Relationships of the nursing practice environment, nursing silence behaviors, and nurse perceived patient safety

Medical errors have an increasing prevalence in the healthcare system today, and communication is often at the heart of many of these issues. Challenges or difficulties for nurses in communicating about errors, as well as instances of nursing silence about errors, have been noted in the healthcare and nursing literature. While numerous studies have noted constraints and difficulties in speaking up about errors, no studies were found that examined silence in specific relationship to the nurse practice environment and patient safety. The primary purpose of this study was to explore how the nursing practice environment influences nursing silence and patient safety. The secondary purpose was to examine the reliability of the Four Forms of Employee Silence Scale by Knoll and van Dick (2013) for use in the nursing population. A predictive, correlational research design was used. Several variables were examined, including perceptions of the nurse practice environment, preferences and motives for silence, and perceptions of patient safety. Ninety one registered nurses completed an electronic survey via the Internet which contained 58 questions. Parametric and non-parametric statistics were used for data analysis. The data revealed that the perception of the nurse practice environment is a predictor of both preferences for silence, and the perception of patient safety. In addition, findings were that nurses working in Magnet® practice environments do not differ significantly from those in Non-Magnet® practice environments in terms of silence behaviors related to the observation of errors. Results suggest that feelings of fear and lack of value sometimes exist among nurses in both Magnet® and Non-Magnet® organizations. Despite the promotion of collaborative relationships, participation, and feedback by Magnet® organizations, these activities do not seem to result in less frequent silence behaviors among registered nurses working in these organizations. Finally, the Four Forms of Employee Silence Scale was noted to be a reliable scale for use in the nursing population. Based upon the findings, implications and recommendations for future study are made.