This secondary analysis combined survey data from individual nurses with hospital safety culture data and found that both individual characteristics such as education level and hospital characteristics such as safety culture were associated with risks of medication administration errors and falls. The authors conclude that improving safety culture should be a high priority.

This literature review found that the relationship between safety culture and patient safety outcomes is inconsistent across studies. Researchers recommend use of a theoretical framework and validated safety culture instruments to shed light on the correlation between safety culture and patient harm.

The health care environment is known to influence teamwork and the culture of safety. This integrative review explored the literature to clarify the relationship between nurses' work environment and patient safety. The authors found weak definitional concurrence and measure inconsistency in the evidence base and advocate for improved research design to support future investigation in this area.

Sleep deprivation can worsen clinical performance. Early studies on the effects of fatigue in clinical trainees formed some of the basis behind duty hour restrictions for resident physicians. This study surveyed intensive care unit (ICU) nurses about levels of fatigue and clinical decision-making. Nurses who regretted a clinical decision were more apt to be fatigued and to work 12-hour shifts. Sleep deprivation among ICU nurses was found to be common, with almost three-quarters of surveyed nurses having lost 8 or more hours of sleep in a 5-day period. The study was limited by a very low (17%) response rate, potentially biasing the results. Prior research has linked extended nursing shift lengths with compromised patient safety.

This study describes the successes and challenges associated with implementing a formal program to combat fatigue among nurses. Although the program was well received, organizational culture and lack of resources were perceived as barriers to wider implementation.

Nurses reported struggling to stay awake during nearly one in three shifts, and drowsiness during work and commuting was associated with longer shift length.

The investigators reviewed logbook entries from 502 critical care nurses asked to record information about hours worked, sleep-wake patterns, and errors or near misses. They found that the risk of error doubled after a shift of 12.5 hours or longer.

This AHRQ-funded study demonstrated that the risk of error increased in association with extended work shifts, overtime, or longer than 40-hour work weeks. Using logbooks from nearly 400 nurses sampled out of a larger group from the American Nurses Association, investigators determined that an alarmingly high percentage of nurses report working extended hours. For those shifts longer than 12.5 hours, the error rate increased notably. The authors advocate for continued attention to relationships between nursing work hours and patient safety, building on past research that linked staffing to poor patient outcomes.