The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.
Nurses and others have expressed a great deal of interest in the potential for incorporating notions about organizational culture and climate in research and practice aiming to improve health care safety. In this review, definitions and measures of these terms are explored, the state of the research literature connecting culture and climate with safety is reviewed, and directions for future research and leadership practice are outlined.
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