New Study finds Links between Work Stress and Medication Error in Hospitals

Nurses who worked in hospital settings where staffing and resources were perceived to be inadequate, as well as those who usually worked overtime, were more likely to report that a patient had received the wrong medication or dosage, according to a new study released by Statistics Canada.

The study, "Correlates of medication error in hospitals," published on May 14, 2008 in Health Reports, analyzed findings from the 2005 National Survey of the Work and Health of Nurses to determine factors underlying the likelihood of making errors when giving medications to patients.

The survey data showed that nearly one-fifth (19%) of registered nurses in hospitals acknowledged that during the year before the survey, errors involving medication for patients who were in their care had occurred "occasionally" or "frequently."

The study found several strong links between medication error and both work organization and workplace environment. These associations persisted independent of factors such as a nurse's experience and level of education.

Factors that were related to medication error included usually working overtime, role overload, perceived staffing shortages or inadequate resources, poor working relations with physicians, lack of support from co-workers, and low job security.

The survey was the first to focus on nurses' working conditions at the national level. It was a collaborative effort in partnership with the Canadian Institute for Health Information and Health Canada.

From October 2005 through January 2006, nearly 19,000 nurses reported information on the conditions in which they practice and on their physical and mental health. In general, the survey found that nurses face a broad range of physical and emotional challenges in a demanding, often hectic, workplace.

Medication errors significantly related to overtime

Medication error was significantly related to whether nurses worked overtime. Among nurses who usually worked overtime, 22% reported medication error, compared with 14% of those who did not work overtime.

As well, medication error was related to nurses' perceived "role overload." In fact, data suggested that the likelihood of error rose with the level of role overload. Perceived inadequacy of staffing and resources was similarly related to the likelihood of medication error.

The quality of working relations between nurses and physicians was also associated with medication error. Among registered nurses whose working relations with physicians were least favourable, 27% reported medication error. This proportion was only 12% among those whose working relations with physicians were most favourable.

Work stress associated with medication errors

The study found links between work stress and medication error. Nurses with low support from their co-workers were significantly more likely to report medication error than were those with more support.

It pointed out that low co-worker support might result from inadequate staffing. Nurses working at full capacity to care for their own patients may be less able or willing to lend a hand to co-workers.

Low job security was significantly related to medication error. Just under one-third (32%) of nurses with low job security reported medication error, compared with 19% of those with better job security.

Dissatisfaction with the job was another factor linked to medication error. About 28% of nurses who said they were dissatisfied reported medication error, compared with 18% of those who were satisfied.

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