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Making Sure: Registered Nurses Watching Over Their Patients

Schmidt, Lee A.

Nursing Research:
doi: 10.1097/NNR.0b013e3181faa1c9

Background: Surveillance has been identified as an important patient quality and safety intervention, but the process used by registered nurses as they perform this function with their hospitalized patients on a single work shift has not been conceptualized or studied.

Objective: The purpose of this study was to generate a substantive theory of the process used by hospital registered nurses as they watch over their assigned patients during a work shift.

Methods: Classical grounded theory was used to generate the substantive theory. Fifteen registered nurses from a variety of hospital patient care settings were interviewed to determine the process they used to watch over their assigned patients during a work shift and the conditions that facilitated or hindered their abilities to watch over their patients.

Results: Making Sure emerged as the basic social process used by registered nurses as they watch over their assigned patients during a single work shift. Making Sure was conceptualized as a process involving six categories: (a) knowing what's going on and (b) being close set conditions for (c) watching in which the nurse is (d) not taking anything for granted. As necessary, (e) taking action occurs to achieve the outcome of this process, (f) protecting patients from harm and negative events to the extent possible. As more information about the patient is obtained through the process, this information is incorporated into the knowing what's going on category.

Conclusions: The results of this study provide the theoretical basis for the process used by registered nurses as they watch over their patients on a work shift and provide insight into one of the key nursing care processes that may impact patient outcomes. Measures should be developed to operationalize the concepts of the theory and to conduct quantitative testing of the theory.

Author Information

Lee A. Schmidt, PhD, RN, is Assistant Professor and Director of the PhD in Nursing Program, Marcella Niehoff School of Nursing, Loyola University, Chicago, Maywood, Illinois.

Accepted for publication August 25, 2010.

Partial funding for this study was provided through a James A. MacLamore Award in Business and Social Sciences through the University of Miami, Coral Gables, FL.

Corresponding author: Lee A. Schmidt, PhD, RN, School of Nursing, Loyola University Chicago, Medical Center Campus, 2160 S. First Ave., Maywood, IL 60153 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.