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Perception is reality: How patients contribute to poor workplace safety perceptions

McCaughey, Deirdre; McGhan, Gwen; DelliFraine, Jami L.; Brannon, S. Diane

doi: 10.1097/HMR.0b013e3181f3c04c

Background: Nurses and aides are among the occupational subgroups with the highest injury rates and workdays lost to illness and injury in North America. Many studies have shown that these incidents frequently happen during provision of patient care. Moreover, health care workplaces are a source of numerous safety risks that contribute to worker injuries. These findings identify health care as a high-risk occupation for employee injury or illness.

Purpose: The purpose of this study was to examine the relationships among patient care, employee safety perceptions, and employee stress. Using the National Institute for Occupational Safety and Health Model of Job Stress and Health as a foundation, we developed and tested a conceptual workplace safety climate-stress model that explicates how caring for high-risk patients is a safety stressor that has negative outcomes for health care providers, including poor workplace safety perceptions and increasing stress levels. We introduced the concept of "high-risk patients" and define them as those who put providers at greater risk for injury or illness.

Methodology: Using a nonexperimental survey design, we examined patient types and safety perceptions of health care providers (nurses, aides, and allied health) in an acute care hospital.

Findings: Health care providers who care for high-risk patients more frequently have poor safety climate perceptions and higher stress levels. Safety climate was found to mediate the relationship between high-risk patients and stress.

Practice Implications: These findings bring insight into actions health care organizations can pursue to improve health care provider well-being. Recognizing that different patients present different risks and pursuing staffing, training, and equipment to minimize employee risk of injury will help reduce the staggering injury rates experienced by these employees. Moreover, minimizing employee stress over poor workplace safety is achievable through comprehensive workplace safety climate programs that include supervisor, management, and organizational commitment to safety enhancement.

Deirdre McCaughey, MBA, PhD, is Assistant Professor, Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA. E-mail:

Gwen McGhan, RN, MN, is a Jonas/Hartford Doctoral Scholar, The Pennsylvania State University, University Park, PA. E-mail:

Jami L. DelliFraine, MHA, PhD, is Assistant Professor, Division of Management, Policy, and Community Health, Fleming Center for Healthcare Management, University of Texas School of Public Health, Houston, TX. E-mail:

S. Diane Brannon, MSS, PhD, is Professor, Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA. E-mail:

This study was conducted with approval from the Joint-Faculty Research Ethics Board, the Research Ethics Board Committee at the University of Manitoba (JFREB), and the Ethics Committee of the hospital involved in the study.

Funding Disclosure: No funding was provided for this study.

© 2011 Lippincott Williams & Wilkins, Inc.