Safety organizing, emotional exhaustion, and turnover in hospital nursing units

Med Care. 2014 Oct;52(10):870-6. doi: 10.1097/MLR.0000000000000169.


Context: Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on how engaging in safety organizing affects caregivers.

Objectives: While we know that organizational processes can have divergent effects on organizational and employee outcomes, little research exists on the effects of pursuing highly reliable performance through safety organizing on caregivers. Specifically, we examined whether, and the conditions under which, safety organizing affects RN emotional exhaustion and nursing unit turnover rates.

Subjects: Subjects included 1352 RNs in 50 intensive care, internal medicine, labor, and surgery nursing units in 3 Midwestern acute-care hospitals who completed questionnaires between August and December 2011 and 50 Nurse Managers from the units who completed questionnaires in December 2012.

Research design: Cross-sectional analyses of RN emotional exhaustion linked to survey data on safety organizing and hospital incident reporting system data on adverse event rates for the year before survey administration. Cross-sectional analysis of unit-level RN turnover rates for the year following the administration of the survey linked to survey data on safety organizing.

Results: Multilevel regression analysis indicated that safety organizing was negatively associated with RN emotional exhaustion on units with higher rates of adverse events and positively associated with RN emotional exhaustion with lower rates of adverse events. Tobit regression analyses indicated that safety organizing was associated with lower unit level of turnover rates over time.

Conclusions: Safety organizing is beneficial to caregivers in multiple ways, especially on nursing units with high levels of adverse events and over time.

MeSH terms

  • Adult
  • Causality
  • Critical Pathways / organization & administration
  • Cross-Sectional Studies
  • Female
  • Hospitals, Urban
  • Humans
  • Male
  • Medication Errors / nursing
  • Middle Aged
  • Midwestern United States
  • Nurse's Role / psychology
  • Nursing Staff, Hospital / organization & administration*
  • Nursing Staff, Hospital / psychology
  • Nursing Staff, Hospital / statistics & numerical data
  • Occupational Diseases / epidemiology*
  • Organizational Culture
  • Patient Safety / standards*
  • Patient Safety / statistics & numerical data
  • Personnel Staffing and Scheduling / organization & administration
  • Personnel Turnover / statistics & numerical data*
  • Risk Management / organization & administration
  • Risk Management / statistics & numerical data
  • Safety Management / organization & administration*
  • Stress, Psychological / epidemiology*