rehabilitation series departments	106	15.41 ± 5.18	53.74 ± 11.04	90.62 ± 22.08	56.27 ± 5.90	28.93 ± 23.70
	Emergency department and Critical care Medicine Department	131	16.50 ± 6.37	52.77 ± 10.14	89.43 ± 18.12	56.92 ± 4.23	33.27 ± 21.51
	F		3.170	1.070	0.614	2.410	1.280
	P		.004^a	.379	.720	.026^b	.264
Sex	Man	80	15.71 ± 5.56	53.64 ± 10.56	91.31 ± 21.87	56.41 ± 5.15	30.59 ± 24.41
	Woman	1004	14.93 ± 5.37	52.49 ± 9.96	88.79 ± 21.01	56.42 ± 5.03	30.93 ± 21.26
	t		1.256	0.989	1.028	−0.017	−0.137
	P		.209	.323	.304	.987	.891
Age (year)	<30	283	14.70 ± 5.47	51.94 ± 10.78	87.42 ± 21.35	56.21 ± 5.02	32.18 ± 22.65
	30～35	449	14.98 ± 5.11	52.26 ± 9.69	88.76 ± 20.65	56.42 ± 4.93	32.13 ± 21.34
	>35	352	15.20 ± 5.66	53.48 ± 9.70	90.51 ± 21.34	56.60 ± 5.18	28.31 ± 20.54
	F price		0.661	2.248	1.737	0.473	3.810
	P		.516	.106	.177	.623	.022^b
Work years (years)	<5	181	14.80 ± 5.48	52.83 ± 10.74	88.30 ± 21.19	56.51 ± 4.96	30.29 ± 22.32
	5～10	379	15.05 ± 5.31	52.13 ± 10.02	88.85 ± 20.41	56.30 ± 4.80	32.38 ± 21.69
	>10	524	14.99 ± 5.42	52.81 ± 9.73	89.31 ± 21.54	56.48 ± 5.23	30.05 ± 21.04
	F		0.136	0.580	0.165	0.177	1.388
	P		.873	.560	.848	.838	.250
Marital status	Have a spouse	809	14.95 ± 5.50	52.72 ± 9.94	89.42 ± 21.38	56.40 ± 5.15	30.62 ± 21.24
	No spouse	275	15.07 ± 5.07	52.15 ± 10.16	87.68 ± 20.14	56.49 ± 4.67	31.73 ± 22.24
	t		−0.336	0.820	1.188	−0.278	−0.735
	P		.737	.412	.235	.781	.462
Education level	Junior college	104	15.32 ± 5.39	53.39 ± 10.91	90.10 ± 19.83	56.19 ± 6.04	29.55 ± 20.92
	Undergraduate course	964	14.97 ± 5.37	52.45 ± 9.92	89.06 ± 21.03	56.46 ± 4.86	31.10 ± 21.55
	Postgraduate	16	13.90 ± 6.77	54.75 ± 8.78	76.75 ± 28.29	55.81 ± 7.88	28.00 ± 23.75
	F		0.534	0.805	2.857	0.248	0.261
	P		.586	.448	.058	.780	.853
Professional ranks and titles	Nurse	153	14.60 ± 5.42	52.55 ± 10.64	87.47 ± 21.71	56.32 ± 5.11	30.57 ± 21.85
	Primary nurse	300	15.02 ± 5.22	51.76 ± 9.97	88.68 ± 19.47	56.41 ± 4.58	33.13 ± 21.76
	Nurse-in-charge	519	14.92 ± 5.44	52.49 ± 9.91	88.51 ± 21.86	56.30 ± 5.20	31.33 ± 21.19
	Co-chief superintendent nurse	101	15.53 ± 5.69	55.01 ± 9.48	93.73 ± 20.82	57.31 ± 5.13	23.62 ± 20.73
	Chief superintendent nurse	11	17.33 ± 3.91	56.55 ± 7.48	96.73 ± 13.11	58.55 ± 1.81	21.64 ± 16.31
	F		0.990	2.454	1.938	0.912	4.324
	P		.412	.044^b	.102	.456	.002^a
Position	Not have	1009	14.86 ± 5.39	52.31 ± 10.04	88.44 ± 21.17	56.35 ± 5.09	31.59 ± 21.53
	Deputy head nurse	44	16.31 ± 4.50	56.48 ± 7.80	96.64 ± 16.01	57.34 ± 3.70	21.14 ± 16.39
	Head nurse	31	17.06 ± 5.84	55.71 ± 9.89	95.65 ± 21.49	57.32 ± 4.84	22.29 ± 22.01
	F		3.912	5.278	4.816	1.323	7.648
	P		.020^b	.005^a	.008^a	.267	.001^a
Only child	Yes	255	14.52 ± 5.46	51.65 ± 10.39	86.58 ± 21.32	56.27 ± 4.89	33.16 ± 22.08
	No	829	15.13 ± 5.36	52.86 ± 9.87	89.72 ± 20.96	56.47 ± 5.08	30.21 ± 21.27
	t		−1.581	−1.677	−2.079	−0.533	1.923
	P		.114	.094	.038^b	.594	.055
Nurse level	N0	128	15.24 ± 5.38	52.47 ± 10.74	88.23 ± 21.41	56.23 ± 5.22	30.67 ± 22.38
	N1	114	14.46 ± 5.24	51.49 ± 11.07	86.71 ± 20.37	56.64 ± 4.16	33.04 ± 23.04
	N2	302	14.29 ± 5.19	51.92 ± 9.95	87.42 ± 21.22	55.70 ± 5.50	33.25 ± 21.42
	N3	349	15.25 ± 5.46	53.16 ± 9.60	90.43 ± 20.85	56.76 ± 4.65	30.46 ± 20.91
	N4	191	15.73 ± 5.56	53.24 ± 9.60	90.65 ± 21.33	56.88 ± 5.21	26.89 ± 20.68
	F		2.684	1.169	1.500	2.411	2.905
	P		.030^b	.323	.200	.048^b	.021^b
Working hours per day (h)	<8	109	13.48 ± 5.97	51.05 ± 11.51	84.65 ± 23.69	55.69 ± 6.41	32.90 ± 23.90
	8～10	886	15.07 ± 5.26	52.94 ± 9.76	89.45 ± 20.99	56.52 ± 4.70	30.24 ± 21.08
	>10	89	15.98 ± 5.62	50.79 ± 10.18	89.63 ± 17.98	56.35 ± 6.22	35.08 ± 22.06
	F		5.932	3.302	2.567	1.335	2.580
	P		.003^a	.037^b	.077	.264	.076
Average number of night shifts per month (Number)	0	240	15.32 ± 5.61	53.15 ± 9.98	89.36 ± 21.92	56.05 ± 5.97	28.98 ± 21.46
	1～4	255	14.27 ± 5.64	51.73 ± 10.14	87.97 ± 21.81	56.22 ± 5.02	31.26 ± 21.95
	5～9	291	15.00 ± 5.26	52.83 ± 9.99	88.94 ± 20.90	56.39 ± 4.72	31.03 ± 20.82
	10～14	288	15.34 ± 4.97	52.52 ± 9.93	88.59 ± 20.00	56.96 ± 4.51	31.85 ± 21.90
	≥15	10	14.19 ± 7.67	54.30 ± 9.63	89.30 ± 20.24	55.10 ± 3.51	37.00 ± 17.74
	F		1.741	0.773	0.226	1.267	0.839
	P		.139	.543	.924	.281	.501
Recruit and use work force form	Contract system	939	14.89 ± 5.38	52.28 ± 10.12	88.39 ± 21.14	56.33 ± 4.96	31.84 ± 21.62
	Officially in the	145	15.58 ± 5.42	54.47 ± 9.01	92.79 ± 20.32	57.02 ± 5.44	24.85 ± 19.70
	t		−1.436	−2.459	−2.345	−1.541	3.666
	P		.151	0.014^b	.019^b	.124	.000^a
Experience of adverse nursing events	Yes	355	16.19 ± 5.11	53.57 ± 9.41	91.54 ± 19.62	57.13 ± 4.59	29.39 ± 20.41
	Deny	729	14.39 ± 5.43	52.09 ± 10.25	87.73 ± 21.65	56.08 ± 5.20	31.64 ± 21.98
	t		5.208	2.306	2.800	3.246	−1.615
	P		.000^a	.021^b	.005^a	.001^a	.107

P < .01. ^bP < 05.

Correlation of Nurses’ Risk Perception of Nursing Adverse Events, Organizational Support, Head Nurse Leadership Behavior, Nurse Safety Behavior, and Job Burnout

Pearson correlation analysis showed that nurses’ adverse events score was positively correlated with total organizational support, head nurse leadership behavior, and nurse safety behavior score (P < .01) and total burnout score (r = −.568, P < .01; see Table 3).

Table 3.

The Correlation Analysis of Clinical Nurses’ Risk Perception of Adverse Events, Organizational Support, Head Nurse Leadership Behavior, and Nurses Safety Behavior and Burnout (r).

Variable	Risk perception	Organization support	Head nurse leadership behavior	Nurse safety behavior	Job burnout
Risk perception	1.00
A sense of organizational support	.457^a	1.00
Head nurse leadership behavior	.348^a	.259^a	1.00
Nurse safety behavior	.457^a	.251^a	.412^a	1.00
Job burnout	–.384^a	–.369^a	–.387^a	–.493^a	1.00

P < .01.

Factors Influencing Nurses' Risk Perception of Adverse Events

Nurses’ risk perception of adverse nursing events was defined as the dependent variable. Perceived organizational support, leading behaviors of head nurses, safety behaviors of nurses and job burnout, and the statistically significant demographics in univariate analysis (department, position, daily working time, previous adverse nursing events experience) were labeled as the independent variables. Multiple linear regression analysis showed that department, daily working time, adverse nursing events experience, perceived organizational support, head nurse leadership behavior, and job burnout were entered into the regression equation. These variables explained 42.1% of the total variation in the nurses’ perceived risk of adverse nursing events (R² = 0.421, F = 132.038, P < .01), see Table 4.

Table 4.

Multiple Linear Regression Analysis of the Perceived Risk Influencing Factors of Adverse Events in Clinical Nurses.

Model	B	Std.Error	Beta	t	P price
(Constant)	4.729	1.715		2.758	.006
Department	0.223	0.059	.088	3.788	<.001
Daily working time	1.126	0.297	.089	3.795	<.001
Adverse nursing events experience	−1.526	0.269	−.133	−5.673	<.001
Perceived organizational support	0.103	0.026	.192	3.939	<.001
Head nurse leadership behavior	0.067	0.012	.261	5.685	<.001
Job burnout	−0.049	0.011	−.195	−4.385	<.001

R = .651, R² = 0.424, adjusted R² = 0.421, F = 132.038, P < .001.

Discussion

Nurses’ Risk Perception of Adverse Event Risk

The total score of nurses’ risk perception of adverse events was 14.98 ± 5.39, which was lower than Qiuyun et al (16.48 ± 3.79)⁹ The results indicate that nurses’ risk perception of adverse events needs to be improved. Studies show that improving nurses’ risk perception of adverse nursing events helps to enhance their awareness of risk prevention in work, and promote their active risk prediction in the work process, to reduce the hidden danger of adverse nursing events.¹⁹ In this study, nurses scored the highest in operational risk and lowest in system process risk. In the medical process, clinical nurses deliver direct care to patients. Due to the relatively high patient-to-nurse ratio, daily patient care is demanding with a heavy workload. Therefore, nurses are at high risk of making errors in the working process, and nurses’ operating risk perception is the strongest among all dimensions.

The nature of nursing care and the time of contact with patients determine that they play an essential role in ensuring patient safety. As nurses, they tend to pay more attention to operational and patient care risks closely related to daily work. Meanwhile, nurses may ignore systematic process risks that are not so obvious in daily work.²⁰ The nursing managers should take measures to improve nurses’ risk perception of adverse nursing events, to enhance the importance of the nurses to identify the system process risks and potential hidden dangers in nursing work timely and comprehensively, and prevent adverse nursing events.

Analysis of the Influencing Factors of Adverse Event Risk Perception Among Clinical Nurses

Department

This study shows that, in different departments, nurses’ risk perceptions of adverse nursing events differ. Nurses working in emergency and intensive care units scored highest on the risk perceptions of the adverse nursing event. In these units, the patient’s condition is the most severe, and nursing care is the most challenging, so the nurses perceive that their adverse event risk is high. Nurses working in pediatrics, obstetrics, and gynecology had a lower risk perception of nursing adverse events than other departments. It is consistent with Qiuyun’s results,²¹ indicating that nurses in low-risk departments have a relatively low-risk perception of adverse events. For nurses working in low-risk units, their risk perception level of adverse events should be improved by attending regular training to prevent nursing adverse events. However, the working environment needs to be strengthened for nurses working in high-risk units by increasing the workforce, introducing safety science, and improving the working process.

Working hours a day

This research shows that nurses working less than 8 h a day have the lowest risk perception of nursing adverse events, and work more than 10 h a day have the highest risk perception. Nurses working a long time, with limited energy, and are worried about making errors at work tend to be highly alert to adverse events.²²

Whether they have experienced nursing adverse events

This research showed that nurses who have experienced nursing adverse events have significantly higher risk perception of adverse events than those who have not experienced them. Nursing adverse events experience increases nurses’ adverse event risk prevention consciousness. Most nurses have not experienced any adverse nursing events; nursing managers should prevent adverse events and strengthen patient safety through adverse event risk perception training, improving their sensitivity to adverse events.²³

Leadership behavior of the head nurse

In this study, the leadership behavior of the head nurse is positively correlated with the risk perception of nursing adverse events of the clinical nurses. It may be that the national head nurse’s leadership behavior directly affects the nurses’ enthusiasm, initiative, and responsibility in the department.²⁴ As the grassroots leader of the department, the leadership and management behavior of the head nurse is directly related to the working state of the nursing staff and the culture of nursing²⁴; it will further affect the nurses “perception of patients” safe behavior and the risk of adverse events in care. Therefore, more attention should be paid to developing the head nurse’s leadership competency by regulating their behavior and improving their leadership style.

Sense of Organizational Support

The sense of organizational support refers to the subjective sense of happiness that employees feel from the organization’s attention and care.²⁵ In this study, the sense of organizational support positively predicted nurses’ risk perception of adverse events, which is consistent with Chu Xue Qing’s results.²⁶ The sense of organizational support is closely related to the nurses’ job satisfaction and resignation intention, which impacts the nurses’ service quality.^27,28 Organizational support is the guarantee of nurses’ safe behavior²⁶; a sense of organizational support encourages individuals to increase their autonomous behavior to repay the organization’s support and contribute more to the development and overall efficiency of the organization.²⁹ Therefore, the stronger the nurses’ sense of organizational support, the stronger the sense of responsibility at work, and the higher the level of risk perception of nursing adverse care events.

Burnout

Nurses’ work is highly demanding, with long working hours, frequent shifts, heavy workloads, heavy pressure, and a high incidence of job burnout. Moreover, job burnout will affect the quality of nurses’ work and even the recovery of patients.^30
-32 In this study, nurses’ burnout was negatively associated with nurse adverse event risk perception. It may be because when caregivers are overloaded working for a long time, they are less alert to safety risks.^33,34 Heavy work pressure will put nurses in a tired state, seriously affecting their nursing behavior to ensure the safety of patients. Therefore, nursing managers can improve nurses’ adverse event risk perception by reducing their job burnout levels.²²

Summary

The nurses’ risk perception of nursing adverse events needs to be improved, and the department, daily working hours, adverse nursing events experience, the head nurse leadership behavior, organizational support, and job burnout are the main factors. Nursing managers can develop interventions according to these factors to improve nurses’ risk perception of nursing adverse events, minimize the risk of nursing adverse events, and ensure patient safety. The limitation of this study include: the study was only quantitative and the findings would have been more scientific if qualitative studies had been included, and it is a single-center study, the nurses are working in the same hospital. However, the nurses are from different units of a tertiary, general teaching hospital, with some units identified as high risk and some as low risk; the results of this study may be representative of other teaching hospitals. A multi-center survey is needed to be conducted to strengthen the results.

There is a need to enhance nurses’ perception of risks associated with adverse nursing events. Nursing managers ought to reinforce organizational backing for nurses, alter their leadership approach, mitigate nurses’ burnout, enhance their awareness of risks related to adverse nursing occurrences, prevent such events, and ultimately safeguard patient safety.

Footnotes

Acknowledgements

Not applicable.

Authors’ Contributions

X Chen wrote the manuscript.LT Li, MH Wang gave conceptual advice. CQ Ai revised the manuscript. All authors read and approved the final manuscript.

Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by grants from the Chinese nursing association (grant numbers: ZHKYQ202104); Fund provided by the Philosophy and Social Science Research Project of Hubei Education Department (grant numbers:18D070,21Q194); Fund provided by the Shiyan Science and Technology Bureau Guided Project (grant numbers: 22Y44); Fund provided by the Hospital level project of Shiyan Taihe Hospital (grant numbers: 2021JJXM065).

Ethical Statement

The study was approved and the need for patients informed consent was abandoned by the local Ethics Committee of Taihe Hospital, Shiyan City, Hubei Province. Reference Number: 2022XM001.

Informed consent/Patient consent

All the respondents gave informed consent and volunteered to participate in this study.

Trial registration number/date

Trial registration number: 2021JJXM065.

Date:05/01/2022

Grant number

Grant number: 2021JJXM065

ORCID iD

Xiong Chen

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World Health Organization. 10 facts on patient safety [EB/OL]. March 9, 2021. Accessed June 27, 2024. https://www.who.int/news-room/photo-story/photo-story-detail/10-facts-on-patient-safety

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