Comparison of Safety Culture Between Nurses and Physicians at Cleveland Veterans Affairs (VA) Medical Intensive Care Unit (MICU)

Abstract

Purpose: Recently, workplace safety culture, defined as workers perceptions of safety, has gained prominence as a crucial ingredient in patients' outcomes. Safety culture is increasingly being explored as a guide for quality improvement efforts, particularly in critical care, where the complexity of care and severity of illness make the health care system more vulnerable to error. Our objective was to evaluate safety culture, and detect any differences between physicians and nurses, in the medical intensive care unit (MICU) at the Cleveland Veterans Affairs Medical Center. Methods: Safety Assessment Questionnaire (SAQ) short form was used to evaluate safety culture. SAQ short form contains 36 items with a 5 point Likert scale (A="Disagree Strongly", B="Disagree Slightly", C="Neutral", D="Agree Slightly", E="Agree Strongly"). SAQ measures 6 categories of safety culture. The 6 categories included in SAQ are teamwork climate, job satisfaction, perception of management (includes unit and hospital levels), safety climate, working conditions, and stress recognition. Answers were transposed to a 100 point scale score. Descriptive statistics, including median and interquartile range (IQR), were used to summarize the data for the 6 categories of the questionnaire. Non-parametric testing (Mann-Whitney test) was performed to detect significant differences between nurses and physicians. Results: A total of 40 responses (89% response rate) were received: 18 from physician (45%) and 22 from nurses (55%). Ratings were lowest for stress recognition in both groups (less than 50% which corresponds to "Disagree Slightly" on the original scale). Compared to physicians, nurses had significantly lower scores on perception of management (67.5 vs 75, p-value=0.026) and in particular at the unit level (45 vs 75, p-value=0.001). Conclusions: Both physicians and nurses play down the effect of stress and fatigue. Evidence has shown that denial of stress and its effects on performance increases the likelihood of errors. Therefore, education to encourage a healthy recognition of stressor effects and stress management strategies may be beneficial. Furthermore, building trust between staff nurses and nursing leadership was identified as another area of focus for future quality improvement. Clinical Implications: Targeting stress recognition in both phsyicians and nurses in the MICU have the greatest potential to improve safety culture.